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PubMed2004

[Effects of carvedilol on functional capacity, left ventricular function, catecholamines and oxidative stress in patients with chronic heart failure].

INTRODUCTION AND OBJECTIVE: Carvedilol is an antioxidant and adrenergic antagonist with demonstrated benefits in terms of mortality from heart failure (HF). The aim of the present study was to evaluate clinical parameters, left ventricular function, oxidative stress levels and neurohumoral status at baseline and after 6 months of treatment with carvedilol in patients with chronic HF. PATIENTS AND METHOD: Thirty patients with chronic HF that was stable without beta blocker treatment were included. Functional class was II or III, and left ventricular ejection fraction (LVEF) was < 40%. Mahler score, distance walked in 6 min, peak oxygen consumption, LVEF, plasma catecholamine (norepinephrine) concentration and oxidative stress parameters were evaluated at baseline and after 6 months of treatment with carvedilol. RESULTS: Mean age was 59 (2) years, and 23 patients were men. After 6 months of treatment there were clinical improvements as measured by the Mahler score (from 6.8 to 11.0 points; P=.001) and the 6-min walk distance (from 499 [18] to 534 [17] m; P =.032), but no changes in peak oxygen consumption. The LVEF increased from 24 (1) to 31 (2)% (P=.003). In patients with chronic HF, plasma malondialdehyde concentration was significantly lower after 6 months (decrease from 2.4 [0.2] to 1.1 [0.2] micromol/l; P<.001). No significant changes were observed in plasma catecholamine levels or antioxidant enzyme activities. CONCLUSIONS: In patients with chronic HF, carvedilol treatment for 6 months was associated with clinical improvements, increased left ventricular function and decreased plasma concentrations of malondialdehyde, with no changes in plasma catecholamine levels.

Adrenergic beta-Antagonists↗

PubMed1982

Prognosis of functional capacity and work capacity in rheumatoid arthritis.

In the study functional capacity and work capacity were investigated in a series of 405 hospital patients suffering from rheumatoid arthritis. One-third of the patients had had the disease for 5 years, one-third for 10 years and one-third for 15 years. The functional capacity index presented by Lee et al. (1973) was used. Half of the patients in the 5 and 10-year groups and one-third of those in the 15-year group had good functional capacity. One-fourth in the 5 and 10-year groups and one-third of those in the 15-year group had poor functional capacity. Sixty per cent of the 5-year group, 50 per cent of the 10-year group and 33 per cent of the 15-year group were able to work. The prognosis of functional capacity and work capacity was better for young persons than for older ones. No differences were found between the prognoses for men and women. High ESR, a positive blood rheumatoid factor and joint erosion seemed to be linked with an unfavourable prognosis of functional capacity. Light work was favoured for the prognosis of functional capacity and work capacity and extensive general education and vocational training for work capacity. The results indicate that starting vocational rehabilitation at an early stage of the disease could improve the prognosis of functional capacity and work capacity.

Adolescent↗

PubMed1996

Superoxide release and NADPH oxidase components in mature human phagocytes: correlation between functional capacity and amount of functional proteins.

We evaluated the interrelationship between the respiratory activity and amount of proteins responsible for this function in normal and subnormal human phagocytes, neutrophils, eosinophils, monocytes, and macrophages. The superoxide-producing capacity was eosinophils > neutrophils > monocytes = macrophages when the cells were stimulated with chemotactic peptide or phorbol ester. Consonant with this finding, the protein content of three essential components of phagocyte oxidase (p22-phox, p67-phox, and p47-phox) was also eosinophils > neutrophils > monocytes = macrophages. On the other hand, the amount of another essential component, gp91-phox, was macrophage > neutrophils > eosinophils > monocytes. These findings together indicate an overall positive interrelationship between protein content and its responsible function, though only gp91-phox was not associated with the functional capacity and low amounts of this component supported the increased respiratory burst activity of eosinophils.

Adult↗

PubMedDate not supplied

Performance-Based instrument to assess functional capacity in dementia: The Texas Functional Living Scale.

OBJECTIVE: The Texas Functional Living Scale (TFLS) is a new performance-based measure of functional abilities with an emphasis on instrumental activities of daily living skills that is brief and weighted toward cognitive tasks. The purpose of this study was to examine its psychometric properties and clinical utility in patients with Alzheimer disease (AD) and normal elderly individuals. BACKGROUND: Measures of daily functional capacities used in patients with dementia often rely upon informant-based behavioral ratings or lengthy assessments of instrumental activities of daily living. Few existing quantitative tools emphasize performance-based cognitively-oriented tasks designed for patients with AD, although there is a need for such measures. METHOD: Twenty-two AD patients and 21 healthy controls were administered the TFLS and a measure of global cognitive status (Mini-Mental State Examination). Additionally, informant-based ratings of daily living skills (Blessed Dementia Rating Scale) and emotional and behavioral status (Consortium to Establish a Registry for Alzheimer's Disease Behavior Rating Scale for Dementia) were obtained from caregivers of the AD patients. All subjects were re-evaluated approximately 1 month later using the same instruments. RESULTS: The TFLS showed a strong correlation with the Mini-Mental State Examination (r = 0.92). At 1 month, test-retest reliability was high, and TFLS subscale scores were highly correlated (r > 0.90 for most) with the total score. The TFLS was moderately correlated with informant ratings of functional skills as assessed with the Blessed Dementia Rating Scale but was unrelated to emotional and behavioral symptoms as assessed with the Consortium to Establish a Registry for Alzheimer's Disease Behavior Rating Scale for Dementia. CONCLUSIONS: The TFLS showed evidence of good reliability, internal consistency, and convergent and discriminant validity with several popular measures of global cognitive status and behavioral functioning. It is a brief and easily administered performance-based measure of daily functional capabilities that is sensitive to level of cognitive impairment and seems applicable in patients with varying degrees of dementia.

Activities of Daily Living↗

PubMed1989

Functional capacity and associated factors in elderly Finnish men.

Functional capacity and associated factors were studied in 321 men from eastern Finland and 395 men from southwestern Finland in connection with the 25-year follow-up survey of the East-West Study. The survey was carried out in autumn 1984, when the men were 65-84 years of age. In the measurement of different activities of daily living, 55 to 95% in the east and 62 to 97% in the south-west reported that they managed daily activities without another person's help. Both the mean age of the men and the mean of the sum index of functional capacity as stratified by age were in southwestern Finland significantly higher than in eastern Finland. Older age groups had lower functional capacity in both areas. Lowered functional capacity was associated with cardiovascular diseases, diabetes mellitus and impairments of vision in both areas, and with impairments of the locomotor system in the south-west. High pulmonary function was associated with high functional capacity. No connection was found between smoking and functional capacity, but heavier alcohol and coffee consumption were associated with high functional capacity.

Activities of Daily Living↗

PubMedDate not supplied

Functional capacity evaluation.

The functional capacity evaluation (FCE) is a tool for assessing the extent of a patient's disability. Several factors help to determine whether an FCE should be conducted. Once underway, the evaluation includes an intake interview, musculoskeletal and functional assessments, validation of effort, and interpretation and recommendation.

Back Injuries↗

PubMed1991

Ability, disability, and the functional capacity of patients with cardiovascular disease.

Assessment of functional capacity, of ability and disability among patients with cardiovascular disease raises a number of problems and issues for which there are currently only imperfect or incomplete answers. Emphasis must be placed on the lack of predictable relationship of anatomic abnormality and functional abnormality. For example, the percentage obstruction of the coronary artery documents the anatomic extent of the disease, rather than the limitation of functional capacity; the same lack of predictive value characterizes the decrease in resting ventricular ejection fraction. The response to a challenge of activity or exertion currently appears to offer the optimal method of assessing functional capacity for work, although a brief continuous exercise test may not be the optimal exercise protocol by which to evaluate endurance. As an example, in our laboratory, comparing a low-level continuous exercise test protocol with one with an intermittent exercise design (i.e., periods of exercise alternating with periods at rest), patients typically can perform at least one additional stage of exercise on the discontinuous or intermittent test protocol. This occurred without significant differences in the final heart rate, blood pressure, or rate-pressure product, probably because most patients so tested were limited not by myocardial ischemia but by musculoskeletal problems, fatigue, or dyspnea (8). An unmet need is a comparison of exercise test protocols for the assessment of functional capacity, possibly the development of new test protocols for patients with limited functional capacity, and the evaluation of the relationship of these test data to eight hours of occupational activity in the workplace setting. It appears logical that a diagnostic exercise test should differ from one designed to determine functional capacity, but the results of a variety of exercise test protocols should be compared with the actual physical activity able to be performed in the workplace, as well as with reported symptoms. It should be defined whether testing is to be performed on optimal medical therapy, which I believe should be the case; or whether the technique used for diagnostic exercise testing, that of the minimal medication possible, is to be employed. Next, the time after surgical intervention or following a prolonged hospitalization at which to test should be delineated in that the deconditioning effect of immobilization may substantially decrease effort tolerance, unrelated to the severity of the underlying cardiovascular disease. Finally, should exercise rehabilitation be recommended or required before testing for cardiovascular impairment; major improvement in functional capacity has occurred in previously sedentary patients with a variety of cardiovascular diseases, including those with important manifestations of myocardial ischemia and ventricular dysfunction.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiovascular Diseases↗

PubMed1990

Predictors of functional capacity in elderly Finnish men; a path analysis.

Factors predicting functional capacity in 1984 in men aged 65-84 years were studied by path analysis in 716 men from eastern and southwestern Finland as part of the 25 year follow up of the East-West Study i.e., the Finnish part of the Seven Countries Study. The variables selected to predict functional capacity were measured in 1959, 1964, 1969, 1974 and 1984. Diastolic blood pressure levels explained more of the variation in future functional capacity than did those of systolic blood pressure. Body mass index explained more of the variation in the future functional capacity in the east than in the south west. Serum cholesterol concentration and smoking habits were not associated with future functional capacity, accounting for only up to 10.7% and 4% of the variation in functional capacity in old age in the east and the south west respectively. There are area differences between the predictors of functional capacity, but a single health or health practice variable plays little part in the variation in functional capacity.

Aged↗

PubMed2002

Positron emission tomography, echo-doppler, and exercise studies of functional capacity in hypertensive heart disease.

BACKGROUND: This study examines the relationship between functional capacity, left ventricular diastolic function, and myocardial perfusion reserve (MPR) in patients with left ventricular hypertrophy (LVH). METHODS: We studied 16 patients with LVH and 10 controls. Functional capacity was assessed by cardiopulmonary exercise, MPR by positron emission tomography, and left ventricular diastolic function by echo-Doppler. RESULTS: Functional capacity and MPR were significantly lower in the patients. Functional capacity correlated positively with MPR and left ventricular diastolic function. CONCLUSIONS: Diminished functional capacity in patients with hypertension-induced LVH is related to the impairment in MPR and left ventricular diastolic function.

Adult↗

PubMed1983

Evaluation of functional capacity during exercise radionuclide angiography.

This study compared functional capacity during treadmill exercise testing and during bicycle exercise radionuclide angiography. 262 patients performed maximal upright bicycle exercise and also performed maximal graded exercise testing using either the Bruce (n = 158) or Naughton (n = 104) treadmill protocols. The functional capacity was well correlated between bicycle and treadmill for Bruce (r = 0.89), Naughton (r = 0.93), or combined treadmill (r = 0.90) protocols. However, the functional capacity was significantly lower during bicycle than during treadmill testing for Bruce (8.3 vs. 10.5 METs), Naughton (7.8 vs. 8.7 METs), or combined treadmill (8.1 vs. 9.8 METs) protocols. Treadmill functional capacity could be predicted from bicycle functional capacity using the following equations: Bruce METs = 1.00 X (bike METs) + 2.23, Naughton METs = 0.94 X (bike METs) + 1.40, and combined treadmill METs = 0.98 X (bike METs) + 1.85.

Adult↗

PubMed2000

Physical activity and functional capacity measurement in women: a report from the NHLBI-sponsored WISE study.

Physical activity and functional capacity have not been assessed by questionnaire for criterion validity in women. We wished to evaluate the ability of a physical activity and a functional capacity assessment questionnaire to predict functional capacity measured by treadmill exercise stress testing, as well as correlate with cardiac risk factors and angiographic coronary artery disease (CAD) in women. In a National Heart, Lung and Blood Institute (NHLBI)-sponsored cross-sectional population study involving four academic medical centers, 476 women with cardiac risk factors undergoing coronary angiography for evaluation for suspected myocardial ischemia were enrolled in the Women's Ischemia Syndrome Evaluation (WISE). The main outcome measures were functional capacity measured during symptom-limited exercise treadmill testing, cardiac risk factors, and CAD, using core laboratory-determined measures. Physical activity measured by the Postmenopausal Estrogen and Progesterone Intervention physical activity questionnaire (PEPI-Q) and functional capacity measured by the Duke Activity Status Index (DASI) questionnaire, correlated with functional capacity measured in metabolic equivalents (METS), as estimated during symptom-limited exercise treadmill testing (r = 0.27, p = 0.001 and r = 0.31, p = 0. 0002, respectively). The DASI was a significant independent predictor of functional capacity even after adjustment for cardiac risk factors, and the PEPI-Q was not. The DASI and PEPI-Q scores were inversely associated with higher numbers and levels of cardiac risk factors, as well as angiographic CAD. The DASI questionnaire is a reasonable correlate of functional capacity achieved during symptom-limited treadmill exercise testing in women with suspected myocardial ischemia. Lower functional capacity or physical activity measured by the DASI and PEPI-Q, respectively, is associated with more prevalent cardiac risk factors and angiographic CAD. These findings suggest that the DASI and, to a lesser extent, the PEPI-Q have criterion validity for use in health-related research in women.

Activities of Daily Living↗

PubMed2001

The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis.

OBJECTIVE: To investigate the relationship between functional capacity, disease activity, and joint destruction over the course of rheumatoid arthritis (RA). METHODS: The followup data on 378 patients with early RA (duration <1 year), included in an open, prospective study since 1985 at the Department of Rheumatology of the University Medical Center Nijmegen, were used. Functional capacity, disease activity, and joint destruction were assessed using the Health Assessment Questionnaire disability index (HAQ DI), the Disease Activity Score (DAS), and a modification of the sharp radiographic damage score, respectively. Multiple linear regression was used to model the data collected at 0, 3, 6, and 9 years after study start, to investigate which variables influenced functional capacity during the disease course. A general linear mixed model for longitudinal data, which included the variables identified as significant in the multiple linear regression models and several interaction terms between the variables, was run. RESULTS: On average, the functional capacity of the patients, as measured by the HAQ DI, worsened over the course of the disease after an initial improvement. After an initial reduction in the extent of disease activity, the mean DAS remained more or less stable over the course of the disease. The mean modified sharp joint damage score worsened over the course of the disease, with a slower progression rate later in the disease. In the multiple linear regression at 0, 3, and 6 years after study start, disease activity was found to be an important factor influencing functional capacity, and at 6 and 9 years, joint damage had an important effect on functional capacity. Furthermore, at 6 and 9 years, there was an interaction effect of joint destruction with disease activity. In the general linear mixed model, disease activity, joint damage, and an interaction effect of disease activity and joint damage were the main factors explaining functional capacity. CONCLUSION: The effect of disease activity and joint destruction on functional capacity changes over the course of the disease. In early RA, functional capacity is most associated with disease activity, and in late disease, with joint damage.

Adult↗

PubMed2003

Relationships between functional capacity measures and baseline psychological measures in chronic pain patients.

The extent to which baseline psychological measures, pain, and compensation status are related to admission and posttreatment functional capacity and employment outcome was investigated. Four pass/fail functional capacity tests based on the DOT (Dictionary of Occupational Titles) classification system and previously shown to be predictive of treatment outcome in chronic pain patients were analyzed in relation to baseline measures of depression, state and trait anxiety, and perceived stress. Statistical tests of all measures with employment level at admission to treatment, 1 month follow-up and at long-term follow-up were also performed. The results showed that pain level and/or compensation status were the primary predictors of functional capacity and employment status at follow-up. Admission functional capacity measures were also predictors of employment outcome. Depression scores at admission predicted some admission functional capacity results, however, psychological scores were not as significantly related to discharge functional capacity tests. One functional capacity test, the crouching test, was an independent predictor of short- and long-term employment outcome. Trait anxiety was the only psychological factor that was independently predictive of long-term employment outcome. In conclusion, these results suggest that psychological variables are related to measures of functional capacity measured at admission. However, psychological measures at admission are not good predictors of later functional capacity measures. Functional capacity measures are important predictors of follow-up employment outcome, but return to work cannot be predicted without taking pain into account.

Adult↗

PubMed2003

[Factors related to functional capacity in community dwelling elderly people].

PURPOSE: To clarify the content of support for healthy aging, we analyzed age-related changes in functional capacity and factors affecting the maintenance based on a health status survey in elderly people, and also evaluated the results of a survey on functional capacity, living habits, and health in leaders in elderly people's clubs. METHODS: A questionnaire survey was carried out with (1) 1,000 randomly selected elderly subjects aged > or = 65 years and (2) 122 leaders in elderly people's clubs to evaluate functional capacity according to The Tokyo Metropolitan Institute of Gerontology Index of Competence, feeling of happiness according to the morale scale established by Lawton, living habits, and health. Factors affecting functional capacity were identified by stepwise multiple longistic regression analysis. In addition, the elderly people's club leader group and an age- and sex-matched control group were compared. RESULTS: 1) Functional capacity decreased with age, this being more marked in the females than in the males. In particular, Instrumental Activities of Daily Living markedly decreased in the females at late ages. 2) Stepwise multiple logistic regression analysis revealed the following positive and negative factors associated with the maintenance of a high functional capacity (functional capacity score > or = 12). The positive factors were: 1. hobbies, 2. living with the spouse, 3. habitual exercise, 4. positive acceptance of aging, 5. psychological stability, 6. diets with consideration of nutritional balance, 7. busy life, and 8. talking with friends and acquaintances once a week or more. The negative factors were: 1. belonging to a higher age groups, 2. living alone, and 3. smoking. 3) In the elderly people's club leader group, the age-related decline was gradual, and functional capacity was maintained at later ages. The group leaders typically 1. had hobbies, 2. went out almost everyday, 3. exercised almost every day, 4. talked with friends and relatives almost every day, 5. had active roles, 6. were busy, and 7. considered themselves to be healthy more frequently than the control group. The leader group also showed 8. a higher total morale scale score and 9. a higher score for positive acceptance of aging as a subscale than the control group. CONCLUSIONS: Our results suggest that nutrition balance, habitual exercise, hobbies, social roles, frequent contacts with others, positive acceptance of aging, and psychological stability are important for maintaining functional capacity in the maintenance of functional capacity. Early preventive measures are necessary to combat decline in functional capacity, particularly regarding Instrumental Activities of Daily Living, in females at later ages.

Activities of Daily Living↗

PubMed2002

The reliability of determining effort level of lifting and carrying in a functional capacity evaluation.

OBJECTIVES: To establish inter- and intra-rater reliability of observations in a functional capacity evaluation. BACKGROUND: Functional capacity evaluations are used to assess a person's functional capacity as it relates to work. Lifting and carrying are important aspects of a functional capacity evaluation. An evaluator determines the patient's levels of effort through standardized observations. Questions remain with regards to the reliability of these observations. METHODS: Four healthy subjects were videotaped while performing two lifts and four carries with progressive loads. The videotape was scrambled randomly and viewed twice by 3 physical therapists and 2 occupational therapists. The evaluators determined the amount of effort it required (light, medium, heavy, and maximum). The inter- and intra-rater reliability of the observations was expressed by means of percentage agreement. RESULTS: Inter-rater reliability ranged 87-96%, intra-rater reliability ranged 93-97%. CONCLUSION: The results indicate that by means of standardized observations, therapists can reliably determine effort level during lifting and carrying in healthy subjects, and thus affirm the findings of other studies of similar design.

Adult↗

PubMed2006

A pilot study to assess the influence of tai chi chuan on functional capacity among breast cancer survivors.

Treatment of breast cancer can significantly diminish functional capacity in patients months and even years after the completion of treatments. Tai chi chuan (TCC) is a moderate form of exercise that may be an effective therapy for improving functional capacity among breast cancer survivors. We sought to provide pilot data comparing the efficacy of TCC and psychosocial therapy (PST; physical activity control) for improving functional capacity among breast cancer survivors post treatment. Twenty-one women who had completed treatment of breast cancer were randomized to receive TCC or PST 3 times/wk for 12 weeks. Functional capacity was assessed at baseline and at 12 weeks. The TCC group demonstrated significant improvement in functional capacity (specifically aerobic capacity, muscular strength, and flexibility) whereas the PST group showed significant improvement in flexibility only. These data suggest that TCC may be an efficacious intervention for enhancing functional capacity among breast cancer survivors and may support the need for larger randomized, controlled clinical trials to further elucidate these relationships.

Adult↗

PubMed1975

The effects of estrogen and progesterone on the functional capacity of the gonadotrophs.

The functional capacity of the gonadotrophs under the influence of exogenous estrogen and progesterone was assessed by repeated stimulation with submaximal doses of LH-releasing factor (LRF) (10 mug at 2-h intervals) of subjects during the early follicular phase of the cycle and of hypogonadal women. The initial increment of peak serum LH and FSH concentrations after the first administration of LRF, was used to describe the pituitary sensitivity, and the integrated release during the 10 hours of LRF-stimulated pulses was utilized to approximate the pituitary gonadotropin reserve. During the early follicular phase, response to LRF stimulations was relatively stable with corresponding release of LH and FSH. An augmentation of sensitivity, as well as the reserve, for both LH and FSH was elicited by an incremental change in circulating estradiol levels, a change imposed by daily administration of estradiol benzoate for 4 days during the early follicular phase. Under the same conditions, the addition of progesterone (10 mg, im) at the end of the estradiol benzoate treatment induced a marked amplification of the estrogen-augmented pituitary gonadotropin sensitivity and reserve. The pituitary sensitivity, relatively higher than the reserve in hypogonadal subjects, was reversed by the administration of ethinyl estradiol (20-50 mug/day) for 7 days. These data indicate that the functional capacity of the gondotrophs is profoundly modulated by estrogen through relative changes in pituitary sensitivity and reserve, and that progesterone in low doses exhibited an amplifying effect on estrogen-primed gonadotrophs in both the pituitary sensitivity and the reserve.

Estradiol↗

PubMed2004

The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 2: sustained recovery.

STUDY DESIGN: Historical cohort study. OBJECTIVES: We investigated the ability of the Isernhagen Work Systems' Functional Capacity Evaluation to predict sustained recovery. SUMMARY OF BACKGROUND DATA: Functional Capacity Evaluation is commonly used to determine readiness or ability for safe return to work following musculoskeletal injury, implying a low risk of future recurrence or "reinjury." However, this theoretical construct has not yet been tested. METHODS: Workers' compensation claimants who underwent Functional Capacity Evaluation following low back injury and subsequently demonstrated recovery in the form of suspension of total temporary disability benefits or claim closure were studied. The number of failed tasks and performance on the floor-to-waist lift task in the protocol were used as indicators of Functional Capacity Evaluation performance. Indicators of sustained recovery included whether or not total temporary disability benefits restarted, the claim was reopened, or a new back claim was filed. Logistic regression was used to determine the prognostic effect of Functional Capacity Evaluation alone and after controlling for suspected confounding variables. RESULTS: Overall, 46 of 226 patients (20%) experienced a recurrent back-related event within the year following Functional Capacity Evaluation. Opposite to the initial hypothesis, a lower number of failed Functional Capacity Evaluation tasks was consistently associated with higher risk of recurrence after controlling for potential confounding variables. Performance on the floor-to-waist lift task was not related to future recurrence. CONCLUSIONS: Contrary to Functional Capacity Evaluation theory, better Functional Capacity Evaluation performance as indicated by a lower number of failed tasks was associated with higher risk of recurrence. The validity of Functional Capacity Evaluation's purported ability to identify claimants who are "safe" to return to work is suspect.

Adult↗