Colorectal cancer (CRC) is the second most prevalent type of cancer in the world. Surgery is the only curative option. However, postoperative complications occur in up to 50% of patients and are ...associated with higher morbidity and mortality rates, lower health related quality of life (HRQoL) and increased expenditure in health care. The number and severity of complications are closely related to preoperative functional capacity, nutritional state, psychological state, and smoking behavior. Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes. However, recent evidence shows that the preoperative period might be the optimal moment for intervention. This study will determine the impact of multimodal prehabilitation on patients' functional capacity and postoperative complications.
This international multicenter, prospective, randomized controlled trial will include 714 patients undergoing colorectal surgery for cancer. Patients will be allocated to the intervention group, which will receive 4 weeks of prehabilitation (group 1, prehab), or the control group, which will receive no prehabilitation (group 2, no prehab). Both groups will receive perioperative care in accordance with the enhanced recovery after surgery (ERAS) guidelines. The primary outcomes for measurement will be functional capacity (as assessed using the six-minute walk test (6MWT)) and postoperative status determined with the Comprehensive Complication Index (CCI). Secondary outcomes will include HRQoL, length of hospital stay (LOS) and a cost-effectiveness analysis.
Multimodal prehabilitation is expected to enhance patients' functional capacity and to reduce postoperative complications. It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer.
Trial Registry: NTR5947 - date of registration: 1 August 2016.
Diabetic nephropathy is a growing public health challenge with implications on health. Renal function decline impacts the functional ability and overall health and well-being of individuals with ...diabetic nephropathy due to development of several renal manifestations. The objective of the study was to determine the effect of an exercise-based rehabilitation program on functional capacity and renal function among individuals with type 2 diabetic nephropathy.
A total of 283 individuals were screened and 60 eligible participants aged 45-70 years with diabetic nephropathy were randomly allocated (n = 30 each) to the intervention group (IG) and control group (CG), respectively. The study outcome measures comprised of functional capacity (6-min walk test) and renal function assessed at baseline, 12th week and 24th week. Participants allocated to IG received 12 weeks of exercise based rehabilitation (comprising of supervised + home-based exercises) along with standard care and followed-up till 24th week.
The repeated measures ANOVA with Greenhouse-Geisser correction indicated significant timepoint*group interaction effect for 6-min walk distance F
= 619, p < 0.001, serum creatinine F
= 174.8, p < 0.001, estimated glomerular filtration rate F
= 105.2, p < 0.001, serum urea F
= 261.4, p < 0.001 and urine protein F
= 4.58, p < 0.328.
The study found that exercise based rehabilitation improved both functional capacity and renal function among individuals with type 2 diabetic nephropathy.
Objective: This study compared the differences in functionality and depression between younger and older patients with chronic low back pain (CLBP). Materials and Methods: This multi-center ...cross-sectional survey enrolled subjects with CLBP who visited physical medicine and rehabilitation clinics in seven different regions of Turkey. Sociodemographic data were collected via questionnaires. Functional status was evaluated with Roland-Morris Disability index (RMDI), and psychological health was evaluated with Beck Depression inventory (BDI). Results: The sample included 106 younger mean age: 24.3 (range: 18-30) years and 104 older mean age: 70.5 (range: 65-108) years subjects. No significant difference was found in the gender distribution between the younger (38 males, 68 females) and older (38 males, 66 females) groups (p=0.917). The BDI was 11.90±10.6 in the younger subjects and 16.17±10.72 in the older subjects (p=0.002), whereas the mean RMDIs were 10.31±6.36 and 16.04±5.36, respectively (p=0.001). Conclusion: The loss of functional capacity and depression resulting from CLBP are serious threats to public health and are predictive of chronic disability. The development of social programs that address risk factors will reduce the risk of CLBP, improve quality of life, reduce workforce losses and contribute significantly to public health.
Introduction:
The 6-min walk test (6MWT) is commonly used to assess the level of functional capacity of individuals with respiratory diseases. Although previous evidence has provided reference ...standards for the 6MWT in unhealthy older adults, no data have been provided for the Croatian healthy older populations. Therefore, the main purposes of the study were to define sex- and age-specific references for the 6MWT in older adults.
Methods:
Six-hundred and forty-three older adults (260 men and 383 women) aged 60–80 years were recruited in this observational cross-sectional study. The participants were instructed to walk the maximal distance possible for 6 min. The main outcome was the final score in the 6MWT conducted at a 30-m straight corridor.
Results:
Men exhibited longer walking distance, compared to women (678.3 ± 59.1 vs. 653.8 ± 49.9 m,
p
< 0.001) and younger men and women performed better, than their older counterparts (
p
< 0.001). However, the sex*age interaction effect showed no significant differences between men and women in the same age range (
p
= 0.865).
Discussion:
This is the first study with the purpose of providing reference standards for the 6MWT in a large sample of Croatian older adults. Older men and women in lower percentiles may be treated as a “risky group” of individuals with a special attention of implementing interventions to enhance the performance.
Background: Ageing challenges elderly individuals, increasing the risk of malnutrition due to physical, psychological, functional, and social changes. Poor nutritional status is directly related to ...functional capacity and can increase the risk of morbidity and mortality. Early identification of the risk of malnutrition among the elderly can promote independence and well-being with a good quality of life. Objectives: To assess the interrelationship between the nutritional status and indicators of functional capacity and morbidity profile among the elderly population from the Pune District of Maharashtra, India. Methods: The study followed a cross-sectional survey design. The convenience sampling technique was used to recruit participants. Three standardised instruments - the Mini-Nutritional Assessment – Short Form (MNA-SF), the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Cumulative Illness Rating Scale-Geriatric (CIRS-G) – were used to assess the nutritional status, functional capacity and morbidity profile respectively. The data were analysed using Chi-square tests of association, and independent t-test and one-way ANOVA for difference in means. Results: Participants were 100 older adults (age range: 60–90 years). 24 % of the sample were malnourished and 33 % were at risk for malnutrition. Dependent participants had a significantly lower MNA-SF score (5.6 ± 3.5) than independent participants (10.4 ± 3.0) (p < 0.001). There was a significant association between poor nutritional status and morbidity profile specific to disability in organ systems like eyes, ears, throat, haematopoietic, musculoskeletal, and upper GI systems, as well as psychiatric illness (p ≤ 0.05). The CIRS-G score was significantly higher for malnourished participants (12.6 ± 6.2) than those at risk of malnutrition (8.9 ± 4.8) and well nourished (6.0 ± 4.0) (p < 0.001). Conclusion: Nutritional status was associated with functional capacity and indicators of morbidity profile in the elderly. Incorporating routine nutritional risk screening as a component of healthcare can facilitate early identification of at-risk individuals, enabling timely intervention and improving health outcomes. Future research should prioritise investigating routine screening programs to assess the risk of malnutrition and the effectiveness of nutrition interventions such as dietary modifications and supplementation to prevent malnutrition in older adults.
Abstract Introduction Prehabilitation programs aim to optimise patients in order to enhance post-operative recovery. This study aims to review the composition of prehabilitation programs for patients ...undergoing major abdominal cancer surgery and define the outcome measures that are used to evaluate this intervention. Methods A systematic literature review of all comparative studies on prehabilitation versus standard care in patients undergoing abdominal cancer surgery was performed in accordance with PRISMA guidelines. Literature search was performed using Medline, OVID, EMBASE, Google Scholar, and Cochrane databases. Outcomes of interest included prehabilitation program composition (exercise, nutritional, and psychological interventions), duration, mode of delivery, and outcome measures used to determine impact of prehabilitation versus standard care. Results 9 studies (7 randomised controlled and 2 prospective non-randomised trials) comprising of 549 patients (281 prehabilitation versus 268 standard care) were included in this review. 5 studies reported patients undergoing surgery for colorectal cancer, 2 for bladder tumours, 1 for liver resections, and 1 involving unspecified abdominal oncological operations. The 6 minute walk test (6MWT) was used in 4 studies to measure functional capacity with a threshold of >20m improvement at 4-8 weeks post-operatively deemed significant (distance range from 278-560m). Changes in anaerobic threshold and VO2max with prehabilitation were evaluated in 5 studies (ml/kg/min). Health-related quality of life was evaluated using SF-36 system, anxiety assessed using hospital anxiety and depression score (HADS). Post-operative complications were classified according to the Clavien-Dindo classification with no significant difference between prehabilitation and standard care groups. Conclusion Prehabilitation programs in patients undergoing abdominal cancer surgery remain heterogeneous in their composition, mode of administration, outcome measures of functional capacity that are used to evaluate their impact. All these aspects require standardisation prior to the evaluation of prehabilitation on a larger scale.
Heart failure (HF) is one of the most prevalent diseases in the world and is characterized as a complex clinical syndrome. It is a disease that affects both the peripheral muscles and the respiratory ...muscles, causing damage such as reduced strength and endurance. One of the main symptoms is fatigue and exercise intolerance. The aim of this review article is to assess whether the use of inspiratory muscle training (IMT) associated with conventional training enhances inspiratory muscle strength (PImax) and inspiratory muscle endurance (SPImax) and functional capacity in patients with HF. Methods: A literature review was carried out on the use of IMT in patients, including 6 randomized clinical trials, searched in the PubMed, PEDro and Lilacs databases. Results: There is evidence showing an increase in PImax and SPImax with the addition of IMT to training; in addition, an improvement in VO2 peak, circulatory power and ventilatory efficiency. Conclusion: The use of IMT associated with conventional training is an interesting strategy for boosting gains in strength and inspiratory muscle endurance, increasing exercise tolerance and consequently improving patients' quality of life. However, more studies are needed in order to more clearly define the selection criteria and methodology for applying IMT.
Social distancing measures have been used to contain the COVID-19 pandemic; nevertheless, it causes unintended greater time at home and consequently a reduction in general physical activity and an ...increase in sedentary time, which is harmful to older people. A decrease in daily physical activities and an increase in sedentary time culminates in an impactful skeletal muscle disuse period and reduction in neuromuscular abilities related to functional capacity. Home-based resistance training is a strategy to mitigate physical inactivity and improve or retain muscle function and functional performance. Therefore, it is an urgent time to encourage older people to perform resistance exercises at home to avoid a harmful functional decline and promote physical health.
•Skeletal muscle disuse is related to reduction in neuromuscular abilities associated to functional capacity in older people;•COVID-19 pandemic promotes unintended physical inactivity and increased sedentary time;•Home-based resistance training is effective to improve or retain muscle and functional performance in older people;•It is an urgent time to encourage older people to perform resistance exercises at home to promote physical health.
Abstract Cognition, negative symptoms, and depression are potential predictors of disability in schizophrenia. We present analyses of pooled data from four separate studies (all n > 169; total n = ...821) that assessed differential aspects of disability and their potential determinants. We hypothesized that negative symptoms would predict social outcomes, but not vocational functioning or everyday activities and that cognition and functional capacity would predict vocational functioning and everyday activities but not social outcomes. The samples were rated by clinician informants for their everyday functioning in domains of social and vocational outcomes, and everyday activities, examined with assessments of cognition and functional capacity, rated clinically with the Positive and Negative Syndrome Scale (PANSS) and self-reporting depression. We computed a model that tested the hypotheses described above and compared it to a model that predicted that negative symptoms, depression, cognition, and functional capacity had equivalent influences on all aspects of everyday functioning. The former, specific relationship model fit the data adequately and we subsequently confirmed a similar fit within all four samples. Analyses of the relative goodness of fit suggested that this specific model fit the data better than the more general, equivalent influence predictor model. We suggest that treatments aimed at cognition may not affect social functioning as much as other aspects of disability, a finding consistent with earlier research on the treatment of cognitive deficits in schizophrenia, while negative symptoms predicted social functioning. These relationships are central features of schizophrenia and treatment efforts should be aimed accordingly.
To develop, validate, and test the reproducibility of a new test capable of assessing functional performance in children and adolescents (PAY test: Performance Activity in Youth).
participants ...without and with asthma were included in the development and validation phases, respectively. The PAY test includes five activities: transition from sitting to standing, walking 10 m, step climbing, shoulder extension and flexion, and star jumps. Participants underwent the Pediatric Glittre test (TGlittre-P test time), modified shuttle test (MST), and cardiopulmonary exercise test (CPET). Outcomes: PAY test and TGlittre-P test times, oxygen uptake (VO2peak), and distance walked in the MST.
8 healthy volunteers, aged 12 (7 - 15) years old were included in the development phase and 34 participants with asthma, aged 11 (7 -14) years old, in the validation phase. The PAY test elicited greater physiological responses (VO2peak 33.5 ± 6.9 mL/kg) than the TGlittre-P (VO2peak: 27.4 ± 9.0 mL/kg), but lower than the MST (VO2peak: 48.9 ± 14.2 mL/kg) and CPET (VO2peak: 42.0 ± 8.8 mL/kg), p < .05. Moderate correlation between the PAY test time and the TGlittre-P time (r = 0.70, p < .001) and distance walked in the MST (r = -0.72, p < .001). The PAY test time was longer in participants with asthma than in healthy participants (3.1 3.0 - 3.3 min vs. 2.3 2.1 – 2.4 min), p < .001.; and the test was reproducible (ICC 0.78, CI 95% 0.55–0.90, p < .001).
The PAY test is a valid and reproducible tool for assessing functional performance in children and adolescents with asthma.
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