ObjectivesTo (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and ...participants’ experiences while wearing a face mask during a maximal treadmill test.MethodsRandomised controlled trial of healthy adults aged 18–29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.ResultsThe final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (−01:39±01:19 min/sec, p<0.001), maximal oxygen consumption (VO2max) (−818±552 mL/min, p<0.001), minute ventilation (−45.2±20.3 L/min), maximal heart rate (−8.4±17.0 beats per minute, p<0.01) and increased dyspnoea (1.7±2.9, p<0.001). Our data also suggest that differences in SpO2 and rating of perceived exertion existed between the different stages of the CPET as participant’s exercise intensity increased. No significant differences were found between conditions after the 7-minute recovery period.ConclusionCloth face masks led to a 14% reduction in exercise time and 29% decrease in VO2max, attributed to perceived discomfort associated with mask-wearing. Compared with no mask, participants reported feeling increasingly short of breath and claustrophobic at higher exercise intensities while wearing a cloth face mask. Coaches, trainers and athletes should consider modifying the frequency, intensity, time and type of exercise when wearing a cloth face mask.
Individuals with type 2 diabetes mellitus (T2DM) have a greater blood pressure (BP) response to acute maximal exercise compared to those without T2DM; however, whether they exhibit a different ...arterial stiffness response to maximal exercise has yet to be explored. Adults with (n=66) and without T2DM (n=61) underwent an arterial stress testat rest and immediately postexercise, carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness, brachial BP, heart rate, and other hemodynamic measurements were assessed. Linear regression models were used to evaluate between-group differences at rest, and the response to exercise (postexercise value), adjusting for covariates including BP and heart rate when relevant, and the corresponding baseline value of each parameter. All participants (mean±SDage 59.3±10.6 years; body mass index 31.2±3.9 kg/m) had hypertension (mean BP 130±14/80±9 mm Hg). At rest, participants with T2DM had significantly higher carotid-femoral pulse wave velocity (10.3±2.7 versus 9.1±1.9 m/s), heart rate (69±11 versus 66±10 beats/min), and lower diastolic BP (79±9 versus 83±9 mm Hg), but systolic BP (129±15 versus 131±13 mm Hg) was similar. In response to exercise, participants with T2DM showed greater increases in carotid-femoral pulse wave velocity (1.6 95% CI, 0.4–2.9 m/s) and systolic BP (9 95% CI, 1–17 mm Hg) than participants without T2DM. A greater proportion of participants with T2DM had a hypertensive response to exercise compared to participants without T2DM (n=23, 35% versus n=11, 18%; P=0.033). By incorporating exercise as a vascular stressor, we provide evidence of a greater increase in arterial stiffness in individuals with T2DM, independently of resting arterial stiffness, and the BP postexercise.
Highlights • Variability in gait parameters may differ between treadmill and overground walking. • We examined stride-to-stride variability with Poincaré analyses. • Mean values were equivalent ...between treadmill and overground walking. • Short- and long-term variability indicators were reduced on the treadmill. • Treadmill training may induce invariant gait patterns.
Each year, cardiac complications occur within 30 days after major noncardiac surgery in more than 10 million people worldwide; postoperative mortality is 1.5%. Enhanced patient monitoring and ...measurement of natriuretic hormone and troponin levels may improve outcomes.
Although major noncardiac surgery has the potential to improve the quality and prolong the duration of a patient’s life, surgery may also precipitate complications such as death from cardiac causes, myocardial infarction or injury, cardiac arrest, or congestive heart failure.
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In this article, we review what is known about the epidemiology and mechanisms of perioperative cardiac complications (i.e., from induction of anesthesia to within 30 days after surgery), preoperative methods of predicting these complications, perioperative cardiac interventions, and postoperative monitoring.
Epidemiology and Mechanisms of Perioperative Cardiac Complications
Worldwide, more than 200 million adults undergo major noncardiac surgery each year,
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Stroke is a major cause of death and long-term disability across the globe. Previous studies have demonstrated the trainability of stroke survivors and documented beneficial effects of aerobic ...exercises on cardiovascular fitness and gait ability.
The main aim of this study was to compare the effects of a high-intensity treadmill training (HITT) against low-intensity treadmill training (LITT) on gait ability, quality of life, cardiorespiratory fitness and cost of walking in chronic stroke subjects.
Randomized, controlled pilot study.
Patients were recruited among Neurorehabilitation Unit outpatient.
The sample was composed of 16 subjects suffering from chronic stroke.
Subjects were enrolled and randomly allocated either in the HITT (N.=8) or in the LITT (N.=8). Both groups performed 3-month training, 3 times per week. Subjects were evaluated before starting the training and after the end of the training by mean of clinical scales (Six-Minute Walk Test, Ten-Meter Walk Test, Health Survey Questionnaire SF-36, Stroke Impact Scale) and instrumental tests (gait analysis, VO2peak and walking energy cost).
Fifteen subjects completed the study and no dropouts were observed. One patient in the LITT refused to initiate the training. The HITT group produced greater improvements than LITT group on the Six-Minute Walk Test (HITT: 64.25 meters, LITT: 6 meters; p=0.005) and Ten-Meter Walk Test performances (HITT: -1.7 s, LITT: 0.6 s; P=0.007), stride length (HITT: 3.3 cm, LITT: 0.4 cm, P=0.003), step length non-paretic side (HITT: 0.5 cm, LITT: 2.4 cm, P=0.008), step length paretic side (HITT: 1.8 cm, LITT: 0.7 cm, P=0.004), cadence (HITT: 1.6 step/min, LITT: 0.6 step/min, P=0.021) and symmetry ratio (HITT: 0.04 cm, LITT: 0.01 cm, P=0.004), VO2peak (HITT: 4.6 mL/kg/min, LITT: 0.87 mL/kg/min; P=0.015) and walking energy cost at 100% of self-selected speed (HITT: -30.8 mL/kg∙km, LITT: -20 5 mL/kg∙km; P=0.021). Significant changes were found on Six-Minute Walk Test (P=0.012) and Ten-Meter Walk Test (P=0.042) performances, spatio-temporal gait parameters (stride length P=0.011, step length paretic side P=0.012, cadence P=0.037 and symmetry ratio P=0.012), VO2peak (P=0.025) and cost of walking at 100% of self-selected speed (P=0.018) in the HITT group. In the LITT no significant results were observed.
HITT could be considered a feasible training and led to improvement in gait ability and enhanced VO2peak and reduction in cost of walking compared to LITT.
Chronic stroke survivors should be encouraged to engage regular aerobic treadmill training at medium/high intensity. HITT is safe and feasible and has positive effects on gait ability, cardiovascular fitness and cost of walking in subjects with stroke in chronic phase.
OBJECTIVEThe aim of this study was to estimate the minimal clinically important difference (MCID) for 6-min walk distance (6MWD) in patients with fibromyalgia.
DESIGNData from a recently completed ...trial that included 187 patients who completed the 6-min walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 wks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain as clinical anchors.
RESULTSThe mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (P < 0.001). The anchor-based MCIDs for the 6MWD were 156 and 167 m for the FIQ and SF36-physical function domain, respectively. These MCIDs correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-physical function domain (10-point increase).
CONCLUSIONThe MCID for 6MWD in patients with fibromyalgia was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with fibromyalgia.
The purpose of this study was to assess 1) how treadmill slope variance affected external power output (PO) and propulsion technique reliability; and 2) how PO is associated with propulsion ...technique. Eighteen individuals with spinal cord injury performed two wheelchair treadmill exercise blocks (0% and 1% treadmill slope, standardized velocity) twice on two separate days. PO, velocity, and 14 propulsion technique variables were measured. In a follow-up study, N = 29 performed wheelchair treadmill drag tests. Target and actual slope were documented and PO, intraclass correlation coefficients (ICC) and smallest detectable differences (SDD) were calculated. Within and between visits, the reliability study ICCs were perfect for velocity (1.0), weak for PO (0.33-0.46), and acceptable (>0.70) for five (0% slope) and 10 (1% slope) propulsion technique variables, resulting in SDDs of 35-196%. Measured PO explained 56-90% of the variance in key propulsion technique variables. In the follow-up, PO ICCs were weak (0.43) and SDDs high. Bias between target and actual slope appeared random. In conclusion, PO variability accounts for 50-90% of the variability in propulsion technique variables when speed and wheelchair set-up are held constant. Therefore, small differences in PO between interventions could mask the effect of the interventions on propulsion technique.
To investigate the validity and within-day reliability of the Glittre activities of daily living test (Glittre ADL-test) in patients on hemodialysis.
Ninety-one patients on hemodialysis were ...evaluated using Glittre ADL-test, functional tests, health-related quality of life, human activity profile, and social participation. Convergent validity was analyzed by the correlation analysis. The Glittre ADL-test results were compared among different levels of the functional tests, human activity profile, and participation (known-groups validity). Within-day reliability was examined by Intra-class Correlation Coefficient (ICC).
There was a significant moderate to strong correlation between Glittre ADL-test and functional tests (r = 0.62 to 0.66 and −0.70 to −0.44). A significant weak correlation was found between Glittre ADL-test, health-related quality of life (r = 0.28 to 0.32), and human activity profile (r=−0.33). There was no significant correlation with participation. Except for participation level, the Glittre ADL-test results were able to identify individuals with low performance in all evaluated tests and were able to differentiate among inactive and active individuals by human activity profile (p < 0.05). Within-day reliability was evaluated in 42 patients. The ICC was 0.97.
The Glittre ADL-test is a reliable test associated with functional parameters and physical aspects related to health-related quality of life, with potential value in the functional evaluation of patients on hemodialysis.
Implications for rehabilitation
Functional impairment is a common clinical finding and is an important predictor of poor prognosis in patients on hemodialysis.
The Glittre ADL-test has excellent within-day reliability and is a valid instrument for functional assessment in patients on hemodialysis.
Activity limitations of patients on hemodialysis can be assessed by Glittre ADL-test.
Some patients with COVID-19 who have recovered from the acute infection after experiencing only mild symptoms continue to exhibit persistent exertional limitation that often is unexplained by ...conventional investigative studies.
What is the pathophysiologic mechanism of exercise intolerance that underlies the post-COVID-19 long-haul syndrome in patients without cardiopulmonary disease?
This study examined the systemic and pulmonary hemodynamics, ventilation, and gas exchange in 10 patients who recovered from COVID-19 and were without cardiopulmonary disease during invasive cardiopulmonary exercise testing (iCPET) and compared the results with those from 10 age- and sex-matched control participants. These data then were used to define potential reasons for exertional limitation in the cohort of patients who had recovered from COVID-19.
The patients who had recovered from COVID-19 exhibited markedly reduced peak exercise aerobic capacity (oxygen consumption VO2) compared with control participants (70 ± 11% predicted vs 131 ± 45% predicted; P < .0001). This reduction in peak VO2 was associated with impaired systemic oxygen extraction (ie, narrow arterial-mixed venous oxygen content difference to arterial oxygen content ratio) compared with control participants (0.49 ± 0.1 vs 0.78 ± 0.1; P < .0001), despite a preserved peak cardiac index (7.8 ± 3.1 L/min vs 8.4±2.3 L/min; P > .05). Additionally, patients who had recovered from COVID-19 demonstrated greater ventilatory inefficiency (ie, abnormal ventilatory efficiency VE/VCO2 slope: 35 ± 5 vs 27 ± 5; P = .01) compared with control participants without an increase in dead space ventilation.
Patients who have recovered from COVID-19 without cardiopulmonary disease demonstrate a marked reduction in peak VO2 from a peripheral rather than a central cardiac limit, along with an exaggerated hyperventilatory response during exercise.
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