Disability is pervasive in schizophrenia and is refractory to current medication treatments. Inability to function in everyday settings is responsible for the huge indirect costs of schizophrenia, ...which may be as much as three times larger than direct treatment costs for psychotic symptoms. Treatments for disability are therefore urgently needed. In order to effectively treat disability, its causes must be isolated and targeted; it seems likely that there are multiple causes with modest overlap. In this paper, we review the evidence regarding the prediction of everyday disability in schizophrenia. We suggest that cognition, deficits in functional capacity, certain clinical symptoms, and various environmental and societal factors are implicated. Further, we suggest that health status variables, recently recognized as pervasive in severe mental illness, may also contribute to disability in a manner independent from these other better-studied causes. We suggest that health status be considered in the overall prediction of real-world functioning and that interventions aimed at disability reduction targeting health status may be needed, in addition to cognitive enhancement, skills training, and public advocacy for better services.
Chronic kidney disease (CKD) poses a significant public health challenge globally while impacting patients' physical function and quality of life. Addressing the issues of physical inactivity and ...pain management is essential during treatment to improve health-related quality of life. The present study investigated the effect of an aerobic training program with core stabilization exercises for hemodialysis (HD) patients on a transplant waiting list and renal transplant (RTx) patients.BACKGROUNDChronic kidney disease (CKD) poses a significant public health challenge globally while impacting patients' physical function and quality of life. Addressing the issues of physical inactivity and pain management is essential during treatment to improve health-related quality of life. The present study investigated the effect of an aerobic training program with core stabilization exercises for hemodialysis (HD) patients on a transplant waiting list and renal transplant (RTx) patients.A total of 45 patients with CKD were included in the 12-week study: 25 patients receiving HD (12 HD treatment group, 13 HD control group) and 20 patients with RTx (9 RTx treatment group, 11 RTx control group). Functional capacity was measured using the 6-min walk test, pain was measured using the visual analog scale, and health-related quality of life was measured using the Kidney Disease Quality of Life-Short Form 12 questionnaire. Nonparametric statistical tests were performed at a significance level of 0.05.METHODSA total of 45 patients with CKD were included in the 12-week study: 25 patients receiving HD (12 HD treatment group, 13 HD control group) and 20 patients with RTx (9 RTx treatment group, 11 RTx control group). Functional capacity was measured using the 6-min walk test, pain was measured using the visual analog scale, and health-related quality of life was measured using the Kidney Disease Quality of Life-Short Form 12 questionnaire. Nonparametric statistical tests were performed at a significance level of 0.05.Both the HD and RTx treatment groups showed significantly reduced times for the 6-min walking test (p = 0.002 and p = 0.008, respectively), significantly reduced pain severity (p = 0.002 and p = 0.008, respectively), and significantly improved quality of life scores (p = 0.006 and p = 0.041, respectively) by the end of the study compared with control groups.RESULTSBoth the HD and RTx treatment groups showed significantly reduced times for the 6-min walking test (p = 0.002 and p = 0.008, respectively), significantly reduced pain severity (p = 0.002 and p = 0.008, respectively), and significantly improved quality of life scores (p = 0.006 and p = 0.041, respectively) by the end of the study compared with control groups.Based on the results, structured exercise programs could be effective therapies in CKD management. Therefore, health providers should promote their integration into routine care practices to enhance patient outcomes and well-being.CONCLUSIONBased on the results, structured exercise programs could be effective therapies in CKD management. Therefore, health providers should promote their integration into routine care practices to enhance patient outcomes and well-being.
Abstract
Aims
Diabetes mellitus (DM) aggravates the clinical features of ischaemic and hypertensive heart diseases and worsens the prognosis of heart failure patients. Hypertrophic cardiomyopathy ...(HCM) and diabetes coexist fairly frequently in elderly patients but the impact of DM on the clinical phenotype of HCM is yet unknown. We sought to describe if predominant features of heart failure in DM patients exist independently in HCM.
Methods and results
We reviewed clinical characteristics of 937 patients, age ≥40, diagnosed with HCM, from two tertiary medical centres in Spain and Israel. A propensity score matched cohort of 294 patients was also analysed. Our cohort comprised 102 HCM patients with diabetes (8.7%). Patients with DM were older at diagnosis {median 56 interquartile range (IQR) 47–67 vs. 53 (IQR 43–63), P = 0.02} and had a higher prevalence of comorbidities. Hypertrophic cardiomyopathy patients with DM had a higher prevalence of diastolic dysfunction, pulmonary hypertension, significant mitral regurgitation, and pacemaker implantation. Hypertrophic cardiomyopathy patients with DM had a higher New York Heart Association (NYHA) class (P < 0.001) and lower exercise capacity 7.0 METS (IQR 5.0–10.0) vs. 9.0 METS (IQR 6.6–11.0), P = 0.002. These findings were independent of age, gender, country of origin, hypertension, and coronary artery disease. Patients with diabetes had a significantly higher 15-year mortality (22% vs. 15%, P = 0.03), with no differences in sudden cardiac death, appropriate implanted cardioverter-defibrillator therapy, or heart transplantation.
Conclusion
Hypertrophic cardiomyopathy patients with diabetes are older and have a higher cardiovascular risk profile. They have a lower functional capacity and more heart failure symptoms due to diastolic dysfunction.
Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point ...when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible.
This study aimed to evaluate the presence of dynamic hyperinflation (DH) during the Glittre-ADL test (TGlittre) coupled to the dynamic ventilation measurements in people with central obesity (pwCO) ...and to correlate it with lung mechanics at rest. Sixty-four pwCO underwent TGlittre and the following resting lung function tests: spirometry and impulse oscillometry system (IOS). On TGlittre, 22 participants presented DH at the end of the test (DH group), while 42 did not present DH (NDH group). Body mass index (BMI), waist circumference (WC), and hip circumference (HC) were higher in the DH group than in the NDH group. IOS abnormalities were more common in the DH group compared to the NDH group. TGlittre time significantly correlated with BMI, WC, waist-to-hip ratio (WHR), and neck circumference (NC). Delta inspiratory capacity correlated significantly with WC, HC, NC, and resonance frequency measured by IOS. Thus, pwCO perform worse on TGlittre, and DH is frequent in those with higher anthropometric indices and worse lung mechanics.
•People with central obesity take 80% longer to perform the Glittre-ADL test.•Approximately one-third of them show dynamic hyperinflation on exercise.•People with central obesity and hyperinflation have higher anthropometric indices.•People with central obesity and hyperinflation have worse lung mechanics.•Worse performance on Glittre-ADL test is associated with worse lung mechanics.
Background
Adjuvant chemotherapy with 5‐fluorouracil (5‐FU) and oxaliplatin increases recurrence‐free and overall survival in patients with colon adenocarcinoma. It is known that these drugs have ...been associated with cardio‐ and neurotoxicity. We investigated the effects of 5‐FU ± oxaliplatin on cardiac function, vascular responses, neurovascular control, and physical capacity in patients with colon cancer.
Methods
Twenty‐nine patients with prior colectomy for stage II–III adenocarcinoma and clinical indication for adjuvant chemotherapy were allocated to receive 5‐FU (n = 12) or 5‐FU + oxaliplatin (n = 17), according to the oncologist's decision. All the analyses were performed just before and after the end of chemotherapy. Cardiac function was assessed by echocardiography and speckle tracking, and cardiac autonomic control was assessed by heart rate variability (HRV). Vascular endothelial function was assessed by flow‐mediated dilation (FMD). Muscle sympathetic nerve activity (MSNA) was directly recorded by microneurography technique, and muscle blood flow by venous occlusion plethysmography. Physical capacity was evaluated by cardiopulmonary exercise test.
Results
Chemotherapy (pooled data) did not significantly change left ventricular ejection fraction (58 ± 1 vs. 55 ± 2%, p = .14), longitudinal strain (−18 ± 1 vs. −18 ± 1%, p = .66), and HRV. Likewise, chemotherapy did not significantly change FMD, muscle blood flow, and MSNA (33 ± 2 vs. 32 ± 1 bursts/min, p = .31). Physical capacity was not significantly changed in both groups. Similar findings were observed when the patients were subdivided in 5‐FU and 5‐FU + oxaliplatin treatment groups. 5‐FU and 5‐FU + oxaliplatin did not significantly change cardiac function, HRV, vascular responses, MSNA, and physical capacity.
Conclusion
This study provides evidence that adjuvant treatment with 5‐FU ± oxaliplatin is well tolerated and does not promote changes compatible with long‐term cardiotoxicity.
Implications for Practice
Adjuvant chemotherapy with 5‐fluorouracil (5‐FU) and oxaliplatin increases recurrence‐free and overall survival in patients with colon adenocarcinoma; however, these drugs have been associated with cardio‐ and neurotoxicity. This study investigated the effects of these drugs on cardiac function, vascular responses, neurovascular control, and physical capacity in patients with colon cancer. It was found that 5‐FU and oxaliplatin did not significantly change cardiac function, cardiac autonomic control, vascular endothelial function, muscle sympathetic nerve activity, and physical capacity. This study provides evidence that adjuvant treatment with 5‐FU ± oxaliplatin is well tolerated and does not promote changes compatible with long‐term cardiotoxicity.
This report provides new information about the effect of adjuvant chemotherapy treatment with fluorouracil and oxaliplatin in patients with stage II and III colon cancer.
Aging is characterized by reductions in lean mass simultaneously to increases in visceral adipose tissue, elevating cardiovascular risk (CVR) and physical dependence. Dancing has been recommended for ...improving fall-risk and CVR, however, comparisons with traditional exercises are limited. This study aimed to compare the effects of dancing with walking on CVR and functionality of older women.
Thirty sedentary women (65 ± 5 years, BMI 27 ± 4 kg/m2) were randomized into three groups (n = 10/group): dancing, walking or stretching (active control). All interventions lasted 8 weeks (60 min sessions): dancing/walking 3×/week, stretching 1×/week. Dancing: several styles, no partner. Walking: treadmill, 60% peak oxygen consumption (VO2peak). Stretching: large muscle groups, no discomfort. Before and after interventions assessments: VO2peak (primary outcome), total cholesterol, HDL-C, LDL-C, glucose, insulin, CRP, TNF-α, waist and hip circumferences, visceral adipose tissue (VAT), muscle thickness, maximal muscle strength/power, static and dynamic balance, gait ability, flexibility, chair-raise and level of physical activity (PA). Statistics: generalized estimating equations, post-hoc LSD (p < 0.05), SPSS 22.0.
(Mean-CI): (before vs after): group vs time interaction showed increases in VO2peak (mL·kg−1·min−1) for dancing 23.3 (20.8–25.8) vs 25.6 (23.4–27.8), and walking 23.4 (21.3–25.5) vs 27.0 (25.4–28.6), with no differences for stretching 23.5 (21.3–25.7) vs 23.0 (21.0–24.9). Lower body muscle power and static balance also improved for dancing and walking, but not for stretching. Main time effect showed improvements in CRP, TNF-α, LDL-C, HDL-C, VAT, waist, hip, chair raise, flexibility and level of daily PA for all groups.
Dancing induced similar increases in VO2peak, lower body muscle power and static balance as walking, while the stretching group remained unchanged. Pooled effects showed improvements in body composition, lipid and inflammatory profile, which are supported by increased PA levels.
Trial registration: NCT03262714.
•Dancing induced similar increases in VO2peak, lower body muscle power, and static balance as walking in older women after eight weeks intervention.•Walking induced gains in cardiorespiratory fitness in a larger clinical relevance, while did dancing for lower body muscle power.•Engaging in any type of intervention (dancing, walking, stretching) increased level of physical activity and induced metabolic improvements.•Dancing was as effective as walking in improving cardiovascular and fall-risk associated factors in healthy older women.
Post-COVID-19 Syndrome and the Potential Benefits of Exercise Jimeno-Almazán, Amaya; Pallarés, Jesús G.; Buendía-Romero, Ángel ...
International journal of environmental research and public health,
05/2021, Letnik:
18, Številka:
10
Journal Article
Recenzirano
Odprti dostop
The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is leading to unknown and unusual health conditions that are challenging to ...manage. Post-COVID-19 syndrome is one of those challenges, having become increasingly common as the pandemic evolves. The latest estimates suggest that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Although research is beginning to examine this new condition, there are still serious concerns about the diagnostic identification, which limits the best therapeutic approach. Exercise programs and physical activity levels are well-known modulators of the clinical manifestations and prognosis in many chronic diseases. This narrative review summarizes the up-to-date evidence on post-COVID-19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long-term effects of COVID-19.
Aim: To evaluate the functional capacity through the 6-minutes walk test and the body mass level in patients with Chronic Pulmonary Obstructive Disease, Pulmonary Rehabilitation Program participants, ...in pre moments, 18 sessions and in the end of 36 sessions. Materials and Methods: In the Pulmonary Rehabilitation Program with 3 weekly sessions per a period of 12 weeks of combine exercises (aerobic and strength), it was realized the 6-minutes walk test, to check the functional capacity, before, 18 sessions and after 36 sessions of Pulmonary Rehabilitation; 20 patients diagnosed with CPOD (15 with moderate CPOD and 5 with grave CPOD) were evaluated; it was also checked the Body Mass Index (BMI) from patients in the same time. Results: It was checked distance covered increase in the 6-minutes walk test, in 18 sessions and in the end of 36 sessions from the program; it was checked the patients’ BMI decrease in the end of 36 sessions from rehabilitation program. Discussion: In 18 sessions, it was observed an improvement of 18.75%, as well as in 36 sessions the improvement was 29.47% of covered distance by patients in the 6-minutes walk test; after 18 sessions it has already happened a 3% decrease in BMI and also, with 36 sessions this decrease was 6.24%, showing that way the Pulmonary Rehabilitation Program’s efficiency. Conclusion: After 36 sessions, the pulmonary rehabilitation is effective in the improvement of functional capacity and in BMI decrease on patients with COPD.
The current study evaluated the reliability and validity of a novel, performance-based banking task in 60 younger (18-34 years) and 60 older (50-85 years) adults. All participants completed the ...Telephone-based Daily Instrumental Activities of Living (T-DIAL) using interactive voice response technology to complete a series of mock actions with a financial institution via telephone. The T-DIAL showed strong inter-rater reliability and internal consistency. T-DIAL accuracy was significantly and independently related to better self-reported instrumental activities of daily living and executive functions at a large effect size. Findings from this study provided preliminary supportive evidence for the reliability and validity of the T-DIAL, which had robust associations with manifest everyday functioning and higher-order cognitive ability. Future work is needed on the psychometrics (e.g. test-retest reliability, normative standards), and construct validity (e.g. diagnostic accuracy) of the T-DIAL in neurocognitive disorders and under-served communities for whom remote evaluations might be particularly relevant.
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