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PubMed1975

[Studies on the limitation of the body functional capacity by the pulmonary function in chronic bronchitic patients in the work process].

It is reported on first experiences (18 patients) with investigation of the breathing mechanism during ergometry for the quantification of the respiratory dyspnoea on exertion. The oesophagus-pressure-method is recommended as suitable method. The stopping of the load on account of dyspnoea in the number of patients which above all consisted of obstructive bronchitics was carried out at values for the total breathing capacity (Wtot) of 5 kpm/min and more.

Adult↗

PubMed2003

The relationship of neuropsychological abilities to specific domains of functional capacity in older schizophrenia patients.

BACKGROUND: This study sought to determine the relative importance of cognitive measures in predicting various domains of everyday functional capacity in older outpatients with schizophrenia. METHODS: Ninety-three psychiatry outpatients with diagnoses of schizophrenia and schizoaffective disorders underwent a comprehensive neuropsychiatric evaluation, including neuropsychological testing and clinical ratings of psychopathology. Functional capacity was assessed with the Direct Assessment of Functional Status, a performance measure of basic and instrumental activities of daily living (ADLs/IADLs). RESULTS: Neuropsychological performance significantly predicted most ADLs/IADLs measured, except simple eating behaviors, time orientation, and grooming. Lower educational level and negative symptoms also were associated with worse functional capacity, whereas positive symptoms and depressed mood were not. Measures of cognitive functioning accounted for more variance in functional capacity than did psychiatric ratings of symptoms, and multiple regression analyses demonstrated that neuropsychological performance was predictive of functional capacity, over and above clinical symptoms. No specific cognitive domains were differentially predictive of specific domains of functional capacity. CONCLUSIONS: Neurocognitive abilities were more predictive of functional capacity than level of clinical symptoms; however, these abilities were not specific predictors of functioning. This is consistent with findings of relatively generalized, intercorrelated cognitive impairment in schizophrenia and multiply determined domains of everyday functioning.

Activities of Daily Living↗

PubMed1985

Prediction of functional capacity and use of exercise testing for predicting risk after acute myocardial infarction.

This study evaluated whether an ischemic exercise test response or functional capacity could be predicted from data available during hospitalization in patients discharged after acute myocardial infarction (AMI). The value of exercise test variables for predicting death and new AMI within 1 year was also examined. Among 1,469 patients, 466 (32%) underwent treadmill exercise testing around the time of discharge. An ischemic exercise test response (ST-segment depression or angina) could not be predicted. Good functional capacity (more than 4 METs) could be predicted from age and ST-segment changes at rest. Among the 60% of the patients who were predicted to have functional capacity of more than 4 METs, only 15% had poor functional capacity at the time of testing. Multivariate analysis for predicting death and new infarction selected only functional capacity (continuous variable in METs), which classified 72% of the patients into a low-risk group with less than a 2% rate of death and new AMI in the first year. The high-risk group (29% of the patients) had an 18% rate of death or new AMI. It is concluded that functional capacity is the most important exercise test variable and that patients likely to have good functional capacity can be identified on the basis of age and ST-segment changes at rest. Further, the level of functional capacity on exercise testing can identify groups of patients with very low and relatively high risk of death or new AMI within 1 year.

Adrenergic beta-Antagonists↗

PubMed2004

Nutritional status, functional capacity and exercise rehabilitation in end-stage renal disease.

A significant percentage of patients with end-stage renal disease are malnourished and/or muscle wasted. Uremia is associated with decreased protein synthesis and increased protein degradation. Fortunately, nutritional status has been shown to be a modifiable risk factor in the dialysis population. It has long been proposed that exercise could positively alter the protein synthesis-degradation balance. Resistance training had been considered as the only form of exercise likely to induce anabolism in renal failure patients. However, a small, but growing, body of evidence indicates that for some dialysis patients, favourable improvements in muscle atrophy and fibre hypertrophy can be achieved via predominantly aerobic exercise training. Moreover, some studies tentatively suggest that nutritional status, as measured by SGA, can also be modestly improved by modes and patterns of exercise training that have been shown to also increase muscle fibre cross-sectional area and improve functional capacity. Functional capacity tests can augment the information content of basic nutritional status assessments of dialysis patients and as such are recommended for routine inclusion as a feature of all nutritional status assessments.

Exercise↗

PubMed2003

Functional capacity impairment in patients with coronary artery disease: prevalence, risk factors and prognosis.

BACKGROUND: Some patients developing heart failure and functional capacity impairment have no history of myocardial infarction (MI), and stable angina pectoris is their principal clinical manifestation of coronary artery disease (CAD). The present study was aimed to evaluate the outcome of CAD-related functional capacity impairment in patients with and without a history of MI over a 7.7-year follow-up. METHODS: The study sample comprised 14,283 coronary patients aged 45-74 years, screened for participation in the Bezafibrate Infarction Prevention study. The presence of NYHA functional class II was defined as mild functional capacity impairment and the presence of NYHA functional class III-IV was defined as advanced functional capacity impairment. RESULTS: The patients were divided in two groups: (1) those with a history of MI, 10,307 patients, who formed three subgroups: NYHA I 7,551 patients (73.3%); NYHA II 2,176 patients (21.1%); NYHA III + IV 580 patients (5.6%), and (2) those without a history of MI, 3,976 patients, who also formed three subgroups: NYHA I 2,744 patients (69.0%); NYHA 981 patients (24.7%); NYHA III + IV 251 patients (6.3%). Multivariate analysis identified a history of MI as a consistent predictor of increased all-cause and cardiac mortality for patients with NYHA I, II and III + IV subgroups with escalating significance for patients with advanced functional capacity impairment: hazard ratios of 1.55 (95% CI 1.36-1.75), 1.56 (95% CI 1.30-1.86) and 1.72 (95% CI 1.24-2.40) for all-cause and 1.93 (95% CI 1.60-2.33), 1.73 (95% 1.35-2.20) and 3.22 (95% CI 1.87-5.54) for cardiac mortality, respectively. CONCLUSIONS: The prevalence of low functional capacity is similar among coronary patients with and without a history of MI, but their long-term survival differs substantially in favor of the latter. Therefore, two different types of CAD-related advanced functional capacity impairments (post-MI and non-post-MI) can be distinguished.

Aged↗

PubMed1994

Functional capacity after cardiac surgery in elderly patients.

OBJECTIVES: This study was performed to determine whether cardiac surgery improves functional capacity in patients > 70 years of age and to identify factors associated with good and poor functional results in this age group. BACKGROUND: Cardiac surgery has been used increasingly among older patients, but the effectiveness of surgery in this age group remains controversial. METHODS: Self-reported functional capacity was assessed by the Duke Activity Status Index preoperatively and again 1 year after coronary artery bypass or valve replacement surgery in a total of 199 patients with a mean age of 76 years (range 70 to 91). RESULTS: Functional capacity improved significantly after surgery (mean Duke Activity Status Index 27.9 at baseline vs. 36.8 at 12 months, p < 0.001), with improvements in most patients (74%). Six preoperative factors were independent predictors of less improvement in functional capacity between baseline and 1 year: smoking, female gender, higher Charlson comorbidity index, syncope, previous cardiac operation and older age. Postoperative complications were also a highly significant predictor of lower functional capacity at 1 year. CONCLUSIONS: Most older patients have meaningful improvements in functional capacity after cardiac surgery, and clinical factors appear to modify the degree of improvement attainable.

Age Distribution↗

PubMed1997

Determinants of functional capacity in chronic mitral regurgitation unassociated with coronary artery disease or left ventricular dysfunction.

Impaired functional capacity is common in patients with mitral regurgitation (MR), but the determinants of functional capacity in patients with normal left ventricular (LV) function are unclear. Forty patients with chronic, isolated, nonrheumatic MR with no coronary artery disease underwent exercise echocardiography with continuous expired gas analysis. Cardiac output and regurgitant stroke volume were measured at rest and immediately after exercise by pulsed-wave Doppler echocardiography. For controls, 17 healthy volunteers without MR were also studied. Patients achieved a significantly lower VO2max compared with controls (25.6 +/- 7.7 vs 31.7 +/- 7.7 ml/kg/min, p = 0.008). VO2max showed better correlations with exercise cardiac output than with cardiac output at rest in both patients and controls. Multiple linear regression identified exercise cardiac output (partial r = 0.65), patient age (partial r = -0.56), and gender as independent determinants of VO2max (multiple R = 0.85, p <0.001). Cardiac output at rest, LV ejection fraction, regurgitant stroke volume, and fraction were not significant determinants. With exercise, the regurgitant stroke volume increased in 13 patients and decreased in 27 patients. The former 13 patients had a significantly lower exercise cardiac output (7.4 +/- 2.5 vs 9.4 +/- 2.6 L/min, p = 0.026). Patients who stopped exercise due to dyspnea (n = 7) had a significantly lower exercise cardiac output and VO2max compared with those who stopped due to fatigue (n = 33), with no differences in resting or exercise regurgitant volume. Patients with an increase in LV end-systolic volume with exercise (n = 8) also had a significantly lower exercise cardiac output (6.9 +/- 1.9 vs 9.2 +/- 2.7 L/min, p = 0.037) and showed a trend toward a lower VO2max (21 +/- 7.5 vs 26 +/- 6.4 ml/kg/min, p = 0.07). In patients with chronic MR, exercise cardiac output is the major determinant of VO2max. Regurgitant volume and fraction are not related to functional capacity. Limitations in functional capacity in these patients may be more related to a diminished cardiac reserve than to a large regurgitant volume.

Anaerobic Threshold↗

PubMed1994

Health, functional capacity, health behaviour, psychosocial factors and falling in old age.

This study was done to investigate health, functional capacity, health behaviour and psychosocial factors associated with the occurrence of falls leading to medical treatment in elderly Finns (> or = 65 yrs). An unmatched case-control study was performed in the Town of Pori, Western Finland during the 12 months from September 1987 to August 1988. The series consisted of 380 fallers who sought medical treatment and 342 elderly control subjects selected randomly from the population register. Logistic regression analysis showed falls in the home-dwelling men to be associated with high age, high white blood cell count, poor self-perceived health and presence of depressive symptoms. In the home-dwelling women the occurrence of falls was associated with high white blood cell count, low blood haemoglobin level, high age and being afraid of falling. The occurrence of falling in the women showed a tendency to be associated with poor functional capacity, high axillary temperature and poor mental capacity. In the log-linear model in the men occurrence of falling was independently associated with poor self-perceived health and with high white blood cell count. In the women occurrence of falling was associated with high age, poor functional capacity, poor mental capacity, low blood haemoglobin and high white blood cell count. High age was associated with poor functional capacity and with low blood haemoglobin. Poor functional capacity and poor mental capacity were associated with each other. Poor mental and functional capacities, anaemia in women and acute infections are associated with falls leading to medical treatment in the elderly. Elderly subjects with an acute infection should be treated carefully to avoid falling complications.

Accidental Falls↗

PubMed1997

Surrogate assessment of coronary artery disease patients' functional capacity.

An investigation of the surrogate assessment of coronary artery disease (CAD) patients' functional capacity was conducted using 193 patient and surrogate rater dyads. Mean age of patients and surrogate raters were 60.4 and 54.4 years, respectively. Patients and surrogates independently completed a brief questionnaire that assessed health and psychosocial factors. The Duke Activity Status Index (DASI) was contained in the patients' questionnaire, while a similar form modified to assess patients' functional capacity was imbedded in the surrogates' questionnaire. Results indicated similar psychometric characteristics and clinical validity for patients' self-report and surrogates' ratings, suggesting that the Surrogate Rating Form of the Duke Activity Status Index (DASI-SRF) is a reliable and valid proxy method of assessing patient's functional capacity when this information may not be obtained directly from the patient. Further, while there were no effects of surrogates' health and psychological characteristics on their ratings of patients' functional capacity, in comparison with other surrogates, spouses were more likely to rate patients higher in functional capacity. Exploration of the patient/care provider relationship via concurrent use of the DASI and DASI-SRF is discussed.

Adult↗

PubMed2003

Bedside B-type natriuretic peptide and functional capacity in chronic heart failure.

OBJECTIVES: To determine if B-type natriuretic peptide (BNP) measurement could be useful in determination of functional capacity in patients suffering from chronic heart failure. BACKGROUND: Evaluating functional capacity is a crucial factor in the follow-up of patients with chronic heart failure. There are numerous methods for measuring functional capacity and their relative merits remain under discussion. Clinical classifications are very subjective and other methods are difficult to use in clinical practice. METHODS: We evaluated functional capacity in 151 consecutive patients using the 6-min walk test. All patients were clinically classified using the New York Heart Association (NYHA) classification. We measured BNP plasma levels using a bedside BNP test. RESULTS: Six minute walk test performance decreased through NYHA classes 1 to 4 (469+/-87, 411+/-82, 325+/-83 and 196+/-63 m, respectively, P<0.01) and BNP levels increased through NYHA classes 1 to 4 (26.3+/-7.2, 73+/-13, 401+/-74 and 924+/-84 pg/ml, respectively, P<0.001). There was a significant correlation between 6-min walk test performance and BNP plasma levels (R=0.69 P<0.001) and a weaker correlation between BNP and left ventricular ejection fraction (R=0.45 P<0.04). In some patients there was a mismatch between NYHA classification and 6-min walk test performance. In all cases BNP could correct the clinical estimation of functional capacity. When we divided the patients into three sub-groups within each NYHA class, we showed that using BNP could better define functional capacity in patients suffering from chronic heart failure in NYHA classes I to III. CONCLUSION: The measurement of BNP levels thus usefully supplements the clinical examination. The existence of bedside BNP testing methods facilitates its use in routine clinical practice. It also permits easier follow-up of patients with chronic heart failure.

Adolescent↗

PubMed2004

Measurement properties of performance-based assessment of functional capacity.

Performance-based functional assessments, including standardized functional capacity evaluation (FCE) batteries, are commonly used to determine the physical work abilities of individuals who have sustained musculoskeletal injury. The purpose of this paper is to critically examine research pertaining to the measurement properties of performance-based FCE, along with the theoretical bases for such measurement. While rater judgments of maximum performance during FCE appear reliable, FCEs do not appear to be purely tests of physical capacity as performance during assessment is influenced by multiple personal and environmental contextual factors. FCEs are more accurately considered behavioural tests influenced by multiple factors including physical ability, beliefs, and perceptions, and should be interpreted with in the subject's broader personal and environmental context.

Activities of Daily Living↗

PubMed2003

[Test-retest variation in the Tokyo Metropolitan Institute of Gerontology Index of Competence in community-dwelling older people independent in daily living toward individual assessment of functional capacity].

OBJECTIVES: To assess individual variation in the functional capacity of community-dwelling older people who are almost independent in daily living, using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-Index of Competence). METHODS: Out of 74 elderly outpatients showing a total score of TMIG-Index of Competence above 10 points at baseline, 61 who remained stable during subsequent two months in terms of medical and social aspects were assessed for their functional capacity with the test-retest method using the TMIG-Index of Competence. We assessed individual variation between the tests of one month interval with correspondence rate. RESULTS: The ranges for score differences within which correspondence rates of 95% and over applied were as follows: within 1 point for the total score of the Index (95.1%), 0 point in the Instrumental Self-Maintenance subscale (IADL) (95.1%), and 1 point in the Intellectual Activity subscale (Intellectual Activity) (98.4%) and the Social Role subscale (Social Role) (98.3%). CONCLUSIONS: The variation of 1 point for the total score of the Index, and subscales of Intellectual Activity and Social Role was regarded as a possible measurement error. In other words, variations of 2 points and over for total score, subscales of Intellectual Activity and Social Role, and variations of 1 point and over for IADL should not be ignored in screening of functional capacity among older people.

Activities of Daily Living↗

PubMed2003

Recovery of self-reported functional capacity after coronary artery bypass surgery.

STUDY OBJECTIVES: This study was conducted to determine the effects of age, gender, comorbid conditions, and exercise on the recovery of self-reported functional capacity after coronary artery surgery, and to identify predictors of 1-year functional capacity. PATIENTS: One hundred ninety-eight patients undergoing coronary artery bypass graft surgery. MEASUREMENTS AND RESULTS: Self-reported functional capacity was evaluated before surgery, and 3 months and 1 year postoperatively using the Veterans Specific Activity Questionnaire (VSAQ). Patients were classified into groups based on age, gender, comorbid conditions, and postoperative exercise. Repeated-measures analysis of variance was used to determine if groups differed with respect to functional capacity recovery and multiple linear regression was used to identify predictors of 1-year VSAQ score. A significant time by age interaction was found (p = 0.0001), with a more protracted recovery for older patients. There were significant group effects for gender (p = 0.0001), and presence of comorbid conditions (p = 0.0009); however, there were no time/group interactions for these variables. A significant group effect was found for postoperative exercise (p = 0.0001), with a trend toward group/time interaction (p = 0.096). Predictors of 1-year functional capacity were VSAQ score in the year prior to surgery and performance of regular aerobic exercise in the postoperative period. CONCLUSIONS: This study suggests that older patients attain good self-reported functional outcomes after surgery; however, the time course for recovery is more protracted than for younger patients. Functional capacity in the year prior to surgery and postoperative exercise are key predictors of 1-year functional capacity.

Activities of Daily Living↗

PubMed1995

Sodium pivalate reduces cardiac carnitine content and increases glucose oxidation without affecting cardiac functional capacity.

This study determined how selected functional, metabolic, and contractile properties were impacted by sodium pivalate, a compound which creates a secondary carnitine deficiency. Young male rats received either sodium pivalate (20 mM, PIV) or sodium bicarbonate (20 mM, CONTR) in their drinking water. After 11-12 weeks cardiac function and glucose oxidation rates were measured in isolated, perfused working heart preparations. Hearts were also analyzed for carnitine content, activities of hexokinase (HK), citrate synthase (CS), and B-hydroxyacyl CoA dehydrogenase (HOAD), and myosin isoenzyme distribution. Sodium pivalate treatment significantly reduced cardiac carnitine content and increased glucose oxidation but did not alter cardiac functional capacity. HK activity was increased in the PIV group (p < 0.05), and HOAD activity decreased (p < 0.05). CS activity and myosin isoform distribution (VI > 85%) remained unchanged. These results demonstrate that pivalate treatment of this duration and the accompanying carnitine deficiency shift cardiac substrate utilization without compromising cardiac functional capacity.

3-Hydroxyacyl CoA Dehydrogenases↗

PubMed1996

A specific activity questionnaire to measure the functional capacity of cardiac patients.

Exercise testing is often performed in persons with cardiac disease to measure their functional capacity. Physical activity questionnaires assessing functional capacity have been used a low-cost and convenient alternative to exercise testing, but have not been well validated against measured oxygen consumption in a cardiac population. This study assesses the ability of a simple, 13-item activity questionnaire, known as the Specific Activity Questionnaire (SAQ), to measure functional capacity prospectively in a large sample of cardiac patients. Ninety-seven consecutive cardiac outpatients (85 men and 12 women aged 59 +/- 10 years [mean +/- SD]) completed the SAQ before an elective symptom-limited treadmill test. Subjects returned within 10 days to repeat the treadmill test, following the same protocol, with the additional measurement of peak oxygen consumption, VO2 (ml x kg(-1)min(-1)), using open circuit spirometry. The SAQ score was significantly related to measured peak VO2(r=0.57, p<0.001). Stepwise multiple linear regression analysis found that the addition of patient age, height, and body weight to SAQ score improved the measurement of peak VO2, accounting for 51% of the sample variance (R=0.71, p<0.001). Peak VO2 was obtained from the following regression formula: [formula: see text]. Thus SAQ, a simple 13-item self-administered activity questionnaire, is able to provide a moderately good measure of functional capacity in cardiac patients and may be useful tool in studies of the cardiac population when formal exercise testing is impractical or uneconomical.

Activities of Daily Living↗

PubMed2002

[Effect of functional capacity, coexisting depression and some socio-demographic factors on the quality of life in patients with ischemic cerebrovascular stroke].

The aim of this work was to assess the influence of functional capacity, coexisting depression and socio-demographic factors (age, gender, education level, coexisting disease, employment and hobbies prior to stroke) on the quality of life (QOL) in patients with ischaemic cerebrovascular stroke. Enrollment criteria included consent to participate, age under 70 years, no physical disability or psychiatric disease prior to stroke, no cognitive deficit or speech disorders preventing active participation in the study. Each patient was seen on four occasions: at the day of discharge from hospital, after 3, 6 and 12 months from stroke. The first examination prior to discharge included analysis of the hospital record, assessment of the neurological status and functional capacity, and screening for depression. Subsequent examinations included assessment of functional capacity, search for coexisting depression and evaluation of QOL. Functional capacity was determined using the Repta 2 scale, depression was diagnosed according to ICD 10 criteria and QOL was assessed with the London Handicap Scale. A total of 79 patients appeared for all four examinations. The results were subjected to statistical analysis. It was found that functional capacity and quality of life steadily improve after stroke, particularly during the first 6 months. A positive correlation was disclosed between the functional capacity and QOL, indicating that the functional capacity exerts an influence on QOL. Depression was a frequent finding among patients with ischaemic cerebrovascular stroke, exerting a negative effect on QOL. Higher QOL was observed among females and younger patients, the role of gender and age being most noticeable in the second half of the first year after stroke. Furthermore, patients returning to work and having a hobby demonstrate a higher quality of life.

Activities of Daily Living↗

PubMed1991

Functional capacity and activity level before and after renal transplantation.

Functional capacity and activity level were measured among 9 renal transplant recipients prior to transplantation (T1), 6 weeks (T2), and 16 weeks (T3) after transplantation. Functional capacity was measured by a symptom-limited treadmill test. The Human Activity Profile was used to obtain self-reported activity level. A 24% improvement in functional capacity was found from T1 to T2 with only a 5% improvement from T2 to T3 (p less than .001). In contrast, significant improvement in activity level was not present until after T2. Although activity level increased from T1 to T3 (p less than .01), it continued to be low in comparison with age/gender matched normative data.

Activities of Daily Living↗

PubMed2006

High-level functional capacity and 4-year mortality in an 80-year-old population.

BACKGROUND: Little is known about the relationship between high-level functional capacity and mortality in elderly people. OBJECTIVE: To evaluate the relationship between high-level functional capacity, such as intellectual activity and social role, and 4-year mortality in a population of 80-year-old community residents. METHODS: Participating in the study were 697 individuals (277 males and 420 females) out of 1,282 80-year-old individuals residing in Fukuoka Prefecture, Japan. To measure high-level functional capacity, the daily activities of 656 of the 697 participants were examined through questionnaires, accompanied by physical and laboratory blood examinations. The 697 participants were followed up for 4 years after the baseline examination. For subjects who died during that period, the date and cause of death were recorded from resident registration cards and official death certificates. RESULTS: The relative risk for all-cause mortality decreased with an increase in intellectual activity or total functional capacity, whereas no association was found between total mortality and either the ability to perform instrumental self-maintenance or the ability to maintain a social role. Similarly, the relative mortality risk due to cardiovascular diseases decreased with an increase in intellectual activity or total functional capacity. Mortality due to pneumonia also decreased with an increase in intellectual activity. CONCLUSION: In a population of 80-year-old community residents, levels of intellectual activity and total functional capacity may be associated with all-cause, cardiovascular, and pneumonia mortality, and may be strong predictors of survival.

Activities of Daily Living↗