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PubMed1998

Scoring method for assessing rate adaptive pacemakers: application to two different activity sensors.

To optimize programming of rate adaptive pacemakers (RAPs), we explored a new mathematical method to assess the performance of RAPs during daily-life tests, using customized Windows-based software. By stepwise discriminant analysis and linear regression, this method allows calculation of the acceleration and deceleration capacity of pacemakers and their general behavior during effort and recovery phases. Twenty-three patients (10 females and 13 males; 68 +/- 8 years) with chronic atrial fibrillation and a slow ventricular response were evaluated. They randomly received an accelerometer-controlled VVIR Dash Intermedics pacemaker (10 patients) or a vibration piezoelectric-controlled VVIR Sensolog III Siemens pacemaker (13 patients). All patients underwent the same test protocol: 6 minutes walking, 1.5 minutes climbing stairs, 1.5 minutes descending stairs, and 0.5 minutes sit-ups. By definition, the pacemaker responsiveness slope was programmed so that the heart rate response of paced patients during the walking test corresponded best to that of healthy controls. The slope was left unchanged for the other tests. We considered four scores: an acceleration score (EA score), an effort rate score (ER score), a deceleration score (RD score), and a recovery rate score (RR score). Scores ranged from -10 (hypochronotropic behavior of the pacemaker) to +10 (hyperchronotropic behavior), based on daily-life tests of 15 healthy controls (7 females and 8 males, 65 +/- 9 years). A score of 0 represented exact concordance with healthy controls. During stair descent, the Sensolog III produced excessive acceleration (EA score = +2.9 +/- 1.1) compared to: (1) stair climbing (EA score = -4.0 +/- 1.9; P = 0.01, with the same pacemakers); and (2) the Dash (+1.8 +/- 1.9; P = 0.04) and healthy controls (P = 0.02). The sit-up tests revealed a hypochronotropic response of both pacemakers compared to healthy controls, with a larger difference for the Sensolog III (EA score = -2.0 +/- 5.8; P = 0.04; RD score = -6.8 +/- 3.8' P = 0.02). We conclude that activity-driven pacemakers can accommodate brief activities, except for isovolumetric exercise such as sit-ups. During daily activities, accelerometer-driven pacemakers seem to provide a heart rate resoibse closer to that of healthy controls. Our new mathematical analysis is a simple and reproducible method for evaluating and quantifying the efficacy of any sensor-driven pacemaker.

Adaptation, Physiological↗
PubMed1992

Controlled trial of respiratory muscle training in chronic airflow limitation.

BACKGROUND: Whether respiratory muscle training is of benefit to patients with chronic airflow limitation is controversial. The objective of the study was to determine the effect of resistance breathing training on physiological and functional measures in patients with chronic airflow obstruction. METHODS: The design was a randomised, double blind, controlled trial with a six month follow up. Eighty two patients with a forced expiratory volume in one second (FEV1) of less than 70% predicted, and an FEV1/vital capacity ratio of less than 0.7, were randomised to receive training for 10 minutes five times daily with progressively larger resistances through a resistive breathing device (PFLEX) as tolerated or to a sham device which gave minimal resistance. The main outcome measures, respiratory muscle strength and endurance, a progressive exercise test, a six minute walk test and physical and emotional function (chronic respiratory questionnaire) were assessed at monthly intervals. Patients in both groups were also randomised to wear or not wear nose clips during their training. RESULTS: No significant differences were observed between treatment and control groups, with or without nose clips, for any of the outcomes. Confidence intervals on the difference between treatments were narrow, excluding clinically important difference in any major outcome. CONCLUSION: This training regimen fails to strengthen respiratory muscles or improve exercise or functional capacity in patients with chronic airflow limitation.

Aged↗
PubMed2004

A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of a task-orientated intervention in enhancing competence in walking in people with stroke. DESIGN: Two-centre observer-blinded stratified block-randomized controlled trial. SETTING: General community. SUBJECTS: Between May 2000 and February 2003, 91 individuals with a residual walking deficit within one year of a first or recurrent stroke consented to participate. INTERVENTIONS: The experimental intervention comprised 10 functional tasks designed to strengthen the lower extremities and enhance walking balance, speed and distance. The control intervention involved the practice of upper extremity activities. Subjects in both groups attended sessions three times a week for six weeks. MAIN MEASURES: Six-minute walk test (SMWT), 5-m walk (comfortable and maximum pace), Berg Balance Scale, timed 'up and go'. RESULTS: At baseline, subjects in the experimental (n = 44) and control (n = 47) groups walked an average distance of 209 m (SD = 126) and 204 m (SD =131), respectively, on the SMWT. Mean improvements of 40 m (SD =72), and 5 m (SD =66) were observed following the experimental and control interventions, respectively. The between-group difference was 35 m (95% confidence interval (CI) 7, 64). Significant between-group effects of 0.21 m/s (95% CI 0.12, 0.30) and of 0.11 m/s (95% CI 0.03, 0.19) in maximum and comfortable walking speed, respectively, were observed. People with a mild, moderate or severe walking deficit at baseline improved an average of 36 (SD =96), 55 (SD = 56) and 18 m (SD = 23), respectively, in SMWT performance following the experimental intervention. CONCLUSIONS: Study findings support the efficacy of a task-orientated intervention in enhancing walking distance and speed in the first year post stroke, particularly in people with moderate walking deficits.

Adult↗
PubMed1998

Comparison of short-term functional outcomes following unilateral and bilateral lung volume reduction surgery.

STUDY OBJECTIVES: To compare short-term functional outcomes following unilateral and bilateral lung volume reduction surgery (LVRS) performed in patients with advanced emphysema. METHODS: LVRS was performed unilaterally in 32 patients and bilaterally in 119 patients. Pulmonary function testing and 6-min walk test (6MWT) were performed preoperatively and repeated at 3 to 6 months postoperatively. RESULTS: Bilateral LVRS was associated with increased in-hospital mortality (10% vs 0%, p<0.05) and a higher incidence of postoperative respiratory failure (12.6% vs 0%; p<0.05) compared with unilateral LVRS. There was no significant difference in duration of air leaks between unilateral and bilateral groups, but the mean hospital stay was significantly longer following bilateral LVRS (21.1+/-32.0 days vs 14.2+/-14.0 days; p<0.05). Preoperatively, there was no significant difference between the unilateral and bilateral groups with respect to FEV1, FVC, residual volume, or 6MWT distance. However, for all of these parameters, the magnitude of improvement was significantly greater following bilateral LVRS. Notably, the magnitude of improvement in each parameter following unilateral LVRS exceeded half that following bilateral LVRS, suggesting that functional outcomes after the unilateral procedure were disproportionate to the amount of tissue resected. Serial functional assessment of seven patients undergoing staged unilateral procedures (two unilateral procedures separated in time by at least 3 months) demonstrated somewhat unpredictable responses; failure to achieve a favorable response to the initial procedure did not necessarily portend a similar outcome with the contralateral side, and vise versa. CONCLUSIONS: Bilateral LVRS produces a greater magnitude of short-term functional improvement than does the unilateral procedure and should be considered the procedure of choice for most patients. Unilateral LVRS should be reserved for patients in whom factors contraindicating entrance into one hemithorax exist.

Endoscopy↗
PubMed2001

Apical perfusion fraction as a predictor of short-term functional outcome following bilateral lung volume reduction surgery.

STUDY OBJECTIVES: To examine whether relative hypoperfusion to the apical one third of the lungs as determined by lung scintigraphy predicts a favorable functional outcome following bilateral lung volume reduction surgery (LVRS). METHODS: We performed a retrospective analysis of 128 patients who underwent bilateral LVRS. An apical perfusion fraction (AP%), defined as the percentage of total lung perfusion to the apical one third of both lungs, was derived for each patient by quantitative scintigraphy technique. Pulmonary function testing and 6-min walk test (6MWT) data were obtained preoperatively and 3 to 6 months postoperatively. RESULTS: The mean (+/- SD) improvement in FEV(1) was 309 +/- 240 mL, 209 +/- 293 mL, and 116 +/- 224 mL for patients with an AP% of 20%, respectively (p = 0.01, analysis of variance [ANOVA]). The likelihood of experiencing an increase in FEV(1) >or= 200 mL was 68% for those with an AP% 20%. Preoperative and postoperative 6MWT data were available for 109 of 128 patients. Improvement was 250 +/- 252 feet, 205 +/- 299 feet, and 77 +/- 200 feet for patients with AP% 20%, respectively (p = 0.04, ANOVA). While 50% of those with an AP% or= 180 feet, only 21% of those with an AP% > 20% did so. CONCLUSION: This retrospective analysis suggests that quantification of apical perfusion by nuclear scintigraphy assists in predicting the likelihood of short-term functional improvement after LVRS.

Exercise Test↗
PubMed2005

Reliability and validity of three strength measures obtained from community-dwelling elderly persons.

The purpose of this study was to describe the reliability and validity of 3 strength measures obtained from community-dwelling elderly individuals. The strength of 10 elders was tested initially and 6 and 12 weeks later using the MicroFET 2 hand-held dynamometer (knee extension strength), the Jamar dynamometer (grip strength), and the sit-to-stand (STS) test. Mobility was tested using the timed up-and-go (TUG) test and a timed walk test. Intraclass correlation coefficients, which were used to characterize the reliability of the strength tests, ranged from 0.807 to 0.981. Pearson correlations between the lower extremity strength measures and the TUG and gait speed ranged from 0.635 to -0.943. Our examination of the 3 measures for 12 weeks extends previous evidence of the stability of these strength measures and justifies the use of hand-held dynamometry and the STS test when investigating limitations in mobility.

Aged↗
PubMed1999

Perceptions of physical fitness in patients with heart failure.

This study examined the relationship between perceived physical condition and measured physical fitness and activity levels in 40 patients with moderate heart failure (HF). Self rated physical condition, physical activity, self efficacy, and quality of life were evaluated by self administered questionnaires. Functional capacity was examined by cardiopulmonary exercise testing and 6 minute walk test. We found that physical activity levels were low. Participation in moderate intensity recreational activity and physical fitness were associated with self efficacy. Perceived physical condition was associated with emotional well being and levels of energy and fatigue. We conclude that self efficacy may reflect physical condition and physical activity levels in this sample of HF patients and may be a simple indicator of physical ability. Because of the association between perceived physical condition and emotional well being, caution must be taken when using self reports of physical condition. Further study is needed to explore these relationships.

Adult↗
PubMed2005

Functional evaluation of patients with chronic pulmonary hypertension.

The importance of studying the pathophysiological bases and clinical correlates of exercise limitation in patients with pulmonary arterial hypertension (PAH) is well established. Two modes of exercise testing, the 6-min walk test (6MWT) and the cardiopulmonary exercise test (CPET), are currently proposed for diagnostic, therapeutic and prognostic finalities. The 6MWT is inexpensive, feasible and is thought to better reproduce daily life activities and to reliably detect therapeutic benefits. CPET requires the patient's maximal effort and does not provide a reliable quality of life measure. It is, however, highly reproducible and provides remarkable insights into the pathophysiological mechanisms that lead to exercise intolerance. Due to the limited experience accumulated, CPET is not actually advised for the routine assessment and for the overall clinical decision making of PAH patients. In this review we critically address the knowledge currently acquired on these techniques.

Exercise Test↗
PubMedDate not supplied

Citicoline in the treatment of Parkinson's disease.

Eighty-five patients with an established diagnosis of primary Parkinson's disease were randomly assigned to receive their usual dose of levodopa (mean, 381 mg daily) plus 1,200 mg of citicoline daily or half their usual dose of levodopa (mean, 196 mg daily) plus the citicoline. Results of the Webster Rating Scale, a pegboard test, drawing, writing, and walking tests, a test of emotional state, and an overall assessment, administered before and after four weeks of treatment, revealed no significant between-group differences. Improvements on the tests were shown by more patients who received half their levodopa dose plus citicoline than by those who continued to receive their usual levodopa dose plus the citicoline. It is concluded that the levodopa-saving effect of citicoline could be used to decrease the incidence of side effects and retard the loss of efficacy of levodopa in long-term treatment.

Adult↗
PubMed1990

Falls in the elderly: Part II, Balance, strength, and flexibility.

The purpose of this study was to determine and compare the balance, muscular strength, and flexibility of two groups of elderly adults: one with a history of falls (HF) and one with no history of falls (NHF). Subjects were 19 men and 36 women. Static and dynamic balance was determined by a one-foot stance balance test and a backwards walking test. Hip, knee, and ankle joint muscular strength were assessed on a Cybex Leg Press Dynamometer. A goniometer was used to determine hip, knee, and ankle joint range of motion (flexibility), ANOVA indicated a significant difference between the two groups for static balance (p less than .001), leg strength (p less than .01), and hip and ankle flexibility (p less than .01). The results suggest that balance, leg strength, and flexibility may be factors contributing to falls in the elderly.

Accidental Falls↗
PubMed1993

Evaluation of yoga therapy programme for patients of bronchial asthma.

A study of the effect of yoga therapy programme on 46 indoor patients of chronic bronchial asthma on exercise capacity, pulmonary functions and blood gases was conducted. Exercise capacity was measured by 3 tests: (i) 12 min walk test (12-md); (ii) physical fitness index (PFI) by modified Harvard step test; and (iii) Exercise-Liability index (ELI). Yoga therapy programme resulted in a significant increase in the pulmonary functions and exercise tolerance. A one-year follow-up study showed a good to fair response with reduced symptoms score and drug requirements in these subjects. It is concluded that yoga therapy is beneficial for bronchial asthma.

Asthma↗
PubMed1996

[Development of a functional fitness test for the elderly].

A test of functional fitness defined as physical capacity to independently perform daily functional activities was developed for aged persons. The functional fitness test was composed of four physical capacity evaluation tasks representing physical abilities necessary to perform main activities of daily living; viz. sitting and standing up test, zig-zag walking test, hand working test with pegboard for dexterity evaluation, and rope working test for self-care evaluation. The reliability and feasibility of the test were examined with 765 aged persons living in the community. The distribution of measurement values in each item showed neither extreme skewness nor kurtosis. Retest reliabilities for each task were 0.857 to 0.942, but the second trial showed significantly reduced (p < 0.001) values than the first trial in test-retest. Significant relationships (r = 0.503 to 0.627) between measurement values in each items and chronological age were found in both male and female. Functional fitness test and physical fitness test scores were correlated 0.740. These results showed that the functional fitness test developed in the present study has a high reliability and feasibility to evaluate functional capacity of daily living in aged persons.

Activities of Daily Living↗
PubMed2005

Six-minute walk, maximal exercise tests: reproducibility in fibrotic interstitial pneumonia.

Resting pulmonary function and exercise variables are widely used to stage and monitor idiopathic interstitial pneumonia (IIP). However, the variability of exercise data (maximal exercise and the 6-minute walk test) has not been evaluated definitively. We have prospectively quantified the reproducibility of resting and exercise functional data in fibrotic IIP (idiopathic pulmonary fibrosis, fibrotic nonspecific interstitial pneumonia) and have evaluated interrelationships between variables. Thirty consecutive patients with fibrotic IIP underwent serial resting pulmonary function tests, 6-minute walk (n = 29), and maximal exercise (n = 24) at an interval of 1 week, with all testing performed in accordance with American Thoracic Society standards. Within-subject reproducibility was excellent for 6-minute walk distance (SD/mean = 4.2%) and clinically acceptable for resting pulmonary function indices and VO(2)max on maximal exercise testing. However, the amplitude of oxygen desaturation at the end of exercise was poorly reproducible in both 6-minute walk and maximal exercise testing (SD/mean > 25%). There was a highly significant relationship between VO2max on maximal exercise testing and 6-minute walk distance (r(s) = 0.78, p < 0.0001). In fibrotic IIP, the excellent reproducibility of the 6-minute walk distance is a major advantage in routine staging and monitoring, whereas maximal exercise variables are poorly reproducible.

Aged↗
PubMed2000

Effects of footwear on measurements of balance and gait in women between the ages of 65 and 93 years.

BACKGROUND AND PURPOSE: Footwear is not consistently standardized in the administration of the Functional Reach Test (FRT), Timed Up & Go Test (TUG), and 10-Meter Walk Test (TMW). This study was conducted to determine whether footwear affected performance on these tests in older women. SUBJECTS: Thirty-five women, aged 65 to 93 years, were recruited from assisted living facilities and retirement communities. METHODS: Each subject performed the FRT, TUG, and TMW wearing walking shoes, wearing dress shoes, and barefooted. Because of space constraints at the facilities where the testing was performed, 22 subjects performed the FRT and TUG on a linoleum floor and 13 subjects performed the tests on a firm, low-pile, carpeted floor. All 35 subjects completed the TMW on a firm, low-pile, carpeted floor. One-way repeated-measures analyses of variance (ANOVAs) and a Tukey Honestly Significant Difference test were used to compare the outcomes for the 3 footwear conditions, with separate ANOVAs conducted for the different floor surfaces for the FRT and TUG. RESULTS: Subjects performed better on the FRT when barefooted or wearing walking shoes compared with when they wore dress shoes, regardless of floor surface. Differences were found among all footwear conditions for the TUG performed on the linoleum floor and for the TMW. For these tests, the women moved fastest in walking shoes, slower barefooted, and slowest wearing dress shoes. CONCLUSION AND DISCUSSION: Footwear should be documented and should remain constant from one test occasion to another when the FRT, TUG, and TMW are used in the clinic and in research. Footwear intervention may improve performance of balance and gait tasks in older women.

Aged↗
PubMed2004

Do pulmonary hemodynamics change after effective lung volume reduction surgery for emphysema?

The improvement in lung function, exercise test, blood gas levels, and symptoms in emphysema patients after volume reduction surgery is a result of improvements in breathing mechanics. The question is, is the improvement in the condition related to pulmonary hemodynamics? Few studies have examined pre- and postoperative pulmonary pressure. This paper examines whether there is any significant change in systolic and diastolic pulmonary pressure after effective volume reduction surgery. From October 1999 to October 2002, 12 emphysema patients who underwent volume reduction surgery were studied. Systolic and diastolic pulmonary pressures were measured 2 days before surgery through cardiac catheterization and 2 days after removal of the chest tubes through Swan Ganz catheters placed in the operating room just before surgery. Patients were stable and breathed without assistance during the postoperative pressure measurement. Blood gas analysis, lung function tests, and a 6-minute walk test were performed preoperatively and 3 months postoperatively. The two sets of data were compared using the Wilcoxon signed rank test. There was no significant change in pulmonary hemodynamics, although pulmonary function improved. The improvement in pulmonary function after volume reduction surgery is not related to pulmonary hemodynamics.

Aged↗
PubMed2003

Six-minute walk distance in chronic obstructive pulmonary disease: reproducibility and effect of walking course layout and length.

The 6-minute walk test is used in clinical practice and clinical trials of lung diseases; however, it is not clear whether replicate tests need to be performed to assess performance. Furthermore, little is known about the impact of walking course layout on test performance. We conducted 6-minute walks on 761 patients with severe emphysema (mean +/- SD FEV1% predicted = 26.3 +/- 7.2) who were participants in the National Emphysema Treatment Trial. Four hundred seventy participants had repeated walks on a separate day. The second test was improved by an average of 7.0 +/- 15.2% (66.1 +/- 146 feet, p < 0.0001, by paired t test), with an intraclass correlation coefficient of 0.88 between days. The course layout had an effect on the distance walked. Participants tested on continuous (circular or oval) courses had a 92.2-foot longer walking distance than those tested on straight (out and back) courses. Course length had no significant effect on walking distance. The training effect found in these patients with severe emphysema is less than in previous reports of patients with chronic obstructive pulmonary disease. Furthermore, the layout of the track may influence the 6-minute walk performance.

Aged↗