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PubMed1996

Bone loss in rheumatoid arthritis. Influence of disease activity, duration of the disease, functional capacity, and corticosteroid treatment.

Axial and appendicular bone mass were studied in 95 patients with rheumatoid arthritis. The aims were to quantify bone mineral density (BMD) and to evaluate the importance of disease activity, duration of disease, functional capacity, and corticosteroid treatment for bone loss in patients with rheumatoid arthritis. The BMD in the lumbar spine (BMDSPINE) did not differ from age-matched healthy controls, but distal forearm BMD (BMDARM) and metacarpal BMD (BMDMCB) were significantly lower in the patients (p < 0.01 and p < 0.001, respectively). Neither BMDSPINE nor BMDMCB were related to the disease activity at the time of investigation. By contrast, BMDARM was decreased in patients with active disease. BMD in any of the three measured locations was not directly correlated to duration of the disease. However, the bone mass in the appendicular skeleton was already decreased within the first two years after the start of the disease. The overall functional capacity in terms of physical activity increased BMD in the axial skeleton. The local functional capacity in terms of grip strength was positively related to BMD in the appendicular skeleton. Patients with severe functional impairment had the lowest BMDARM. The decreased BMD in patients with rheumatoid arthritis seems primarily to be caused by an impaired physical activity which may be related to disease activity. Corticosteroids did not decrease BMD in neither the axial nor the appendicular skeleton. The antiinflammatory effect of steroids lead to clinical improvement, which may counteract the expected negative effect of these drugs on bone in rheumatoid arthritis.

Absorptiometry, Photon↗

PubMedDate not supplied

Quantitative evaluation of a home exercise program on muscle and functional capacity of patients with osteoarthritis.

Rehabilitation of patients with osteoarthritis of the knees is typically based on home exercise. These programs are believed to benefit patients and have been shown to qualitatively improve strength. The purpose of the present study was to quantify the effects of a 3-mo home exercise program on muscle function and functional capacity. The progressive program included flexibility, strength, endurance, active range of motion and functional activities. Nineteen subjects (67.4 +/- 7.5 yr) with osteoarthritis of the knees began the program, with only nine completing it. The subjects initially had significantly reduced muscle function and functional capacity. Maximal isometric strength of knee extension increased significantly at a knee flexion position of 45 degrees for hip flexion positions of 120 degrees and 60 degrees (35%); however, it failed to increase at longer muscle lengths. There were no significant improvements in hamstring strength. Maximal angular velocity improved after 3 mo of exercise (40%). Muscle endurance did not improve significantly. Although there was a slight increase in functional capacity, these data failed to demonstrate significant clinical or statistical improvement in overall function in patients after home exercise.

Aged↗

PubMed2005

Intermittent claudication: functional capacity and quality of life after exercise training or percutaneous transluminal angioplasty--systematic review.

PURPOSE: To systematically review published data about the short- and long-term effects of exercise training and angioplasty on functional capacity and quality of life of patients with intermittent claudication. MATERIALS AND METHODS: Articles published between January 1980 and February 2003 were included if patients had intermittent claudication treated with exercise training or angioplasty and if both functional capacity and quality-of-life scores from Medical Outcomes Study 36-Item Short Form health survey were reported for at least 3 months of follow-up. Data were pooled by using a random effects model and weighted means. Pooled results were compared between the treatment groups by using the chi2 test and the Student t test (alpha = .05, two sided). RESULTS: In the analyses, five studies (202 patients) were included in the exercise group, and three studies (470 patients), in the angioplasty group. At 3 months of follow-up, the ankle-brachial index was significantly improved in the angioplasty group (mean change, 0.18; P < .01) but not in the exercise group (mean change, 0.01; P = .29). At 3 months, quality of life was significantly improved with regard to ratings of physical functioning and bodily pain in the exercise group (mean change, 18 and 10, respectively; P < .01) and physical role functioning in the angioplasty group (mean change, 30; P = .03). Mean change in ankle-brachial index significantly differed between the two treatment groups at 3 and 6 months (P < .01); mean change in quality-of-life scores did not. CONCLUSION: Improvement in quality of life was demonstrated after both exercise training and angioplasty, whereas functional capacity showed significant improvement after angioplasty. The ankle-brachial index significantly differed between the two treatment groups at 3 and 6 months, whereas the quality-of-life scores did not.

Angioplasty, Balloon↗

PubMed1980

An electrographic study on the functional capacity of the coronary collateral circulation in dogs with chronic coronary occlusion.

The functional capacity of coronary collaterals was investigated under resting and stress conditions in 15 dogs with chronic occlusion of the anterior descending coronary artery. ST-elevation in epicardial and intramyocardial electrograms was used for assessing the degree of regional myocardial ischemia. In resting condition, epicardial and intramyocardial electrograms from collateral, intermediate and circumflex areas revealed no significant ischemic changes. In 6 of 15 dogs in which atrial pacing was performed, ST-elevation appeared in electrograms from collateral and intermediate areas. In another 9 dogs, pacing tachycardia produced no significant changes in all electrograms. In these dogs more than 50% constriction of the donor coronary artery was necessary to induce ST-elevation in electrogram from collateral area. These findings indicate that the coronary collateral vessels in dog play beneficial role to prevent the myocardium from ischemic injury under stress condition, although their functional capacity is not comparable to that of normal coronary artery.

Animals↗

PubMed2003

Living with chronic renal failure: patients' experiences of their physical and functional capacity.

BACKGROUND AND PURPOSE: Several studies have shown that patients with chronic renal failure have reduced physical exercise capacity compared with the expected norm. There are, however, few qualitative studies showing ways in which patients experience their condition in terms of physical and functional capacity, and the limitations this imposes on their daily lives. The aim of the present study was to describe and analyse ways in which patients with chronic renal failure, in the pre-dialysis phase and patients undergoing haemodialysis or peritoneal dialysis, experienced their physical and functional capacity in their daily lives. METHOD: Semi-structured interviews were used to collect data, which were then analysed according to a contextual analysis within a phenomenographic approach. RESULTS: Analysis yielded a system of categories describing patients' experiences of mental and physical fatigue, physical and functional capacity, in terms of effect on performance and endurance, and their experience of temporal stress, in terms of lack of time as well as lack of peace in their daily lives. CONCLUSIONS: The results of the study will contribute to our understanding of how these patients experience their daily lives, and will help when meeting patients with chronic renal failure. This knowledge enables physiotherapists to focus rehabilitation training on problem areas that are important to patients themselves.

Activities of Daily Living↗

PubMed1985

Functional capacities of lungs and thorax in beagles after prolonged residence at 3,100 m.

Functional capacities of the lungs and thorax in beagles taken to high altitude as adults for 33 mo or in beagles raised from puppies at high altitude were compared with functional capacities in corresponding sets of beagles kept simultaneously at sea level. Comparisons were made after reacclimatization to sea level. Lung volumes, airway pressures, esophageal pressures, CO diffusing capacities (DLCO), pulmonary blood flow, and lung tissue volume (Vt) were measured by a rebreathing technique at inspired volumes ranging from 15 to 90 ml/kg. In beagles raised from puppies we measured anatomical distribution of intrathoracic air and tissue using X-ray computed tomography at transpulmonary pressures of 20 cm H2O. Lung and thoracic distensibility, DLCO, and Vt were not different between beagles that had been kept at high altitude for 33 mo as adults and control subjects kept simultaneously at sea level. Lung distensibility, DLCO, and Vt were significantly greater in beagles raised at high altitude than control subjects raised simultaneously at sea level. Thoracic distensibility was not increased in beagles raised at high altitude; the larger lung volume was accommodated by a lower diaphragm, not a larger rib cage.

Altitude↗

PubMedDate not supplied

[Aerobic functional capacity in normal subjects].

The functional evaluation of a subject may be performed by measurement of the functional aerobic capacity by means of exercise-stress tests. The maximal oxygen consumption (VO2 max) is the best parameter to establish this. The values of VO2 max were determined in twenty-five normal subjects, residents of Mexico City. There were twenty men and five women whose ages ranged between the third and fourth decades of life. A maximal exercise-stress test was performed in a treadmill, with constant inclination and progressive speed increments. Electrocardiogram and blood pressure were monitorized at rest, during exercise and in the recovery period. Four collections of espired gas were obtained, one at rest and three at different levels of exercise. VO2/kg. at rest (the value of one met) was 3.49+/-0.58 ml/kg. min. for the whole group somewhat lower for males (3.37+/-0.53 ml/kg. min.) than for female subjects (3.99+/-0.51 ml/kg. min.). These results are comparable to the ones informed in the literature. VO2 max/kg. was 27.8+/-5.57 ml/kg. min. for the entire group and 28.0+/-5.64 and 27.3+/-5.94 ml/kg. min. for men and women respectively. The values of VO2 max/kg. are definitely lower than the ones obtained from normal subjects in other countries. Considerations are made on the possible causes of this discrepancy. A linear correlation was found between VO2/kg or mets in one side and load imposed, cardiac rate or double product (pulse-pressure) in the other. The different VO2 max/kg. values found in this study as compared to the results obtained from other countries, serve to emphasize the need for each laboratory to establish its own normal values and to construct nomograms for the adquate evaluation of functional aerobic capacity. This, in turn, will permit the accurate and correct prescription of exercise for individual subjects or patients.

Adult↗

PubMed1994

Objective evaluation of functional capacity: medical, occupational, and legal settings.

Clinicians are called upon to perform objective evaluation of functional capacity in a variety of treatment and evaluation settings. To assist the clinician in selecting the appropriate testing methods for assessment of functional capacity in different settings, a survey of available techniques is presented. It is structured around the goals of treatment as the patient progresses from the stage of acute injury or disease through early postacute care to long-term rehabilitation. The role of the clinician in treatment of the patient is contrasted to the role of the clinician in evaluation of the patient for reasons other than making clinical decisions. In particular, the specific demands of workers fitness and risk evaluation are described. The goal-related differences in the design and the correct use of clinical dynamometers vs. work simulators are presented. The key concepts are the professional role of the clinician, reliability of measurements, and validity in the sense of the decisions one is justified in making based on the results of these measurements in a particular context.

Cardiovascular Physiological Phenomena↗

PubMed1993

Importance of the exercise programme for the assessment of functional capacity after myocardial infarction.

To evaluate the effect of different bicycle exercise programmes on estimates of functional capacity in cardiac patients, the cumulated exercise capacity, physiologic and gas exchange responses were measured in eleven men 5-10 weeks after an acute myocardial infarction. The patients were not limited by angina and all were treated with a beta-blocker. On separate days and in randomized order the patients performed symptom-limited cardiopulmonary exercise testing on 50 W/3 min stage, 50 W/6 min stage and continuous 'ramp' (15 W per min) programmes. Submaximal and peak oxygen consumption, peak heart rate, rate pressure product, workload and minute ventilation were independent of the various exercise programmes, but exercise time and maximal cumulated exercise capacity (workload x time integral) were significantly higher on the 50 W/6 min stage (50.3 +/- 20.0 kJ) and ramp (41.1 +/- 16.4 kJ) programmes compared to the 50 W/3 min stage programme (32.8 +/- 11.9 kJ). The variation of exercise time and cumulated work capacity, but not oxygen consumption between different exercise programmes has to be considered when estimating functional capacity early after acute myocardial infarction.

Adult↗

PubMed2006

[Relationship between the mechanical and anatomic axis and orientation angles of the knee joint and functional capacity of patients with osteoarthritis].

OBJECTIVES: We investigated the relationship between the mechanical-anatomic axes and angles of the knee joint and functional levels of patients with primary osteoarthritis. METHODS: A total of 35 patients (27 females, 8 males; mean age 58+/-9 years; range 42 to 77 years) with knee osteoarthritis were included. After physical examination, weight-bearing anteroposterior x-rays of the knees were obtained, on which measurements of the following were made: mechanical axis deviation (MAD), medial proximal tibial angle (MPTA), anatomic tibiofemoral angle (aTFA), mechanical lateral distal femoral angle (mLDFA), and joint line congruence angle (JLCA). Pain was evaluated by both the Western Ontario McMaster Osteoarthritis Index (WOMAC) and a visual analog scale (VAS). Functional capacity was assessed using the physical function and global indices of WOMAC. RESULTS: There was a moderate correlation between body mass index and the WOMAC global index (r=0.47, p<0.05). Radiographic evaluations revealed varus deformity in 28 patients. There was a correlation between aTFA and the physical function (r=0.47) and global (r=0.41) indices of WOMAC (p<0.05). Functional capacity and pain were not correlated with the other mechanical angles of the knee joint (p>0.05). CONCLUSION: In view of our results, aTFA may be considered one important criterion in designing treatment and planning surgery for patients with primary osteoarthritis.

Adult↗

PubMed1996

Antioxidants and reduced functional capacity in the elderly: findings from the Nun Study.

BACKGROUND: This study investigated the relationship of plasma antioxidants to reduced functional capacity in the elderly. A hallmark of reduced functional capacity in the elderly is dependence in self-care (i.e., requiring assistance with bathing, walking, dressing, standing, toileting, and feeding). METHODS: This relationship was assessed in a cross-sectional study of 88 Catholic sisters (nuns). These 77- to 98-year-old women lived in the same building, ate food prepared in the same kitchen, and had all nursing services provided by the same staff. In 1993, ability to perform self-care was assessed, and blood was drawn to determine plasma carotenoids (lycopene, beta carotene, alpha carotene, zeaxanthin and lutein combined, and beta cryptoxanthin) and alpha tocopherol. RESULTS: Dependence in self-care had a strong negative association with lycopene, but was not clearly related to other carotenoids or alpha tocopherol. Results from age-adjusted least squares regression indicated that a 30 micrograms/dl decrease in lycopene was associated with 2.4 additional dependencies in self-care (95% confidence interval = 1.5, 3.3; p < .001). Lycopene's relationship to dependence was modified by plasma LDL-cholesterol, the predominant carrier of lycopene in the blood. Women with low lycopene and low LDL-cholesterol had 3.6 dependencies (95% confidence interval = 3.1, 4.2; p < .001), compared to 1.0 dependency (95% confidence interval = 0.3, 1.8) in those with high lycopene and low LDL-cholesterol. CONCLUSIONS: This is the first study to report an association between lycopene and functional status. This finding needs to be replicated in other human and animal studies before the association is accepted as real.

Aged↗

PubMed1990

[Functional capacity and rhythm changes after atrial correction of transposition of great arteries].

A group of 12 patients, previously submitted to atrial correction of the transposition of the great vessels, were studied through stress test with direct metabolimetry and Holter to assess aerobic functional capacity and its relationship with conduction disturbances. The results were compared with those obtained with a control group of 23 non athletic healthy children. All the patients showed amputation of their heart rates on effort, though this parameter and the oxygen consumption were normal at low work load levels. The VO2 at anaerobic threshold, the maximum VO2, and the maximum work load were also decreased in most of the patients. Holter studies demonstrated sick sinus syndrome in nine of them. Aerobic functional capacity was reduced in most of the patients with atrial correction of the transposition of the great vessels. The amputation of the heart rate on effort is a common finding though its relationship with the decrease of the aerobic functional capacity in these patients is limited. Finally, the stress test is probably more sensible than Holter for the detection of slight degrees of sinus disfunction.

Adolescent↗

PubMed1989

[Cooperation concerning admission to and discharge of elderly people from the hospital. 3. Functional capacity, self-assessed health and quality of life].

As part of a total project concerning description and effects of the coordinating efforts of home nurses in connection with admission to and discharge from hospital of persons over the age of 65 years, the functional capacity and the subjective parameters: quality of life, self-assessed health and loneliness were registered on discharge and two months later. In order to assess the effect of intervention, the intervention group was compared with a control group. No differences in the functional capacity could be demonstrated on discharge or after two months. No differences could be demonstrated in the subjective parameters either. The effect of the home nurses' efforts in the total project could be measured as a reduction in the number of institution-days in the intervention group. These results suggest that, in further attempts to reduce the risk of complications in recently discharged elderly patients, further assistance of the functional capacity should be added to the forms of intervention described.

Activities of Daily Living↗

PubMed2001

Exercise training, vascular function, and functional capacity in middle-aged subjects.

PURPOSE: The aim of this study was to investigate the effect of 8 wk of exercise training on functional capacity, muscular strength, body composition, and vascular function in sedentary but healthy subjects by using a randomized, crossover protocol. METHODS: After familiarization sessions, 19 subjects aged 47 +/- 2 yr (mean +/- SE) undertook a randomized, crossover design study of the effect of 8 wk of supervised circuit training consisting of combined aerobic and resistance exercise. Peak oxygen uptake (.VO(2peak)), sum of 7 maximal voluntary contractions and the sum of 8 skinfolds and 5 segment girths were determined at entry, crossover, and 16 wk. Endothelium-dependent and -independent vascular function were determined by forearm strain-gauge plethysmography and intrabrachial infusions of acetylcholine (ACh) and sodium nitroprusside (SNP) in 16 subjects. RESULTS: Training did not alter ACh or SNP responses. .VO(2peak), (28.6 +/- 1.1 to 32.6 +/- 1.3 mL.kg(-1).min(-1), P < 0.001), exercise test duration (17.4 +/- 1.1 to 22.1 +/- 1.2 min, P < 0.001), and muscular strength (465 +/- 27 to 535 +/- 27 kg, P < 0.001) significantly increased after the exercise program, whereas skinfolds decreased (144 +/- 10 vs 134 +/- 9 mm, P < 0.001). CONCLUSION: These results suggest that moderate intensity circuit training designed to minimize the involvement of the arms improves functional capacity, body composition, and strength in healthy, middle-aged subjects without significantly influencing upper limb vascular function. This finding contrasts with previous studies in subjects with type 2 diabetes and heart failure that employed an identical training program.

Anthropometry↗

PubMed1995

Survival in institutionalized patients. Influence of dementia and loss of functional capacities.

BACKGROUND: Several studies have shown a negative correlation between dementia and survival. To our knowledge, the simultaneous effect of other factors has not been systematically studied in institutionalized patients. OBJECTIVE: To determine survival in demented inpatients compared with that in a matched population of nondemented patients institutionalized for other chronic debilitating diseases. DESIGN: The sample consisted of 213 patients with dementia and 157 patients without dementia. We studied the effect on survival of gender, age, loss of functional capacities, and cognitive functions with the method of Kaplan and Meier and with the model of Cox. RESULTS: Demented patients had significantly shorter survival when other factors were kept constant in the multivariate analysis. There was a strong correlation between survival and the degree of autonomy as measured by ability to walk, continence, and preserved activities of daily living. Survival was significantly shorter for men. No correlation was found with neuropsychological measures of severity of dementia or with age on admission. CONCLUSIONS: Survival of demented patients is shorter than that of patients institutionalized for other invalidating conditions. The lack of correlation between neuropsychological test results and survival indicates that in the population we studied, the severity of dementia did not predict length of survival. The data show that the combination of dementia and loss of functional capacities is the most important factor in predicting survival.

Activities of Daily Living↗

PubMed2001

Functional capacity evaluations in persons with spinal disorders: predicting poor outcomes on the Functional Assessment Screening Test (FAST).

This study determines how performance on the simple, low exertion Functional Assessment Screening Test (FAST) relates to performance on more extensive physical and psychological testing. One hundred eighty-eight persons with chronic back disability and 17 spine healthy volunteers underwent the FAST (three 2-min static tests [kneeling, stooping, and squatting] and two 5-min tests [repetitive stooping and repetitive twisting while standing]), the Progressive Isoinertial Lifting Evaluation (PILE), trunk extension endurance, submaximal bicycle ergometry, and psychological profiles. All FAST components were completed by 88% of spine healthy subjects, but only by 19.7% (n = 37) of the back patients. Internal consistency for overall test performance was 0.82 (alpha coefficient). Back pain noncompleters had poorer performance on the PILE and trunk extension endurance despite similar cardiovascular fitness and perceived exertion during testing. They had more dysfunctional coping mechanisms, pain avoidance, depression, and self-reported disability. Since performance on nonstrenuous testing is so poor, and psychosocial variables relate strongly to test performance, extensive Functional Capacity Evaluations may not be necessary or valid in assessing the physical performance of this population of chronic back pain patients.

Activities of Daily Living↗

PubMed2006

[Functional capacity as a criterion for patient selection--too poor or too good for CRT?].

The article analyses the status of functional tests used in patient selection for cardiac resynchronization therapy (CRT). Based on published randomized trials, the NYHA classification, the quality of life score, the 6-minute walk and the cardio-pulmonary exercise test (CPX) are reviewed. The NYHA classification is a weak and unspecific test and should be used only as a basic consideration in patient selection. The 6-minute walk test shows a wide spread of values and high dependency on patients' motivation. Patients' functional capacity is measured most objectively by the CPX test, which additionally stratifies prognosis. We conclude that functional capacity is an important criterion in patient selection for CRT. However, primary functional status is of minor importance in estimating the expected functional benefit since multiple factors influence the success of CRT.

Arrhythmias, Cardiac↗

PubMed2004

Reliability and validity of Functional Capacity Evaluation methods: a systematic review with reference to Blankenship system, Ergos work simulator, Ergo-Kit and Isernhagen work system.

OBJECTIVES: Functional Capacity Evaluation methods (FCE) claim to measure the functional physical ability of a person to perform work-related tasks. The purpose of the present study was to systematically review the literature on the reliability and validity of four FCEs: the Blankenship system (BS), the ERGOS work simulator (EWS), the Ergo-Kit (EK) and the Isernhagen work system (IWS). METHODS: A systematic literature search was conducted in five databases (CINAHL, Medline, Embase, OSH-ROM and Picarta) using the following keywords and their synonyms: functional capacity evaluation, reliability and validity. The search strategy was performed for relevance in titles and abstracts, and the databases were limited to literature published between 1980 and April 2004. Two independent reviewers applied the inclusion criteria to select all relevant articles and evaluated the methodological quality of all included articles. RESULTS: The search resulted in 77 potential relevant references but only 12 papers were identified for inclusion and assessed for their methodological quality. The interrater reliability and predictive validity of the IWS were evaluated as good while the procedure used in the intrarater reliability (test-retest) studies was not rigorous enough to allow any conclusion. The concurrent validity of the EWS and EK was not demonstrated while no study was found on their reliability. No study was found on the reliability and validity of the BS. CONCLUSIONS: More rigorous studies are needed to demonstrate the reliability and the validity of FCE methods, especially the BS, EWS and EK.

Humans↗