Exercise Training in Patients with Pulmonary Arterial Hypertension: A Case Report

Purpose: To describe the benefits of a feasible, outpatient exercise training program on exercise tolerance and health-related quality of life (HRQL) in individuals with pulmonary arterial hypertension (PAH). Methods: Case report on two subjects recruited from a tertiary care pulmonary hypertension clinic. Subject 1 was a 50-year-old male with idiopathic PAH. Subject 2 was a 54-year-old female with a 20+ year history of scleroderma and 6-year history of PAH. Both subjects underwent exercise training 3 times per week for 6 weeks using a cycle ergometer at workloads progressing from 50% to 80% of peak workload. Outcomes were assessed using cardiopulmonary exercise testing, six-minute walk test (6MWT), and HRQL using the Chronic Respiratory Disease Questionnaire (CRQ) and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). Results: Both subjects made substantial improvements in oxygen consumption and workload at anaerobic threshold (improvements of 3.8 and 4.2 mL·kg⁻¹·min,⁻¹ 26 and 18 W, respectively) and 6MWT distance (from 496 to 586m and 416 to 517m, respectively). Only Subject 1 made substantial improvements in peak oxygen consumption (from 16.0 to 18.3 mL·kg⁻¹·min⁻¹and from 15.0 to 15.6 mL·kg⁻¹·min,⁻¹ respectively) and peak work rate (from 112 to 130W and 66 to 69W, respectively). Both subjects demonstrated improved HRQL. No adverse events were noted. CONCLUSIONS: A short and practical exercise training program can improve measures of workload, aerobic capacity, and HRQL in individuals with PAH with no adverse effects shown in these two case studies.Key Words: pulmonary arterial hypertension, exercise training     

老年人生命质量与体育锻炼行为关系的实证研究

目的：实证分析老年人生命质量和体育锻炼行为的关系,为促进健康老龄化提供参考。方法：采用简明健康调查问卷（SF-36）和体育锻炼行为问卷对男女配对抽取的200名60岁以上老年人进行调查。结果：不同体育锻炼项目数、锻炼频率、锻炼时间和锻炼行为阶段的生命质量8个子维度得分均值均有显著性差异。结论：老年人生命质量各维度与参加锻炼项目数、锻炼频率、锻炼时间和锻炼坚持均有显著相关,总体来讲老年人参加的锻炼项目数量越多、每周参与体育锻炼的次数越多、在90 min内老年人单次体育锻炼时间越长、坚持有规律的体育锻炼越长,生命质量得分越高。老年人在锻炼频率、锻炼时间和锻炼坚持方面比较好,但参与体育锻炼项目数较少,在锻炼内容的丰富性上有较大欠缺;老年人生命质量较差,需要加强体育锻炼促进生命质量,重点在于增加老年人体育活动的丰富性和促进锻炼坚持性,适当增加锻炼频率、时间。     

Improved Health-Related Quality of Life After Lung Volume Reduction Surgery and Pulmonary Rehabilitation

Purpose: It has been hypothesized that lung volume reduction surgery (LVRS) and pulmonary rehabilitation improve health-related quality of life (HRQOL). The purpose of this study was to test the hypothesis by examining the long-term functional consequences and general health status of patients with emphysema who have undergone LVRS and pulmonary rehabilitation. Methods: Forty-nine subjects with severe emphysema, aged 51 to 84 years old, post-LVRS and pulmonary rehabilitation participated in this study. Subjects reported changes in physical and mental domains on the Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36) over 3 time periods: prior to surgery, 6 months postsurgery, and 18 months postsurgery. The population as a whole was studied and both gender and age were analyzed as subsets. Subjects participated in an intensive 2-week (10 daily sessions) pulmonary rehabilitation program following LVRS. Results: Subjects showed significant improvements in both the physical and mental component summaries at Time 2 (3 months post-LVRS through 6 months post-LVRS) and Time 3 (12 months post-LVRS through 18 months post-LVRS) when compared to Time 1 (pre-LVRS). On the mental component summary scale, subjects younger than 65 years old had significant improvement compared to subjects 65 years and older at Time 3 (P < .05). Women significantly improved more than men at Time 3 on the physical component summary scale (P < .05). Conclusions: Lung volume reduction surgery and 2 weeks (10 daily sessions) of intensive pulmonary rehabilitation appears to improve HRQOL in people with emphysema up to at least 18 months postsurgery. What these data further suggest is that even after declines in health, women can improve HRQOL later in life, and that greater focus should be given to the emotional needs of our older patients.Key Words: lung volume reduction surgery, rehabilitation, quality of life     

Physical Therapists’ Perceptions of Knowledge and Clinical Behavior Regarding Cardiovascular Disease Prevention

Purpose

The study purpose was to assess perceptions of physical therapists (PTs) regarding the role of physical therapy in cardiovascular disease (CVD) prevention.

Methods

A 25-item survey, validated by expert cardiovascular/pulmonary (CVP) PTs, was sent electronically to 2,673 PTs. Each item represented an element of clinical practice behavior: education of CVD/risk factors (EDCVD), administration of primary CVD prevention (PRECVD), identifying underlying CVD/risk factors (IDCVD), monitoring CV status in patients with CVD (MONCVD). Responses were assigned numeric values (strongly agree = 5 to strongly disagree = 1), and mean element scores were analyzed.

Results

Most of the 516 respondents were APTA Section members (34% CVP Section, 42% other Section membership) and worked in academia (53%). Items showing a high (> 95%) level of agreement included patient education of smoking (97%) and monitoring exercise intensity (99%), assessing exercise benefits (99%), clinically identifying obesity (97%) and hypertension (97%), and monitoring CV response to exercise (99%). Items failing to reach 80% overall agreement were patient education of CVD medications (79%) and blood chemistry (72%), and assessing CVD family history (75%), patient BMI (60%), and body composition (33%). Identifying underlying CVD (77.2%) was the only practice behavior failing to reach 80% agreement. Outpatient PTs agreed significantly less to all elements vs. academics, and to IDCVD vs. all PTs except home health.

Conclusions

Physical therapists support most CVD prevention behaviors, but not given elements of patient education and identifying underlying CVD/risk factors.Key Words: cardiovascular disease, primary disease prevention, secondary disease prevention     

对运动前心血管疾病筛查的综述与探讨

采用文献资料法,回顾了近年来美国、意大利等国家对运动前心血管疾病筛查体系的相关研究。关国普遍采用美国心脏学会推荐的心血管疾病筛查12要素,意大利着重强调了12导联心电图的作用。大量研究证实,心电图确实在疾病筛查方面起到了积极作用。但它需要耗费大量的医疗资源,且费用过高的特性也被人所质疑,因此如何发挥其效用还有待进一步研究与证实。     

The Evidence Regarding Exercise Training in the Management of Cystic Fibrosis: A Systematic Review

Purpose: To conduct a systematic review of the evidence regarding the efficacy of exercise training in the management of cystic fibrosis (CF).Methods: Articles were found by searching PEDRO, MEDLINE, and CINAHL databases. Included articles involved exercise-related interventions for long-term adaptations (ie, not acute effects of exercise). Articles were excluded if the language was other than English or if other non-exercise interventions were used. Date of publication was not a factor for exclusion. Two independent reviewers evaluated the included articles using Sackett''s levels of evidence and select scoring criteria.Results: Twelve articles were eligible for inclusion. Interventions studied included various aspects of exercise training: anaerobic, aerobic, or resistance training. Study end-points included pulmonary function, aerobic capacity, strength, and health-related quality of life (HRQL).Conclusions: Exercise training in individuals with CF is beneficial, with aerobic and resistance training having the greatest support in the literature for improved aerobic capacity and strength, respectively. Exercise training does not appear to have an effect of improving pulmonary function, but may have a preservation effect. Strong conclusions about improvement in HQRL from exercise training cannot be made. However, greater consistency in measuring this outcome is needed in future trials. There is a paucity of evidence regarding the role of exercise training in reducing hospitalization and health care utilization, and questions raised by this review should be considered in the design of future trials.Key Words: cystic fibrosis, aerobic exercise, review     

Barriers to Physical Activity in Disadvantaged Population: A Qualitative Comparison between Roma and Non-Roma Women

ABSTRACT

Purpose: Despite the well-known health benefits of physical activity (PA), disadvantaged populations usually have lower PA levels than the rest of the population. Some intra- and interpersonal factors such as different types of barriers to PA may influence PA levels, particularly among disadvantaged adult women. The first aim of this qualitative study was to identify the barriers to PA perceived by disadvantaged adult women. The second aim was to analyse the differences in perceived barriers to PA between adult Roma and non-Roma women. Methods: Eleven disadvantaged adult women participated in the current study (M = 37.72; SD = 8.34), seven of whom belonged to the Roma population. Data were obtained from discussion groups as well as from one-to-one interviews, and these were analysed by NVivo Pro 11. Results: Three categories of perceived barriers to PA were identified: personal (i.e., economy, labour, physical limitations, illness, and psychological characteristics) social (i.e., culture, lack of social support, and family), and environmental. Family was identified as the main common and most frequent barrier to PA in disadvantaged adult women. Differences in perceived barriers to PA between adult Roma and non-Roma women were found. While Roma women perceived culture, physical limitations, and lack of social support barriers to PA, non-Roma women mainly perceived labour-related barriers to PA. Conclusions: Multilevel interventions addressing specific barriers to PA for disadvantaged adult women are required to overcome barriers to PA and, consequently, increase PA levels. Particular attention should be paid to specific barriers to PA among adult Roma and non-Roma women, respectively.     

Perception of Physical Activity Participation of Chinese Female Graduate Students: A Case Study

Purpose: Chinese female international students (CFIS) have been identified as one of the least physically active groups in the United States. In an effort to better understand this situation, this study's purpose was to examine CFIS in American higher education in terms of the meaning they assigned to physical activity and facilitators and barriers they experienced with regard to physical activity participation. Method: Twenty CFIS from a university in the Northwest region of the United States were recruited and interviewed. All of the interviews were conducted in Mandarin Chinese and translated and transcribed into English. The 1-on-1 semistructured interviews lasted between 45 min and 60 min each. Data were analyzed by NVivo8. Results: In terms of meaning, physical activity provided the participants with a break from their academic work, allowed them some alone time, and taught them a process for accomplishing other things in their lives. Major facilitators included social influences, ample available resources, their changing perceptions of femininity, and the need to improve or maintain health. Barriers included a lack of time, low self-efficacy, limited social support, cultural barriers, and a lack of “how-to” information. Conclusions: Understanding the physical activity experiences of CFIS is an important step in the process of promoting their long-term health and well-being. It may behoove universities with growing Chinese international student populations to add more cross-cultural content into their curriculums and fitness programs, increase awareness of cultural differences on campus, and increase accessibility to information in an effort to remove physical activity participation barriers experienced by CFIS.     

当前我国高校体育教学发展

文章主要结合高校体育教学发展中存在的基础设施服务差、教师综合素质有待提高、体育教学评价内容与标准单一、高校体育课程设置与学生的生活脱轨等问题,提出我国高校体育教学的发展趋势有优化高校的体育教学环境,提高学校体育教学管理水平和教师的综合素养,注重体育教学与生活的联系等,旨在为将来高校体育教学模式的构建提供一定的理论基础和技术指导。     

运动干预对老年糖尿病-Ⅱ型患者生命质量的影响

目的:评价运动干预对老年糖尿病-Ⅱ型患者生命质量的影响。方法:将30例老年糖尿病-Ⅱ型患者随机分为运动干预组和对照组,采用规律运动对干预组进行12周干预实验,对照组则不进行任何规律运动,两组均检测血糖等指标、测量体质状况、SF-36量表。结果:实验后干预组与对照组在血糖等指标、体质状况、生命质量各维度得分等方面,差异具有统计学意义。结论:规律性运动干预对老年糖尿病-Ⅱ型患者血糖降低、体质增强有积极的影响,可有效提升患者生命质量。     

Triangulating Clinically Meaningful Change in the Six-minute Walk Test in Individuals with Chronic Heart Failure: A Systematic Review

Purpose

The purpose of the present review was to use existing, published data to provide an estimate of the amount of change in six-minute walk test distance (Δ6MWT) that represents a clinically meaningful change in individuals with chronic heart failure (CHF).

Methods

The present review included two separate literature searches of the CINAHL and Medline databases for articles that: (1) reported the intraclass correlation coefficient (ICC) of the 6MWT in individuals with CHF, and (2) used the 6MWT along with either aerobic capacity or health-related quality of life (HRQL) as study endpoints in randomized controlled trials (RCTs) of exercise-based intervention for individuals with CHF. The ICCs were used to calculate the minimum detectable difference (MDD) at the 95% confidence interval for each included study. The Δ6MWT associated with aerobic capacity and HRQL within-group effect sizes for the intervention and control groups in each included RCT was analyzed using receiver operating characteristic (ROC) curves.

Results

Thirteen articles reported the ICC for the 6MWT. The mean (standard deviation) MDD calculated based on these data was 43.1(16.8) m. Eighteen RCTs measured the 6MWT and either aerobic capacity and/or HRQL. A Δ6MWT of 40–45 m was associated with at least moderate aerobic capacity and HRQL effect sizes in the intervention groups. The Δ6MWT thresholds that discriminated between intervention and control groups using ROC curves revealed the following sensitivity/specificity for the respective thresholds: 19 m, 94.4/83.3%, 32 m, 83.3/94.4%, and 48 m 44.4/100% (AUC = .935, p = .009, CI_95% .855, 1.015).

Conclusions

A Δ6MWT of approximately 45 m appears to exceed measurement error and be associated with significant changes in either aerobic capacity and/or HRQL.Key Words: heart failure, six-minute walk test, clinically meaningful change, minimum detectable difference     

小学生体质健康的影响因素及对策研究

儿童青少年是祖国的未来与希望,在一定程度上直接决定着国家未来的发展。随着“健康中国”和“体育强国”的规划与实施,小学生体质健康再次成为我们国家关注的热点问题。目前,我国中小学生的身体素质、肺活量持续下降,肥胖或超重学生比率增长较快,近视率居高不下。因此为了更好的提升小学生体质健康,促进小学生健康快乐的成长,通过对小学生体质下降的影响因素进行相关调研,发现了目前影响小学生体质健康的因素包括外界因素和自身因素,外界因素包括家庭因素、社会因素和学校因素,自身因素包括学习压力大、睡眠不足、体育锻炼意识不强等。针对出现的相关现状问题,为实现“健康中国”的战略目标和促进小学生体质健康,提出了我们需要注重素质教育,重视创新能力、调整膳食结构,倡导健康生活和加强体育参与,重视体育锻炼的相关对策。     

不同方式运动对慢性阻塞性肺疾病患者肺功能及生存质量影响的Meta分析

目的:评价有氧运动、抗阻运动、瑜伽、传统健身功法4种不同运动对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的影响,从肺功能、6 min步行实验(6 minutes walk test,6MWT)、生存质量3方面,分析比较不同运动方式对慢性阻塞性肺疾病患者肺功能及生存质量的改善效果,有针对性的在慢性阻塞性肺疾病的预防和管理方面提供合理建议和科学依据。方法:建立纳入和排除标准,通过检索PubMed、Web of Science、Embase、Cochrane Library、中国知网(CNKI)、万方等文献数据库,收集运动对慢性阻塞性肺疾病干预的随机对照试验(randomized controlled trial,RCT),运用Revman5.3软件和Stata16.0软件对所纳入文献的结局指标进行分析。结果:共纳入23篇文献,包括1440例受试者,其中实验组719人,对照组721人。Meta分析结果显示,与对照组相比,运动锻炼能够提高COPD患者第1 s用力呼吸容积(forced expiratory volume in the first second,FEV1)(SMD=0.51,95%CI:0.19,0.83,P=0.002)、用力肺活量(forced vital capacity,FVC)(SMD=0.78,95%CI:0.08,1.47,P=0.03)、第1 s用力呼气容积与用力肺活量比值FEV1/FVC(SMD=0.51,95%CI:0.18,1.10,P=0.007)和第1 s用力呼气容积占预计值百分比FEV1/%(SMD=0.35,95%CI:0.10,0.60,P=0.006),延长了6 min步行距离6MWT(SMD=0.49,95%CI:0.33,0.65,P≤0.0001),降低患者呼吸困难指数,提高了生存质量(SMD=-0.59,95%CI:-0.87,-0.31,P≤0.0001)。传统健身功法和有氧运动对COPD患者肺功能、6MWT及生存质量的改善效果更好,抗阻运动和瑜伽虽然在6 min步行距离的加长和生存质量的提高方面效果显著,但在与慢性阻塞性肺疾病最密切相关的肺功能方面的改善效果并不明显。结论:有氧运动、抗阻运动、瑜伽和传统健身功法都对慢性阻塞性肺疾病有一定的预防和改善效果,对肺功能、6MWT及生存质量有明显的改善作用,且传统健身功法和有氧运动的改善效果更全面。     

Self-efficacy for coping with barriers helps students stay physically active during transition to their first year at a university

The present study examined undergraduate students' physical activity during transition from high school to first-year university. Students' (N = 127) self-efficacy for coping with barriers to physical activity was investigated both as a predictor of physical activity and mediator of the relationship between pretransition and first-year physical activity. Physical activity was found to track moderately from pretransition to first year (rs = .58). Self-efficacy for coping with barriers predicted physical activity (R2adjusted = .18, p < .05) and partially mediated the relationship between pretransition and first-year physical activity. Results support an interpretation that future intervention efforts could target first-year students' self-efficacy for coping with barriers to help curb the decline in physical activity that occurs during the transition to university life.