Giane Amorim Ribeiro-Samora

Effects of pulmonary rehabilitation in lung transplant candidates: a systematic review

Objectives The aim of this systematic review of randomised controlled trials (RCTs), and quasi-experimental and retrospective studies is to investigate the effects of pulmonary rehabilitation (PR) in patients with advanced chronic disease on the waiting list for lung transplantation. Setting PR performed for inpatient or outpatient lung transplant candidates. Intervention PR programme including aerobic exercise training and/or resistance exercise training. Primary and secondary outcomes Quality of life and exercise capacity (primary outcomes). Survival rate after transplant surgery; pulmonary function; respiratory muscle strength; psychological aspects; upper and lower extremity muscle strength and adverse effects (secondary outcomes). Two review authors independently selected the studies, assessed study quality and extracted data. Studies in any language were included. Results This was a systematic review and studies were searched on the Cochrane Library, MEDLINE, EMBASE, CINAHL and PEDro. Experimental and retrospective studies evaluating the effects of PR in candidates for lung transplantation (>18 years old) with any lung diseases were included. 2 RCTs, and two quasi-experimental and two retrospectives studies, involving 1305 participants were included in the review. 5 studies included an enhancement reported in quality of life using the Short Form 36 questionnaire and showed improvements in some domains. All studies included exercise capacity evaluated through 6 min walk test and in five of them, there were improvements in this outcome after PR. Owing to the different characteristics of the studies, it was not possible to perform a meta-analysis. Conclusions Studies included in this review showed that PR is an effective treatment option for patients on the waiting list for lung transplantation and can improve quality of life and exercise capacity in those patients. Although individual studies reported positive effects of PR, this review shows that there is a need for more studies of a high methodological quality addressing PR effects in lung transplant candidates. Trial registration number PROSPERO CDR42015025110.

Energy expenditure and cost of walking and stair climbing in individuals with chronic stroke

Highlights • Stroke subjects had lower EE during the 6MWT and SCT compared to the healthy subjects.• Stroke subjects had higher EC during the 6MWT and SCT compared to the healthy subjects.• Walking speed differentiated healthy from stroke subjects gait.• The stroke subjects who walked faster showed better energy efficiency.• Evidence-based interventions to improve walking speed should be implemented.

Could peak oxygen uptake be estimated from proposed equations based on the six-minute walk test in chronic heart failure subjects?

Highlights • Measured and estimated VO2peak in CHF patients showed a moderate association.• With the exception of equation 1, all equations underestimated VO2peak by up to 51%.• The agreement evaluated using Bland–Altman was not consistent.

Disability in older adults with acute low back pain: the study Back Complaints in the Elderly – (Brazil)

Highlights • Older adults reported moderate to severe acute low back pain.• Irrelevant association between acute pain intensity with disability was observed.• There is interaction between age groups and marital status with disability.

Using the Human Activity Profile to Assess Functional Performance in Heart Failure.

PURPOSE: To investigate (1) the validity of using the Human Activity Profile (HAP) in patients with heart failure (HF) to estimate functional capacity; (2) the association between the HAP and 6-Minute Walk Test (6MWT) distance; and (3) the ability of the HAP to differentiate between New York Heart Association (NYHA) functional classes. METHODS: In a cross-sectional study, we evaluated 62 clinically stable patients with HF (mean age, 47.98 years; NYHA class I-III). Variables included maximal functional capacity as measured by peak oxygen uptake ( O2) using a cardiopulmonary exercise test (CPET), peak O2 as estimated by the HAP, and exercise capacity as measured by the 6MWT. RESULTS: The difference between the measured (CPET) and estimated (HAP) peak O2 against the average values showed a bias of 2.18 mL/kg/min (P = .007). No agreement was seen between these measures when applying the Bland-Altman method. Peak O2 in the HAP showed a moderate association with the 6MWT distance (r = 0.62; P < .0001). Peak O2 in the HAP was able to statistically differentiate NYHA functional classes I, II, and III (P < .05). CONCLUSIONS: The estimated peak O2 using the HAP was not concordant with the gold standard CPET measure. On the contrary, the HAP was able to differentiate NYHA functional class associated with the 6MWT distance; therefore, the HAP is a useful tool for assessing functional performance in patients with HF.

Validity of the accelerometer and smartphone application in estimating energy expenditure in individuals with chronic stroke

OBJECTIVE To examine the concurrent validity of the GT3X® ActiGraph accelerometer and Google Fit® smartphone application in estimating energy expenditure in people who had suffered a stroke, during fast overground walking. METHODS Thirty community-dwelling stroke individuals walked on a 10-meter hallway over 5min at their fastest speeds, wearing a Cortex Metamax 3B® ergoespirometer, a GT3X® ActiGraph accelerometer, and a smartphone with the Google Fit® application. Pearson correlation coefficients were calculated to verify the associations between measures of energy expenditure, in kilocalories (kcal), estimated by both devices and those obtained with the Cortex Metamax 3B® ergoespirometer (gold-standard measure). RESULTS Fair association was found between the energy expenditure values estimated from the combined formula of the ActiGraph GT3X® and those obtained with the gold-standard measure (r=0.37; p=0.04). No significant associations were found between the energy expenditure values estimated by the Google Fit® application and those provided by the gold-standard measure. CONCLUSIONS The findings demonstrated that both the GT3X®ActiGraph accelerometer and the Google Fit® smartphone application do not provide valid measures of energy expenditure in chronic stroke individuals during fast overground walking.

Test–retest reliability of the unsupported upper-limb exercise test (UULEX) and 6-min peg board ring test (6PBRT) in healthy adult individuals

ABSTRACT Background: The unsupported upper-limb exercise (UULEX) and 6-min peg board ring tests (6PBRTs) have been developed to measure peak unsupported arm exercise capacity and arm endurance, respectively, in individuals with chronic obstructive pulmonary disease. These tests are valid and reproducible in this population; however, the reproducibility of healthy adults is currently unknown. Objective: To determine the within-day test–retest reliability of the UULEX and 6PBRT in healthy adults. Method: The study included 41 healthy adults, aged 38.3 ± 17.9 years old, who performed both tests, twice each on the same day, with a 30-min rest in between. Before and immediately after the tests, blood pressure (BP), heart rate (HR), perception of exertion, and arm fatigue were measured. Time to perform the test and number of rings moved were recorded for the UULEX and 6PBRT, respectively. Results: The UULEX was reproducible on Bland–Altman analysis with lower and upper limits of agreement: 2.40 and −2.49 min, respectively (bias = −0.05; p = 0.817) and intraclass correlation coefficient (ICC) = 0.85 (p < 0.0001) for time in minutes for the first and second tests. The 6PBRT was not reproducible on Bland–Altman analysis with lower and upper limits of agreement of 31.64 and −114.54 (bias = −41.45; p < 0.0001) and ICC = 0.91 (p < 0.0001) for the number of rings moved. Conclusion: UULEX is a reliable test in healthy adults. Only one test is adequate when measuring peak unsupported arm exercise capacity using the UULEX in healthy adults, while more than two tests may be needed to measure arm endurance using the 6PBRT.

Comparison between parameters of muscle performance and inflammatory biomarkers of non-sarcopenic and sarcopenic elderly women

Background Sarcopenia is a multifactorial geriatric syndrome with complex interrelationships. Increased plasma levels of inflammatory mediators increase the catabolic stimuli of the musculature, thereby causing a decrease in mass and muscular function. Objective The objective of this study was to compare the performance of the knee extensors test (by isokinetic dynamometer) and plasma levels of interleukin-6 (IL-6) and soluble receptors of tumor necrosis factor alpha (sTNFR1) between sarcopenics and non-sarcopenics community-dwelling elderly women residents of Brazil. Material and methods The diagnosis of sarcopenia included measurements of body composition (by densitometry with dual energy source of X-ray), handgrip strength (by Jamar® dynamometer), and the usual gait velocity according to the recommendations of the European Working Group on Sarcopenia in Older People. In both sarcopenics and non-sarcopenics elderly women, we evaluated the muscle function by knee extensors test (using an isokinetic dynamometer Byodex System 4 Pro®) at angular speeds of 60°/s and 180°/s) and also we evaluated the plasma concentrations of IL-6 and sTNFR1. Comparisons of muscle performance between groups were carried out using mixed factorial ANOVA with post hoc Bonferroni test; sTNFR1 and IL-6 variables were analyzed by applying Mann–Whitney U test. Results Statistical differences were observed between groups regarding muscle power (P=0.01), total work adjusted to body weight (P=0.01) at a rate of 180°/s, and plasma levels of sTNFR1 (P=0.01). Conclusion Sarcopenic elder women showed lower performance of the lower limbs, especially at a higher speed, predisposing these older women to greater vulnerability in functional activities that require agility and postural stability. Plasma levels of sTNFR1 were higher for non-sarcopenics elderlies. However, due to the observational nature of the study, it was impossible to infer causality among the variables surveyed.