Predictive equations for respiratory muscle strength according to international and Brazilian guidelines

Background:

The maximum static respiratory pressures, namely the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), reflect the strength of the respiratory muscles. These measures are simple, non-invasive, and have established diagnostic and prognostic value. This study is the first to examine the maximum respiratory pressures within the Brazilian population according to the recommendations proposed by the American Thoracic Society and European Respiratory Society (ATS/ERS) and the Brazilian Thoracic Association (SBPT).

Objective:

To establish reference equations, mean values, and lower limits of normality for MIP and MEP for each age group and sex, as recommended by the ATS/ERS and SBPT.

Method:

We recruited 134 Brazilians living in Belo Horizonte, MG, Brazil, aged 20-89 years, with a normal pulmonary function test and a body mass index within the normal range. We used a digital manometer that operationalized the variable maximum average pressure (MIP/MEP). At least five tests were performed for both MIP and MEP to take into account a possible learning effect.

Results:

We evaluated 74 women and 60 men. The equations were as follows: MIP=63.27-0.55 (age)+17.96 (gender)+0.58 (weight), r2 of 34% and MEP= - 61.41+2.29 (age) - 0.03(age2)+33.72 (gender)+1.40 (waist), r2 of 49%.

Conclusion:

In clinical practice, these equations could be used to calculate the predicted values of MIP and MEP for the Brazilian population.     

Reproducibility of the six-minute walk test and Glittre ADL-test in patients hospitalized for acute and exacerbated chronic lung disease

Background:

The 6-minute walk test (6MWT) and the Glittre ADL-test (GT) are used to assess functional capacity and exercise tolerance; however, the reproducibility of these tests needs further study in patients with acute lung diseases.

Objectives:

The aim of this study was to investigate the reproducibility of the 6MWT and GT performed in patients hospitalized for acute and exacerbated chronic lung diseases.

Method:

48 h after hospitalization, 81 patients (50 males, age: 52±18 years, FEV₁: 58±20% of the predicted value) performed two 6MWTs and two GTs in random order on different days.

Results:

There was no difference between the first and second 6MWT (median 349 m [284-419] and 363 m [288-432], respectively) (ICC: 0.97; P<0.0001). A difference between the first and second tests was found in GT (median 286 s [220-378] and 244 s [197-323] respectively; P<0.001) (ICC: 0.91; P<0.0001).

Conclusion:

Although both the 6MWT and GT were reproducible, the best results occurred in the second test, demonstrating a learning effect. These results indicate that at least two tests are necessary to obtain reliable assessments.     

Regression equations to predict 6-minute walk distance in Chinese adults aged 55–85 years

The 6-minute walk distance (6MWD) is used as a measure of functional exercise capacity in clinical populations and research. Reference equations to predict 6MWD in different populations have been established, however, available equations for Chinese population are scarce. This study aimed to develop regression equations to predict the 6MWD for a Hong Kong Chinese population. Fifty-three healthy individuals (25 men, 28 women; mean age = 69.3 ± 6.5 years) participated in this cross-sectional study. Each participant performed two 6-minute walk tests (6MWTs) in accordance with a standard protocol. Heart rate (HR) was continuously monitored throughout the 6MWTs and the maximum HR was recorded. Measurements from the 6MWT that resulted in the highest 6MWD were used for regression analysis. The mean 6MWD was 563 ± 62 m and was significantly correlated with age (r = −0.62), height (r = 0.39), and percentage of predicted maximal HR (%predHR_max; r = 0.50). A regression equation derived from the data showed that age, sex, and %predHR_max were independent contributors and together explained 65% of the variance in 6MWD. When HR was excluded, the equation explained 52% of the variance. Application of these equations to a Chinese population living in different parts of China warrants further investigation.     

The Chinese (Mandarin) instructions of the 6-minute walk test: A validation study

Background/Objective:To date, a validated Chinese (Mandarin) six-minute walk test (6MWT) translated instruction is not available. Translation of the Chinese 6MWT instruction is done in an ad hoc manner within the Chinese-speaking populations. This study aimed to develop a set of valid and reliable Chinese (Mandarin) instructions of the 6MWT.Methods:Translation was performed from the original English instruction via the recommended “Process of translation and adaptation of instruments” by the World Health Organization to generate the Chinese instructions. The Chinese instructions were tested with 52 healthy adult participants for its validity. Each participant underwent three 6MWTs and a cardiopulmonary exercise test. Randomization allowed participants to undergo the walk test in both the original English and the new Chinese instructions. Face and content validity, intra-rater and inter-rater reliability of the Chinese instructions of the 6MWT were established through the translation process. Criterion validity was established by analyzing the results of the 6MWT and cardiopulmonary exercise test.Results:Intraclass correlation coefficient for inter-rater reliability was excellent (ICC=0.999, 95% confidence interval=0.996–1.000). Similarly, the intra-rater reliability across the three raters was high (R1: ICC=0.996, 95% confidence interval (CI)=0.812–1.000; R2: ICC=1.000, 95% CI=0.994–1.000; R3: ICC=1.000, 95% CI=0.998–1.000). The 6-min walk distances collected from the Chinese and English instructed trials correlated positively with the maximal oxygen consumption (r=0.315, p=0.023; r=0.309, p=0.026).Conclusion:This is the first study to develop and validate the Chinese (Mandarin) instructions of the 6MWT, and the translation is as reliable and valid as the original English instructions.     

Validity of the six-minute step test of free cadence in patients with chronic obstructive pulmonary disease

Objectives:

to evaluate the concurrent validity of the six-minute step test (6MST) in assessing exercise capacity of COPD patients using the six-minute walk test (6MWT) as a gold-standard. The predictive validity of the 6MST was assessed to determine a cut-off point for identification of low exercise capacity.

Method:

thirty-two COPD patients (50-87 years old) with mild to very severe obstruction performed the 6MST and 6MWT twice.

Results:

Concurrent validity: a strong positive correlation (Pearson) between the number of ascents on the first (T1), second (T2) and the best of both (T1 or T2) tests during the 6MWT was observed. Although a moderate negative correlation with BODE index and FEV₁ was found, it was considered insufficient to test the validity, therefore ROC curves were not applied. The predictive validity (ROC) of the 6MST to identify low physical capacity (compared with the 6MWT) using the performance of T1 or T2, or solely T1 was considered accurate, and the area under the curve was 0.8 (IC95% 0.62-0.98) and 0.85 (IC95% 0.70-0.99), respectively. To classify patients, the cut-off points of 86 and 78 steps were chosen, with both values showing 90% of sensitivity and specificity of 64% and 68% for T1 or T2, or solely T1, respectively.

Conclusion:

The number of steps on the 6MST was valid to verify exercise capacity in COPD patients and the cut-off point of 78 steps was able to identify patients with poor exercise tolerance. Values under this cut-off point are considered to identify patients with a poorer prognosis.     

Home-based exercise is associated with improved cardiac functional performance in patients after acute myocardial infarction

ObjectiveTo evaluate the effects of home-based exercise and physical activity on cardiac functional performance in patients after acute myocardial infarction (MI) during the coronavirus disease 2019 (COVID-19) pandemic.MethodsThis retrospective study enrolled patients that received treatment of acute ST-segment elevation MI between and were followed-up 6 months later. The patients were divided into physically active and inactive groups based on their levels of home exercise after hospital discharge.ResultsA total of 78 patients were enrolled in the study: 32 were physically active and 46 were physically inactive. The baseline characteristics were comparable between the two groups. At the 6-month visit, left ventricular ejection fraction and six-minute walking test (6MWT) were significantly improved while the proportion of patients with a New York Heart Association (NYHA) functional III classification was decreased in the active patients, whereas these parameters were not significantly changed in the inactive patients. In addition, the 6MWT was greater while the proportion of patients with an NYHA III classification was lower in the active group than the inactive group at the 6-month visit.ConclusionMaintaining physical activity at home was associated with improved cardiac functional performance in patients after acute MI during the COVID-19 pandemic.     

Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis

Objective

To systematically review the available evidence on the efficacy of the Pilates method in patients with chronic nonspecific low back pain.

Method

Searches were performed in MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL and CENTRAL in March 2013. Randomized controlled trials that tested the effectiveness of the Pilates method (against a nontreatment group, minimal intervention or other types of interventions) in adults with chronic low back pain were included regardless the language of publication. The outcome data were extracted from the eligible studies and were combined using a meta-analysis approach.

Results

The searches identified a total of 1,545 articles. From these, eight trials were considered eligible, and seven trials were combined in the meta-analysis. The comparison groups were as follows: Pilates versus other types of exercises (n=2 trials), and Pilates versus no treatment group or minimal intervention (n=4 trials) for short term pain; Pilates versus minimal intervention for short-term disability (n=4).We determined that Pilates was not better than other types of exercises for reducing pain intensity. However, Pilates was better than a minimal intervention for reducing short-term pain and disability (pain: pooled mean difference=1.6 points; 95% CI 1.4 to 1.8; disability: pooled mean difference=5.2 points; 95% CI 4.3 to 6.1).

Conclusions

Pilates was better than a minimal intervention for reducing pain and disability in patients with chronic low back pain. Pilates was not better than other types of exercise for short-term pain reduction.     

Fluorescence-guided surgery for osteoradionecrosis of the jaw: a retrospective study

ObjectiveOsteoradionecrosis of the jaw (ORNJ) is one of the most severe head and neck complications in patients treated with radiotherapy. The goal of treatment is to suppress ORNJ progression. Currently, surgical removal of necrotic bone is an effective management approach for advanced stages. In this study, we present our experience in managing ORNJ using fluorescence-guided surgery.MethodsNineteen ORNJ lesions in 15 hospitalized patients were treated with fluorescence-guided surgery. We retrospectively reviewed patients’ demographic data, comorbidities, local preceding event, location, ORNJ stage, and treatment outcomes with a median follow-up of 12 months.ResultsTwelve lesions (63%) were treated surgically under tetracycline fluorescence, and seven lesions (37%) were surgically treated under auto-fluorescence. Overall, four lesions (21%) achieved complete mucosal healing, eight lesions (42%) showed partial mucosal healing with bone exposure and no signs or symptoms of inflammation, and seven lesions (37%) were progressive. The results showed that either healing or ORNJ stabilization was achieved in 63% of lesions (n = 12).ConclusionFluorescence-guided surgery can be beneficial in curing or stabilizing ORNJ. However, randomized clinical trials are needed to confirm these findings.     

A new equation based on the 6-min walking test to predict VO2peak in women with obesity

Objective: The 6-min walking test (6?MWT) is commonly used to assess obese patients’ aerobic fitness, but it has rarely been compared with a direct measurement of maximal aerobic capacities (VO_2max or VO_2peak) in obese adults. The aim of this study was to investigate the relationship between the distance covered during a 6?MWT with objectively measured VO_2peak and to propose a new equation to predict VO_2peak from this walking test in obese patients.

Methods: One hundred and thirty-seven obese patients (45.6?±?12.5?years) admitted to our hospital for a multidisciplinary rehabilitation program were enrolled. After assessment of their body composition, the participants were asked to perform a 6?MWT and their maximal aerobic capacities (VO_2peak) were measured.

Result: There is a significant linear relation between VO_2peak and the distance covered during the 6?MWT (p?r?=?0.349). The determinant of VO_2peak was body mass index, waist-to-hip ratio, fat free mass, leading to the follow prediction equation VO_2peak such as VO_2peak (l/min)?=?(body mass index ×0.0150065)???(waist-to-hip-ratio?×?0.8595088)?+?(fat-free-mass?×?0.0295478)?+?(6-min walk test?×0.0020672)???0.5853372.

Conclusion: The 6-min walk test is a reliable method to reflect obese women’s aerobic capacities and the distance covered can be used to accurately estimate VO_2peak according to our newly proposed equation.

• Implication for rehabilitation

• Obesity is a worldwide disease and physical capacity evaluation is a key point for rehabilitation.

• The six minutes’ walk test is commonly used in obese people to assess aerobic fitness.

• This study proposes a new equation using 6?MWT performance to estimate VO_2peak.

     

A multidisciplinary collaborative model based on single-port thoracoscopy for the treatment of giant mediastinal lymph node hyperplasia: a case report

Mediastinal unicentric Castleman disease (UCD) frequently manifests as a hyper-enhancing lymph node mass and is often surgically curable. However, because of excessive vascularisation and adhesion to important surrounding structures, surgery is often associated with severe haemorrhage that is often difficult to control thoracoscopically. Therefore, thoracotomy is often preferred, which increases the trauma to the patient and affects postoperative recovery. Here, we describe the case of a 30-year-old male patient with a large upper mediastinal lymph node (7 × 5 × 4 cm) that was compressing his superior vena cava. The distribution of nutritive arteries of the mass was analysed in detail, and the main branches were embolised prior to surgery. With the assistance of preoperative isovolumetric haemodilution, we achieved complete resection through single-port thoracoscopy, with only minor haemorrhage, which enabled the patient to recover rapidly. This multidisciplinary collaborative model, based on single-port thoracoscopic surgery, may be of wide practical use for the treatment of mediastinal UCD.     

Reference values for the physical work capacity on a bicycle ergometer for men -- a comparison with a previous study on women

The aim of the study was to collect new reference values for the clinical ramp exercise test on bicycle, because in our experience, the commonly used values were too low. A group of healthy men (n = 81, 20-80 years) was randomly selected from the local municipal register to achieve an even distribution in age. Data were compared with those obtained in a similar, previous study on women (n = 87). The subjects were encouraged to cycle until exhaustion (19 on the Borg scale) when maximal load, heart rate and systolic blood pressure were recorded. Maximal load (W(max)) was related to age (years) and height (m) using a non-linear function: W(max) = (244.6 x height - 92.1)/[1 + exp[0.038 x (age - 77.3)]]. Maximal heart rate (HRmax) was described by a similar function: HRmax = 203.7/[1 + exp[0.033 x (age - 104.3)]]. The maximal systolic blood pressure (BP(max)) was described by a linear function based on age: BP(max) = 0.505 x age + 192. Similar functions for the women are also given. It is suggested that 80-120% of the predicted maximal load can be taken as a reference interval for both men and women and similarly 90-110% of the maximal heart rate. In this study, 84% of the men reached a maximal load within the reference interval and 93% maximal heart rate within the reference interval. The reported values for maximal load were 104-132% of the reference values published by others.     

Reference values for the Modified Timed Up and Go Test in Saudi children aged 4–12 years old in Riyadh city: cross-sectional study

PurposeThe study aimed to report within-session reliability, estimate the reference values for the Modified Timed Up and Go (mTUG) test in typically developing (TD) Saudi children aged 4–12 years old, develop a reference equation for the estimated mTUG, and compare the measured mTUG in the present study with the predicted mTUG obtained from the previous regression equation.MethodsIn this cross-sectional observational study, anthropometric measurements and mTUG test were investigated in 805 child. The association between the mTUG test and predictive variables was studied.ResultsAverage mTUG speed was 4.63 ± 0.68 s. Within-session reliability was excellent with intraclass correlation coefficient of 0.90. The test was significantly and negatively correlated with age, height, and weight (r = −0.66, p = .00), (r = −0.54, p = .01), and (r = −0.33, p = .01) respectively. According to the stepwise regression analysis, age and weight were the predictors and explained 47% of total variance of mTUG scores.ConclusionThis study provided the mTUG reference values that can be used clinically to evaluate functional mobility and dynamic balance in TD Saudi children aged 4–12 years. The mTUG scores can be predicted as a function of age and weight.

KEY MESSAGES

• Modified Timed Up and Go test used to assess the functional mobility and dynamic balance for children with or without developmental abnormalities.
• Availability of reference values according to age is helpful to compare the performance of children at same ages.

     

6min步行距离和气短指数在城乡COPD患者中的差异性研究

目的探讨6min步行距离和气短指数在城乡COPD患者中的差异。方法 2010年6月至2011年10月,处于缓解期肺功能Ⅱ～Ⅳ级COPD患者108例,按照患者来源(农村或城市)分为城市组和农村组,进行6min步行试验,记录两组患者6min步行距离及步行前后的气短指数评分。结果 6min步行距离,Ⅱ、Ⅲ级COPD患者农村组高于城市组(P<0.05);Ⅳ级COPD患者农村组和城市组之间无明显差异(P>0.05)。同时,6分钟步行试验前后的气短指数评分,Ⅱ、Ⅲ级COPD患者农村组低于城市组(P<0.05);Ⅳ级COPD患者城市组与农村组之间无明显差异(P>0.05)。结论肺功能Ⅱ～Ⅲ级城乡COPD患者进行6min步行试验时6min步行距离和气短指数存在差异,提示COPD患者长期坚持适度体力劳动或运动锻炼有利于提高运动耐力。     

Reference values for respiratory pressures in a general adult population – results of the Study of Health in Pomerania (SHIP)

Background and Objective: Respiratory muscle pressures have been gaining increasing interest because of prognostic value. The study aim was to acquire reference values for respiratory pressures in a large‐scale population‐based survey – the Study of Health in Pomerania (SHIP). Methods: One thousand eight hundred and nine participants (885 men) of a cross‐sectional epidemiologic survey, called ‘Study of Health in Pomerania – SHIP’, underwent lung function and respiratory muscle pressure measurements. After excluding individuals with cardiopulmonary disorders, prediction equations for men and women were established by quantile regression analysis. Results: The final study population comprised 912 individuals (432 men), aged 25–80 years. The study provides a representative set of sex‐specific prediction equations of respiratory muscle strength. Respiratory pressures are decreasing with age and are lower in women when compared to men. Conclusions: Prediction equations for relevant respiratory pressures are given. Based on this well‐described population‐based survey with extensive cardiopulmonary investigations to exclude relevant interfering disorders a sufficient comprehensive set of reference values was obtained.     

Age‐specific pediatric reference ranges for immunoglobulins and complement proteins on the Optilite™ automated turbidimetric analyzer

Background

Measurement of immunoglobulins and complement proteins are frontline tests used in the assessment of immune system integrity, and reference values can vary with age. Their measurement provides an insight into the function of the innate and adaptive immune systems.

Methods

We generated pediatric reference ranges for IgG, IgA, IgM, IgD, the IgG and IgA subclasses, and C3 and C4 using the Optilite™ turbidimetric analyzer.

Results

The concentrations of IgG, IgA, and IgD showed an increase with age, as expected, while IgM remained stable between the age groups. For the IgG subclasses, no significant differences were observed in IgG1 or IgG3, while IgG2 and IgG4 concentrations increased steadily with age. The concentration of IgG2 plateaued at 15‐18 years, while IgG4 plateaued at 10‐14 years. The trend of concentrations across all groups was IgG1 > IgG2 > IgG3 > IgG4. For both IgA1 and IgA2, concentrations increased significantly with age, plateauing at 15‐18 years. The median IgA1 concentration was greater than IgA2 across all groups. There was a good correlation between the total IgG or IgA concentration and summation of their subclasses (R² = 0.89, P < .0001, slope y = 0.98x + 14.51 mg/dL and R² = 0.91, P < .0001, slope y = 1.35x‐3.28 mg/dL, respectively). The concentration of C3 and C4 remained stable across the groups, with no significant differences observed.

Conclusion

We have generated age‐specific reference ranges in healthy children for C3, C4, IgG, IgA, IgM, IgD and the IgG and IgA subclasses using the Optilite^™ turbidimetric analyzer. These ranges will help identify individuals with abnormal concentrations, thus will aid in the diagnosis of both primary and secondary immunological disorders.

     

Reference values for the physical work capacity on a bicycle ergometer for women between 20 and 80 years of age

A sample of women (n=87) uniformly distributed in age (20–80 years) was randomly selected from the municipal population register and conventional clinical exercise tests were performed on a bicycle. The load started at 30 W and increased (5 W/30 s) until exhaustion. Care was taken to perform a maximum exercise test. The women were required to be cardiovascularly healthy and not on regular medication to be included in the study. The maximum work load was found to be dependent on age and height. The following equation described the maximum load. Max load (W)=(137·7 * Height (m) – 23·1)/(1 + exp (0·064 * (Age (years) – 75·9))). The upper and lower limits of the reference interval were 120 and 80% of the predicted load, respectively. The upper and lower limits for maximum heart rate were 110 and 90% of the maximum heart rate given by 190·2/(1 + exp (0·0453 * (Age – 107·5))). The reference value for maximum systolic blood pressure was taken as the interval between the two lines 153·3 + 0·281 * Age and 172·0 + 1·13 * Age. The reference values presented for work capacity are higher than those normally used in Sweden.     

Family support for physical activity post‐myocardial infarction: A qualitative study exploring the perceptions of cardiac rehabilitation practitioners

Physical activity post‐myocardial infarction has numerous health benefits, yet uptake through cardiac rehabilitation is poor. Whilst family support can facilitate patients' recovery, little is known about the role family may play in supporting physical activity for post‐myocardial infarction patients. This qualitative study used semistructured interviews with 14 cardiac rehabilitation practitioners to explore their perceptions about the role of the family in supporting post‐myocardial infarction patients' physical activity. Data were transcribed verbatim and analyzed thematically. Three familial roles were identified: “family as a second pair of ears,” “family as physical activity regulators,” and “family as social support.” A fourth theme, “factors that influence family support,” described how family health beliefs and perceptions could influence the physical activity support provided. Practitioner perceptions suggest families play an important role in post‐myocardial infarction patients' physical activity, which is enhanced when families personally value physical activity. Integrating the family into cardiac rehabilitation may help facilitate physical activity‐related interactions and promote positive engagement for patients.     

Establishing reference intervals for major biochemical analytes for the Russian population: a research conducted as a part of the IFCC global study on reference values

ObjectivesBecause reference intervals (RIs) for biochemistry analytes matched to the Russian population are not well defined, we joined the global study on reference values (RVs) coordinated by the IFCC Committee on Reference Intervals and Decision Limits (C-RIDL).MethodsAccording to the C-RIDL harmonized protocol, 793 healthy volunteers were recruited in Saint-Petersburg, Moscow, and Yekaterinburg. Serum samples were tested for 34 biochemistry analytes. Sources of variation of RVs were explored using multiple regression analysis. The need for partitioning RVs by sex and age were judged using standard deviation ratio based on ANOVA. Latent abnormal values exclusion (LAVE) method was applied to reduce the influence of individuals with metabolic syndrome and/or inappropriate sampling conditions. RIs were computed by the parametric method.ResultsNo appreciable between-city differences were observed. Partition of RVs by sex was required for 17 analytes. Age-related changes in RVs were observed in many analytes, especially in females. The trend was exaggerated in nutritional and inflammatory markers that were closely associated with body mass index (BMI), because BMI increases prominently with age. Therefore, for those analytes, volunteers with BMI > 28 kg/m² were excluded in determining RIs for age-specific RIs. The LAVE method was effective in lowering the upper limits of the RIs for nutritional and inflammatory markers.ConclusionRIs matched to the Russian population were established for 34 biochemical analytes using up-to-date methods in detailed consideration of sources of variation of RVs. The majority of Russian RIs are similar to those of Caucasian populations among the participating countries.