V. Gremeaux

Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis

Background The health benefits of 150 min a week of moderate-to-vigorous-intensity physical activity (MVPA) in older adults, as currently recommended, are well established, but the suggested dose in older adults is often not reached. Objectives We aimed to determine whether a lower dose of MVPA was effective in reducing mortality, in participants older than 60 years. Methods The PubMed and Embase databases were searched from inception to February 2015. Only prospective cohorts were included. Risk ratios of death were established into four doses based on weekly Metabolic Equivalent of Task (MET)-minutes, defined as inactive (reference), low (1–499), medium (500–999) or high (≥1000). Data were pooled and analysed through a random effects model using comprehensive meta-analysis software. Results Of the 835 reports screened, nine cohort studies remained, totalling 122 417 participants, with a mean follow-up of 9.8±2.7 years and 18 122 reported deaths (14.8%). A low dose of MVPA resulted in a 22% reduction in mortality risk (RR=0.78 (95% CI 0.71 to 0.87) p<0.0001). MVPA beyond this threshold brought further benefits, reaching a 28% reduction in all-cause mortality in older adults who followed the current recommendations (RR=0.72 (95% CI 0.65 to 0.80) p<0.0001) and a 35% reduction beyond 1000 MET-min per week (RR=0.65 (95% CI 0.61 to 0.70) p<0.0001). Conclusions A dose of MVPA below current recommendations reduced mortality by 22% in older adults. A further increase in physical activity dose improved these benefits in a linear fashion. Older adults should be encouraged to include even low doses of MVPA in their daily lives.

Determining the Minimal Clinically Important Difference for the Six-Minute Walk Test and the 200-Meter Fast-Walk Test During Cardiac Rehabilitation Program in Coronary Artery Disease Patients After Acute Coronary Syndrome

OBJECTIVE To estimate the minimal clinically important difference (MCID) for the 6-minute walk test (6MWT) and the 200-m fast-walk test (FWT) in patients with coronary artery disease (CAD) during a cardiac rehabilitation program. DESIGN Prospective study using distribution- and anchor-based methods. SETTING Outpatients from a cardiac rehabilitation unit. PARTICIPANTS Stable patients with CAD (N=81; 77 men; mean±SD age, 58.1±8.7y) enrolled 31±12.1 days after an acute coronary syndrome (ACS). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES 6MWT and 200-m FWT results before and after an 8-week cardiac rehabilitation program and at the 6th and 12th sessions. Patients and physiotherapists who supervised the training were asked to provide a global rating of perceived change in walking ability while blinded to changes in walk test performances. RESULTS Mean change in 6MWT distance (6MWD) in patients who reported no change was -6.5m versus 23.3m in those who believed their performance had improved (P<.001). This result was consistent with the MCID determined by using the distribution method (23m). Considering a 25-m cutoff, positive and negative predictive values were 0.9 and .63, respectively. Conversely, there was no difference in 200-m FWT performance between these 2 groups (0.1 vs -1.4s, respectively). There was poor agreement with the physiotherapists perceived change. CONCLUSIONS The MCID for 6MWD in patients with CAD after ACS was 25m. This result will help physicians interpret 6MWD change and help researchers estimate sample sizes in further studies using 6MWD as an endpoint.

Poststroke Disposition and Associated Factors in a Population-Based Study The Dijon Stroke Registry

Background and Purpose— The organization of poststroke care will be a major challenge in coming years. We aimed to assess hospital disposition after stroke and its associated factors in clinical practice. Methods— All cases of stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Demographic features, risk factors, and prestroke treatments were recorded. Admission stroke severity was assessed using the National Institutes of Health Stroke Scale score. At discharge, we collected dementia, disability using the modified Rankin Scale, length of stay, and hospital disposition (home, rehabilitation, convalescent home, and nursing home). Multivariate analyses were performed using logistic regression models to identify associated factors of postdischarge disposition. Results— Of the patients with 1069 stroke included, 913 survived acute care. Among them, 433 (47.4%) returned home, whereas 206 (22.6%) were discharged to rehabilitation, 134 (14.7%) were admitted to a convalescent home, and 140 (15.3%) to a nursing home. Old patients, those under anticoagulants before stroke, those with severe stroke on admission, severe disability at discharge, dementia, or prolonged length of stay were less likely to return home. Moreover, advanced age, severe initial stroke, severe disability at discharge, and dementia were associated with admission to convalescent and nursing homes rather than rehabilitation centers. Conclusion— This population-based study demonstrated that postdischarge destinations are associated with several factors. Our findings may be useful to establish health policy concerning the organization of poststroke care.

Does eccentric endurance training improve walking capacity in patients with coronary artery disease? A randomized controlled pilot study:

Objective: To examine the effect of eccentric endurance training on exercise capacities in patients with coronary artery disease. Design: Randomized parallel group controlled study. Setting: Cardiac rehabilitation unit, Dijon University Hospital. Participants: Fourteen patients with stable coronary artery disease after percutaneous coronary intervention. Intervention: Patients followed 15 sessions of training (1 session per day, 3 days a week), either in the concentric group, following a standard programme, or in the eccentric group, performing eccentric resistance exercises using both lower limbs on a specifically designed ergometer. Main outcomes measured: Symptom-limited Vo2, peak workload, isometric strength of leg extensor and ankle plantar flexors, distance covered during the 6-minute walk test and time to perform the 200-m fast walk test in both groups, before and after the training period. Results: Patients did not report any adverse effects and were highly compliant. All measured parameters improved in eccentric and concentric group, except for 200-m fast walk test: symptom-limited Vo2 (+14.2% versus +4.6%), peak workload (+30.8% versus +19.3%), 6-minute walk test distance walked (+12.6% versus +10.1%) and leg extensor strength (+7% versus +13%) improved to a similar degree in both groups (P<0.01); ankle plantar flexor strength improved in both groups with a significantly greater increase in the eccentric group (+17% versus +7%, P<0.05). Conclusion: Patients with stable coronary artery disease can safely engage in eccentric endurance training, which appears to be as efficient as usual concentric training, with reduced oxygen consumption.

Comparative analysis of oxygen uptake in elderly subjects performing two walk tests: the six-minute walk test and the 200-m fast walk test

Objective: A novel walk test is proposed to assess the ability of elderly subjects to sustain a submaximal effort in ecological surroundings. Vo2 uptake during this test was compared with that of a six-minute walk test and maximal exercise test. Design: Descriptive laboratory study. Setting: Rehabilitation department, Dijon University Hospital. Subjects: Thirty-one subjects, aged from 70 to 85 years, free from any chronic disease. Intervention: Three tests to assess physical capacities: the 200-m fast walk test (200 mFWT), the six-minute walk test (6 MWT) at self-paced speed, and one maximal cardiorespiratory exercise test on an ergocycle. Main measures: Distance walked on the 6 MWT, time to perform the 200 mFWT. Heart rate (HR) and oxygen uptake (Vo2) were measured for each test. Results: All subjects successfully completed the two walk tests without any complaints. They walked more quickly during the 200 mFWT than during the 6 MWT (mean (SD) speed respectively 1.60 (0.17) versus 1.23 (0.16) m/s, P<0.001). Compared with the maximal exercise test, the relative intensity was much higher during the 200 mFWT than during the 6 MWT (mean (SD) Vo2 uptake 86.8 (8.9)% versus 67.4 (10.7)% of peak Vo2, mean (SD) HR 89.9 (9.4) versus 76.2 (0.8)% of peak HR; P<0.001). Conclusion: In healthy elderly subjects, the 200 mFWT requires a more sustained effort than the 6 MWT. This test is simple, ecological and well tolerated. In addition to the 6 MWT, the 200 mFWT could be a useful tool to build up and evaluate training or rehabilitation programmes, especially when interval training is planned

Low-Frequency Electric Muscle Stimulation Combined With Physical Therapy After Total Hip Arthroplasty for Hip Osteoarthritis in Elderly Patients: A Randomized Controlled Trial

OBJECTIVE To assess the effects of low-frequency electric muscle stimulation associated with usual physiotherapy on functional outcome after total hip arthroplasty (THA) for hip osteoarthritis (OA) in elderly subjects. DESIGN Randomized controlled trial; pre- and posttreatment measurements. SETTING Hospital rehabilitation department. PARTICIPANTS Subjects (N=29) referred to the rehabilitation department after THA for hip OA. INTERVENTIONS The intervention group (n=16; 78+/-8 y) received simultaneous low-frequency electric muscle stimulation of bilateral quadriceps and calf muscles (highest tolerated intensity, 1h session, 5 d/wk, for 5 weeks) associated with conventional physical therapy including resistance training. The control group (n=13; 76+/-10 y) received conventional physical therapy alone (25 sessions). MAIN OUTCOME MEASURES Maximal isometric strength of knee extensors, FIM instrument, before and after; a six-minute walk test and a 200 m fast walk test, after; length of stay (LOS). RESULTS Low-frequency electric muscle stimulation was well tolerated. It resulted in a greater improvement in strength of knee extensors on the operated side (77% vs 23%; P<.01), leading to a better balance of muscle strength between the operated and nonoperated limb. The low-frequency electric muscle stimulation group also showed a greater improvement in FIM scores, though improvements in the walk tests were similar for the 2 groups, as was LOS. CONCLUSIONS Low-frequency electric muscle stimulation is a safe, well-tolerated therapy after THA for hip OA. It improves knee extensor strength, which is one of the factors leading to greater functional independence after THA.

Selecting a test for the clinical assessment of balance and walking capacity at the definitive fitting state after unilateral amputation: a comparative study:

Background: There is a lack of data and consensus concerning the most appropriate functional evaluation in clinical practice at the definitive prosthetic phase after lower limb amputation. Objectives: To determine among several selected functional tests the most pertinent to evaluate balance and prosthetic walking. Study Design: Validation of a diagnostic procedure. Methods: Sixty-four patients were included. Outcome measures: Timed Up and Go test, Functional Reach test (FRT), one-leg balance, tandem test, Modified Houghton Scale, Berg Balance Scale, two-minute walk test (2MW test). Correlations were assessed with the Pearson correlation coefficient and the Principal Component Analysis. Score distribution was analyzed with the Shapiro-Wilk W normality test. Receiver operating characteristic curves were drawn to identify the best predictor for the function. Results: The clinical tests correlated highly with each other. Only 2MW test and FRT did not have either a floor/ceiling effect, or a bi-modal distribution. The 2MW test was the best predictor of prosthetic walking limitations (area under the curve 0.93 (0.83–0.97), the best threshold was between 130 and 150 meters), and FRT was best for balance. Conclusions: 2MW test can be proposed as the first-line clinical test. The FRT can be indicated for the specific assessment of balance disorders. Clinical relevance This validation of a clinical evaluation of balance and walking capacity after lower limb amputation may be useful in everyday practice to ensure in a simple and standardized way the follow-up of patients and adapt treatments – especially prosthetics – at the definitive prosthetic phase.

Telephone Support Oriented by Accelerometric Measurements Enhances Adherence to Physical Activity Recommendations in Noncompliant Patients After a Cardiac Rehabilitation Program

OBJECTIVE To assess the efficacy of a strategy, based on telephone support oriented by accelerometer measurements, on the adherence to physical activity (PA) recommendations in cardiac patients not achieving PA recommendations. DESIGN Prospective and randomized study. SETTING A cardiac rehabilitation program (CRP) at a clinic. PARTICIPANTS Stable, noncompliant cardiac (coronary artery disease, heart failure, post-cardiovascular surgery) patients (weekly moderate-intensity PA <150 min) were randomly assigned to an intervention group (n=19) or a control group (n=10). INTERVENTIONS The intervention group wore an accelerometer for 8 weeks. Every 15 days, feedback and support were provided by telephone. The control group wore the accelerometer during the 8th week of the intervention only. MAIN OUTCOME MEASURES Active energy expenditure (EE) (in kilocalories) and the time spent doing light, moderate, or intense PA (minutes per week). RESULTS In the intervention group, the time spent at moderate-intensity PA increased from 95.6±80.7 to 137.2±87.5 min/wk between the 1st and 8th week (P=.002), with 36.8% of the sample achieving the target amount of moderate-intensity PA. During the 8th week, the EE averaged 543.7±144.1 kcal and 266.7±107.4 kcal in the intervention group and control group, respectively (P=.004). CONCLUSIONS Telephone support based on accelerometer recordings appeared to be an effective strategy to improve adherence to PA in noncompliant patients. This intervention could be implemented after a CRP as an inexpensive, modern, and easy-to-use strategy.

Reliability of shoulder rotators isokinetic strength imbalance measured using the Biodex dynamometer

BACKGROUND Isokinetic assessment of shoulder internal and external rotators is commonly used by clinicians to assess muscle performance and to guide rehabilitation. The reliability of isokinetic assessment is fundamental to track small but clinically relevant changes. OBJECTIVES We aimed to analyze the absolute and relative reliability of strength imbalance indices such as peak torque ratios (ERconc/IRconc, ERecc/IRecc, ERecc/IRcon, IRecc/ERcon), bilateral concentric and eccentric strength ratios, and to examine the reliability of external rotator and internal rotator peak torque measured using a Biodex(®) dynamometer in the seated position. DESIGN Cross-sectional laboratory study. METHODS Forty-six healthy participants were tested twice with seven days between sessions, at 60°/s and 120°/s concentrically, and 30°/s eccentrically. RESULTS Low to moderate relative reliability (intraclass correlation coefficient: 0.25-0.81) was found for unilateral and bilateral strength imbalance ratios. High intraclass correlation coefficient values (0.87-0.97) were found for peak torque. Concerning absolute reliability, the standard error of measurement ranged from 9.1 to 25.6% for strength imbalance ratios and from 7.7 to 14.5% for peak torque measurements, and minimal detectable change ranged from 25.2 to 71% for strength imbalance ratios and from 21.3 to 40.2% for peak torque measurements. CONCLUSIONS The standard error of measurement and minimal detectable change reported in the present study should be taken into account when evaluating the individual longitudinal changes in clinical practice.

EFFECT OF INTERVAl TRAININg ON COgNITIVE FUNCTIONINg AND CEREBRAl OxygENATION IN OBESE PATIENTS: A PIlOT STUDy

OBJECTIVE To assess the effect of a 4-month high-intensity interval training programme on cognitive functioning, cerebral oxygenation, central haemodynamic and cardiometabolic parameters and aerobic capacity in obese patients. METHODS Cognitive functioning, cerebral oxygenation, central haemodynamic, cardiometabolic and exercise para-meters were measured before and after a 4-month high-intensity interval training programme in 6 obese patients (mean age 49 years (standard deviation 8), fat mass percentage 31 ± 7%). RESULTS Body composition (body mass, total and trunk fat mass, waist circumference) and fasting insulin were improved after the programme (p < 0.05). V. O2 and power output at ventilatory threshold and peak power output were improved after the programme (p < 0.05). Cognitive functioning, including short-term and verbal memory, attention and processing speed, was significantly improved after training (p < 0.05). Cerebral oxygen extraction was also improved after training (p < 0.05). CONCLUSION These preliminary results indicate that a 4-month high-intensity interval training programme in obese patients improved both cognitive functioning and cere-bral oxygen extraction, in association with improved exercise capacity and body composition.