Ingrid Castres

Quality of life and obesity class relationships.

The aim of this study was to quantify the impact of obesity class on Health-Related Quality Of Life (HRQOL) and Total daily Energy Expenditure (TEE). 69 obese individuals were self-selected to 1 of 3 groups based upon Body Mass Index (BMI). Anthropometric parameters (height, weight, waist and hip circumference, fat mass, lean body mass), biological parameters (high density lipoprotein, low density lipoprotein, triglycerides, glycaemia, total cholesterol), and resting energy expenditure were assessed for each group. The Short Form Health Survey (SF-36) questionnaire and Hospital Anxiety Depression (HAD) scale were used to measure HRQOL, and TEE was estimated by Kurpads method. Class 3 obesity was associated with greater impairment of the physical aspects of the SF-36 (37.2±11.3), greater depression risk (8.2±4.1), and higher TEE (30.0±7.9 Kcal·day (-1)·kg (-1)) than the lower obesity classes. No difference was observed among the 3 groups in the mental and psychosocial aspects of HRQOL. Impaired physical functioning was correlated with fat mass, age, waist circumference, glycaemia control and bodily pain. TEE was positively correlated with BMI, weight, fat mass and lean body mass. The obesity class had a negative impact on the physical health aspect of HRQOL, depression risk and energy expenditure. These impairments were associated with excess fat mass, waist circumference and glycaemia parameters.

Reproducibility and Sensitivity of the 6-Minute Stepper Test in Patients with COPD

Abstract The aims of this study were to test the reproducibility of the 6-minute stepper test (6MST), and evaluate its accuracy in detecting improved functional capacity after pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). Thirty-five COPD outpatients performed two 6MSTs in the same session, before (6MST1 and 6MST2) and after (6MST3 and 6MST4) PR. The performance, perceived exertion, heart rate and arterial oxygen saturation were measured during each 6MST. The performance was higher during the second 6MST of the same session (before PR: 514 strokes during the 6MST2 > 471 strokes during the 6MST1, and after PR: 559 strokes during the 6MST4 > 508 strokes during the 6MST3; p = 0.04). After PR, 6MST performance was higher than before PR (6MST3 > 6MST1 and 6MST4 > 6MST2; P < 0.01). The bias (the difference in the number of strokes) between the two 6MSTs from the same session (before PR: 6MST2-6MST1 = 42 strokes vs after PR: 6MST4-6MST3 = 52 strokes) was not different (P = 0.34). However, both bias were greater than 0 (P < 0.001). The mean performances for the two 6MSTs of the same session (before PR: 6MST1 and 6MST2 and after PR: 6MST3 and 6MST4) were correlated with the bias between these performances (P < 0.01; r = 0.32). The perceived exertions were lower after PR (P < 0.02). The systematic improvement of performance (8–10%) during the second 6MST of the each session may be explained from the warming of hydraulic jacks of the stepper and/or learning effect. On the other hand, the 6MST seems sufficiently sensitive to detect functional capacity improvements after PR in patients with COPD.

Home-based neuromuscular electrical stimulation improves exercise tolerance and health-related quality of life in patients with COPD

Background This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR), including transcutaneous neuromuscular electrical stimulation (NMES) or usual endurance physical exercise (UEPE), on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL) in patients with COPD. Methods Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [GNMES]), while 117 patients participated in home-based PR with the UEPEs (Group UEPE [GUEPE]). NMES was applied for 30 minutes twice a day, every day. The endurance exercises in GUEPE began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for GUEPE, NMES for GNMES, resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home. Results The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in GUEPE), exercise capacity (+20.8% in GNMES and +21.8% in GUEPE), depression (−15.8% in GNMES and −30.1% in GUEPE), and overall HRQoL (−7.0% in GNMES and −18.5% in GUEPE) in the patients with COPD, regardless of the group (GNMES or GUEPE) or severity of airflow obstruction. Moreover, no significant difference was observed between the groups with respect to these data (P>0.05). Conclusion Home-based PR including self-monitored NMES seems feasible and effective for severely disabled COPD patients with severe exercise intolerance.

The oxygen-conserving potential of the diving response: A kinetic-based analysis

ABSTRACT We investigated the oxygen-conserving potential of the human diving response by comparing trained breath-hold divers (BHDs) to non-divers (NDs) during simulated dynamic breath-holding (BH). Changes in haemodynamics [heart rate (HR), stroke volume (SV), cardiac output (CO)] and peripheral muscle oxygenation [oxyhaemoglobin ([HbO2]), deoxyhaemoglobin ([HHb]), total haemoglobin ([tHb]), tissue saturation index (TSI)] and peripheral oxygen saturation (SpO2) were continuously recorded during simulated dynamic BH. BHDs showed a breaking point in HR kinetics at mid-BH immediately preceding a more pronounced drop in HR (−0.86 bpm.%−1) while HR kinetics in NDs steadily decreased throughout BH (−0.47 bpm.%−1). By contrast, SV remained unchanged during BH in both groups (all P > 0.05). Near-infrared spectroscopy (NIRS) results (mean ± SD) expressed as percentage changes from the initial values showed a lower [HHb] increase for BHDs than for NDs at the cessation of BH (+24.0 ± 10.1 vs. +39.2 ± 9.6%, respectively; P < 0.05). As a result, BHDs showed a [tHb] drop that NDs did not at the end of BH (−7.3 ± 3.2 vs. −3.0 ± 4.7%, respectively; P < 0.05). The most striking finding of the present study was that BHDs presented an increase in oxygen-conserving efficiency due to substantial shifts in both cardiac and peripheral haemodynamics during simulated BH. In addition, the kinetic-based approach we used provides further credence to the concept of an “oxygen-conserving breaking point” in the human diving response.

Comparison of Specific Prediction Equations to Estimate Peak Oxygen Uptake in Obese Women

The aim of the current study was to compare 2 equations to predict peak oxygen uptake (V̇O2peak) in obese women, according to their obesity class. 92 maximal cardiopulmonary exercise testing sets (CPET with initial and subsequent increments set to achieve an exercise duration between 8-12 min) were retrospectively analysed. These CPET were divided into 3 groups according to the women body mass indexes (BMI): class 1 (30 kg.m-2≤BMI<35 kg.m-2, n=22), class 2 (35 kg.m-2≤BMI<40 kg.m-2, n=36) or class 3 (BMI≥40 kg.m-2, n=34). Each participants V̇O2peak was predicted from 2 prediction equations (from Wasserman et al.s and Debeaumont et al.s equations) and compared with the actual V̇O2peak. Moreover, the correlations between these values were studied, and the accuracy of the predictions was analysed. Only predicted V̇O2peak from the Debeaumont et al.s equation was not significantly different from the actual V̇O2peak in the women in obesity class 3 (p=0.89). Moreover, significant correlation was found between these values (p<0.001, r=0.68). The bias and the 95% limits of agreement represented -3.2±34.0%. In women in obesity class 3, Debeaumont et al.s equation may be the accurate one to predict V̇O2peak. However, the accuracy of predictions is low. Consequently, to improve this accuracy, new prediction equations for obese women are required according to the obesity class.