Clinically Meaningful Change Estimates for the Six-Minute Walk Test and Daily Activity in Individuals With Chronic Heart Failure

Purpose

The purpose of the present pilot study was to provide a preliminary estimate of the minimum detectable difference (MDD) and minimum clinically important difference (MCID) of the six-minute walk test (6MWT) and daily activity in outpatients with chronic heart failure (CHF).

Methods

A convenience sample of 22 adults with stable New York Heart Association Functional Class II and III CHF performed two baseline 6MWTs separated by 30 minutes of rest. Subjects then wore a triaxial accelerometer for 7 days to monitor daily activity. After 7 weeks of usual care, subjects again wore the accelerometer for 7 days and then returned to the clinic to complete the Global Rating of Change Scale (GRS) with regard to their heart disease and perform another set of 6MWTs. For the 6MWT, the MDD was calculated using the two baseline 6MWT distances. For daily activity, the MDD was calculated using two methods: (1) day-to-day test-retest reliability during baseline monitoring, and (2) baseline to follow-up test-retest reliability in those who reported no change on the GRS. The MCID for the 6MWT and daily activity was calculated using the mean and 95% confidence interval (CI_95%) for those subjects who reported ‘improvement’ on the GRS.

Results

The MDD at the CI_95% for the 6MWT was 32.4 meters. The MCID for the 6MWT was 30.1 (CI_95% 20.8, 39.4) meters. The MDD for daily activity was 5,909 vector magnitude units (VMU·hr.⁻¹) The MCID for daily activity was 1,337 VMU·hr.⁻¹ There was good alignment of the MDD and MCID for the 6MWT, suggesting that clinically meaningful change is approximately 32 meters. However, the calculated MCID was substantially less than measurement error as represented by the MDD, indicating that the MCID was underestimated in this sample or that daily activity may be robust to change in overall disease status.Key Words: six-minute walk test, daily activity, heart failure, clinically meaningful change     

Lack of Relationship Between Functional and Perceived Quality of Life Outcomes Following Pulmonary Rehabilitation

Individuals with chronic obstructive pulmonary disease (COPD) have been shown to benefit from participation in pulmonary rehabilitation (PR) programs that include exercise training and education. Purpose: To examine the relationship between improvements in 6 minute walk distance and perceived quality of life in individuals with COPD following completion of a PR program. Methods: The records of 139 individuals completing a PR program (3 times a week for 8 weeks) were retrospectively examined. Prior to entry and upon completion of the program each individual completed a 6 minute walk test (6MWT), the SF-36 Health survey, and the UCSD Shortness of Breath Questionnaire (SOB). SF-36 results were analyzed according to 8 subscales [Physical Functioning (PF), Role Physical (RF), Bodily Pain (BP), General Health (GH), Vitality (V), Social Functioning (SF), Role Emotional (RE), and Mental Health (MH)]. Results: PR resulted in significant improvements in 6MWTdistance (Pre = 845 ± 37 ft, Post = 1127 ± 32 ft, p < 0.001), PF (p < 0.001), RF (p = 0.001), Vitality (p = 0.002), SF (p < 0.001), RE (p = 0.037), MH (p < 0.001) and SOB (Pre = 53 ± 2, Post = 47 ± 2, p < 0.001). The change in 6MWT distance was not related to changes in PF (r = 0.17), RF (r = 0.03), GH (r = 0.03), Vitality (r = −0.001), SF (r = 0.01), RE (r = 0.06), MH (r = −0.04) or SOB (r = 0.12). The magnitude of improvement in 6MWT distance (68%) was much greater than that observed in PF (15%), RF (16%), GH (6%), VT (18%), SF (20%), RE (14%), MH (14%), or SOB (8%). Conclusions: PR has a positive impact on 6 minute walk distance and perceived quality of life in individuals with COPD; however, changes in 6 minute walk distance appear to have no relationship to changes in perceived quality of life.     

Inter-individual differences in the responses to aerobic exercise in Alzheimer’s disease: Findings from the FIT-AD trial

Background:Despite the strong evidence of aerobic exercise as a disease-modifying treatment for Alzheimer’s disease(AD)in animal models,its effects on cognition are inconsistent in human studies.A major contributor to these findings is inter-individual differences in the responses to aerobic exercise,which was well documented in the general population but not in those with AD.The purpose of this study was to examine inter-individual differences in aerobic fitness and cognitive responses to a 6-month aerobic exercise intervention in community-dwelling older adults with mild-to-moderate dementia due to AD.Methods:This study was a secondary analysis of the Effects of Aerobic Exercise for Treating Alzheimer’s Disease(FIT-AD)trial data.Aerobic fitness was measured by the shuttle walk test(SWT),the 6-min walk test(6MWT),and the maximal oxygen consumption(VO2max)test,and cognition by the AD Assessment Scale-Cognition(ADAS-Cog).Inter-individual differences were calculated as the differences in the standard deviation of 6-month change(SDR)in the SWT,6MWT,VO2max,and ADAS-Cog between the intervention and control groups.Results:Seventy-eight participants were included in this study(77.4±6.3 years old,mean±SD;15.7±2.8 years of education;41%were female).VO2max was available for 26 participants(77.7±7.1 years old;14.8±2.6 years of education;35%were female).The SDR was 37.0,121.1,1.7,and 2.3 for SWT,6MWT,VO2max,and ADAS-Cog,respectively.Conclusion:There are true inter-individual differences in aerobic fitness and cognitive responses to aerobic exercise in older adults with mild-tomoderate dementia due to AD.These inter-individual differences likely underline the inconsistent cognitive benefits in human studies.     

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     

Tai Ji Quan as antihypertensive lifestyle therapy: A systematic review and meta-analysis

BackgroundProfessional health organizations are not currently recommending Tai Ji Quan alongside aerobic exercise to treat hypertension. We aimed to examine the efficacy of Tai Ji Quan as antihypertensive lifestyle therapy.MethodsTai Ji Quan interventions published in English and Chinese were included when they involved healthy adults, reported pre- and post-intervention blood pressure (BP), and had a non-exercise/non-diet control group. We systematically searched 11 electronic databases for studies published through July 31, 2018, yielding 31 qualifying controlled trials. We (1) evaluated the risk of bias and methodological study quality, (2) performed meta-regression analyses following random-effects assumptions, and (3) generated additive models representing the largest possible clinically relevant BP reductions.ResultsParticipants (n = 3223) were middle-aged (56.6 ± 15.1 years of age, mean ± SD) adults with prehypertension (systolic BP (SBP) = 136.9 ± 15.2 mmHg, diastolic BP (DBP) = 83.4 ± 8.7 mmHg). Tai Ji Quan was practiced 4.0 ± 1.4 sessions/week for 54.0 ± 10.6 min/session for 22.3 ± 20.2 weeks. Overall, Tai Ji Quan elicited significant reductions in SBP (–11.3 mmHg, 95%CI: –14.6 to –8.0; d₊ = –0.75) and DBP (–4.8 mmHg, 95%CI: –6.4 to –3.1; d₊ = –0.53) vs. control (p < 0.001). Controlling for publication bias among samples with hypertension, Tai Ji Quan trials published in English elicited SBP reductions of 10.4 mmHg and DBP reductions of 4.0 mmHg, which was half the magnitude of trials published in Chinese (SBP reductions of 18.6 mmHg and DBP reductions of 8.8 mmHg).ConclusionOur results indicate that Tai Ji Quan is a viable antihypertensive lifestyle therapy that produces clinically meaningful BP reductions (i.e., 10.4 mmHg and 4.0 mmHg of SBP and DBP reductions, respectively) among individuals with hypertension. Such magnitude of BP reductions can lower the incidence of cardiovascular disease by up to 40%.     

Cardiovascular fitness and haemodynamic responses to maximal cycle ergometer exercise test in children 6–8 years of age

Abstract

We investigated cardiovascular fitness and haemodynamic responses to maximal cycle ergometer exercise test in children. The participants were a population sample of 425 children (204 girls, 221 boys) aged 6–8 years. Heart rate (HR) and systolic blood pressure (SBP) were measured from the beginning of pre-exercise rest to the end of recovery period. We provided reference values for peak workload and changes in HR and SBP during and after maximal exercise test in girls and boys. Girls had a lower cardiovascular fitness, indicated by peak workload per body weight [mean (2 s) 2.7 (0.9) vs. 3.1 (1.0) W · kg^–1, P < 0.001] and lean mass [mean (2 s) 3.5 (0.9) vs. 3.8 (1.0) W· kg^–1, P < 0.001] than boys. Plateau or decline in SBP close to the end of the test was found in about third of children and was considered a normal SBP response. Girls had a slower HR decrease within 2 min after the test than boys [mean (2 s) 53 (18) vs. 59 (22) beats · min^–1, P < 0.001]. The results are useful for physicians and exercise physiologists to evaluate cardiovascular fitness and haemodynamic responses to exercise in children and to detect children with low exercise tolerance or abnormal haemodynamic responses to exercise.     

Associations of physical activity,sedentary time,and physical fitness with mental health during pregnancy: The GESTAFIT project

PurposeThis study was aimed to analyze the associations of objectively measured physical activity (PA), sedentary time, and physical fitness with mental health in the early second trimester (16 ± 2 gestational weeks) of pregnancy.MethodsFrom 229 women initially contacted, 124 pregnant women participated in the present cross-sectional study. Data were collected between November 2015 and March 2017. The participants wore Actigraph GT3X+ Triaxial accelerometers for 9 consecutive days to objectively measure their PA levels and sedentary time. A performance-based test battery was used to measure physical fitness. Self-report questionnaires assessed psychological ill-being (i.e., negative affect, anxiety, and depression), and psychological well-being (i.e., emotional intelligence, resilience, and positive affect). Linear regression analyses were adjusted for age, educational level, accelerometer wear time, miscarriages, and low back pain.ResultsModerate-to-vigorous PA was negatively associated with depression (β = –0.222, adjusted R² = 0.050, p = 0.041). Higher levels of sedentary time were negatively associated with positive affect (β = –0.260, adjusted R² = 0.085, p = 0.017). Greater upper-body flexibility was positively associated with better emotional regulation (β = 0.195, adjusted R²= 0.030, p = 0.047). The remaining associations were not significant (all p > 0.05).ConclusionAn active lifestyle characterized by higher levels of moderate-to-vigorous PA and lower levels of sedentary time during pregnancy might modestly improve the mental health of pregnant women. Although previous research has focused on the benefits of cardiorespiratory exercise, the present study shows that only upper-body flexibility is related to emotional regulation in early pregnant women. If the present findings are corroborated in further experimental research, physical exercise programs should focus on enhancing flexibility to promote improvements in emotional regulation during early second-trimester of pregnancy.     

Outcomes of an Education and Exercise Program for Adults with Type 2 Diabetes,and Comorbidities that Limit their Mobility: A Preliminary Project Report

Purpose: Some adults with type 2 diabetes mellitus (T2DM) have comorbidities and mobility impairments that limit their exercise capacity. In consideration of this, we developed and piloted a program called Active Steps for Diabetes for people with T2DM, comorbidities, and mobility impairments. The purpose of this paper was to report outcomes for the pilot program. Methods: Active Steps for Diabetes, an 8-week program, included instruction on diabetes self-care andgroup and home exercise programs. Twenty-two females (62.7 ± 6.1yrs) with T2DM and self-reported mobility impairments completed the program. Six participants used a walking aid. Outcome measures included two risk factors for coronary artery disease [daily physical activity and body mass index (BMI)], cardiovascular fitness (6-minute walk distance), and knowledge of diabetes-specific exercise guidelines. A two-way repeated measures ANOVA was used to compare outcomes before and after the program and between participants who did and did not use a walking aid. Results: Active Steps for Diabetes was effective in increasing daily physical activity in both groups of subjects (walking aid group: 2.6 days/week [95% confidence interval (CI) = 2.1 to 3.3]; no walking aid group: 1.9 days/week [95% CI=1.2 to 2.5]). This was accompanied by increases in 6-minute walk distances (walking aid group: 54.0 m [95% CI = 36.4 to 71.6]; no walking aid group: 62.6 m [95% CI=55.7 to 69.4]). Changes in BMI were not significant (walking aid group: −0.4 [95% CI = −1.2 to 0.4]; no walking aid group: −.24[95% CI = −.91 to .44]). Increases in knowledge of diabetes-specific exercise guidelines were observed in both groups (walking aid group: 18.8% [95% CI = 11.3 to 26.4]; no walking aid group: 19.3% [95% CI = 16.1 to 22.5]). Discussion:: Physical inactivity and low cardiovascular fitness are predictors of CAD morbidity and mortality in adults with T2DM. This pilot program suggests that a model for diabetes education, incorporating exercise programs developed by a physical therapist, may increase physical activity, improve endurance, and thereby potentially reduce CAD risk in people with T2DM and mobility impairments from comorbidities.Key Words: type 2 diabetes, physical activity     

Influence of ingesting a carbohydrate‐electrolyte solution on endurance capacity during intermittent,high‐intensity shuttle running

The aim of this study was to examine the effects of ingesting a carbohydrate‐electrolyte solution on endurance capacity during a prolonged intermittent, high‐intensity shuttle running test (PIHSRT). Nine trained male games players performed two exercise trials, 7 days apart. On each occasion, they completed 75 min exercise, comprising of five 15‐min periods of intermittent running, consisting of sprinting, interspersed with periods of jogging and walking (Part A), followed by intermittent running to fatigue (Part B). The subjects were randomly allocated either a 6.9% carbohydrate‐electrolyte solution (CHO) or a non‐carbohydrate placebo (CON) immediately prior to exercise (5 ml kg^‐1 body mass) and every 15 min thereafter (2 ml kg^‐1 body mass). Venous blood samples were obtained at rest, during and after each PIHSRT for the determination of glucose, lactate, plasma free fatty acid, glycerol, ammonia, and serum insulin and electrolyte concentrations. During Part B, the subjects were able to continue running longer when fed CHO (CHO = 8.9 ± 1.5 min vs CON = 6.7 ± 1.0 min; P < 0.05) (mean ± s.e.m.). These results show that drinking a carbohydrate‐electrolyte solution improves endurance running capacity during prolonged intermittent exercise.     

Building muscle: nutrition to maximize bulk and strength adaptations to resistance exercise training

Abstract

Several nutritional strategies can optimize muscle bulk and strength adaptations and enhance recovery from heavy training sessions. Adequate energy intake to meet the needs of training and carbohydrate intake sufficient to maintain glycogen stores (>7 g carbohydrate·kg^?1·day^?1 for women; >8 g carbohydrate·kg^?1·day^?1 for men) are important. Dietary protein intake for top sport athletes should include some foods with high biological value, with a maximum requirement of approximately 1.7 g·kg^?1·day^?1 being easily met with an energy sufficient diet. The early provision of carbohydrate (>1 g·kg^?1) and protein (>10 g) early after an exercise session will enhance protein balance and optimize glycogen repletion. Creatine monohydrate supplementation over several days increases body mass through water retention and can increase high-intensity repetitive ergometer performance. Creatine supplementation can enhance total body and lean fat free mass gains during resistance exercise training; however, strength gains do not appear to be enhanced versus an optimal nutritional strategy (immediate post-exercise protein and carbohydrate). Some studies have suggested that β-OH-methyl butyric acid (β-HMB) can enhance gains made through resistance exercise training; however, it has not been compared “head to head” with optimal nutritional practices. Overall, the most effective way to increase strength and bulk is to perform sport-specific resistance exercise training with the provision of adequate energy, carbohydrate, and protein. Creatine monohydrate and β-HMB supplementation may enhance the strength gains made through training by a small margin but the trade-off is likely to be greater bulk, which may be ergolytic for any athlete participating in a weight-supported activity.     

The effect of acute aerobic exercise on central arterial stiffness,wave reflections,and hemodynamics in adults with diabetes: A randomized cross-over design

BackgroundIndividuals with diabetes have greater central arterial stiffness, wave reflections, and hemodynamics, all of which promote the accelerated cardiovascular pathology seen in this population. Acute aerobic exercise has been shown to be an effective strategy for reducing central arterial stiffness, wave reflections, and hemodynamics in healthy individuals; however, the effects of acute aerobic exercise in reducing these outcomes is not well established in people with diabetes. Recently, implementation of high-intensity interval exercise (HIIE) has shown superior improvements in cardiovascular health outcomes when compared to traditional aerobic exercise. Yet, the effect of HIIE on the aforementioned outcomes in people with diabetes is not known. The purpose of this study was to (i) describe the central arterial stiffness, wave reflections, and hemodynamic responses to a bout of HIIE and moderate-intensity continuous exercise (MICE) in adults with diabetes; and (ii) compare the effects of HIIE and MICE on the aforementioned outcomes.MethodsA total of 24 adult men and women (aged 29–59 years old) with type 1 (n = 12) and type 2 (n = 12) diabetes participated in a randomized cross-over study. All participants completed the following protocols: (i) HIIE: cycling for 4 × 4 min at 85%–95% of heart rate peak (HR_peak), interspersed with 3 min of active recovery at 60%–70%HR_peak; (ii) MICE: 33 min of continuous cycling at 60%–70%HR_peak; and (iii) control (CON): lying quietly in a supine position for 30 min.ResultsA significant group × time effect was found for changes in central systolic blood pressure (F = 3.20, p = 0.01) with a transient reduction for the HIIE group but not for the MICE or CON groups. There was a significant group × time effect for changes in augmentation index at a heart rate of 75 beats/min (F = 2.32, p = 0.04) with a decrease following for HIIE and MICE but not for CON. For all other measures of central arterial stiffness and hemodynamics, no significant changes were observed (p > 0.05).ConclusionA bout of HIIE appears to lead to a greater transient reduction in central systolic blood pressure than the reduction observed following MICE; however, both HIIE and MICE improved augmentation index at a heart rate of 75 beats/min in people with diabetes. There was no significant difference in response to HIIE and MICE in all outcomes. This provides preliminary evidence on the role of HIIE on such outcomes in people with diabetes.     

Home IV Antibiotic Therapy and Exercise Capacity in Children with CF: A Case Series

Purpose: This case series describes the effect of home intravenous (IV) antibiotic therapy on spirometry and exercise capacity in a group of children with cystic fibrosis (CF). Methods: Outcomes from 10 children with CF who were prescribed a 14-day course of home IV antibiotics for a respiratory exacerbation are reported. All children performed spirometry and a modified shuttle test (MST) before and after 14-days of home IV therapy. Results: After 14 days, FEV₁ increased by mean (± SE) 12 ± 4 % (p < 0.05) but mean MST did not improve compared to baseline. All children improved or maintained spirometry values with treatment, however, only 5 improved MST distance. Conclusion: After 14 days of home IV antibiotic therapy, a significant improvement in spirometry, but not exercise capacity, was seen in this small series of children with CF. The lack of improvement in exercise capacity for all children following home IV antibiotic therapy suggests factors other than spirometry determine exercise capacity. Identifying and investigating the factors that influence exercise capacity during home IV antibiotic therapy requires further investigation.Key Words: cystic fibrosis, home IV therapy, FEV₁, Modified Shuttle Test     

Training load characteristics and injury and illness risk identification in elite youth ski racing: A prospective study

PurposeThe study aimed to investigate the role of training load characteristics and injury and illness risk in youth ski racing.MethodsThe training load characteristics as well as traumatic injuries, overuse injuries, and illnesses of 91 elite youth ski racers (age = 12.1 ± 1.3 years, mean ± SD) were prospectively recorded over a period of 1 season by using a sport-specific online database. Multiple linear regression analyses were performed to monitor the influence of training load on injuries and illnesses. Differences in mean training load characteristics between preseason, in-season, and post-season were calculated using multivariate analyses of variance.ResultsDifferences were discovered in the number of weekly training sessions (p = 0.005) between pre-season (4.97 ± 1.57) and post-season (3.24 ± 0.71), in the mean training volume (p = 0.022) between in-season (865.8 ± 197.8 min) and post-season (497.0 ± 225.5 min) and in the mean weekly training intensity (Index) (p = 0.012) between in-season (11.7 ± 1.8) and post-season (8.9 ± 1.7). A total of 185 medical problems were reported (41 traumatic injuries, 12 overuse injuries, and 132 illnesses). The weekly training volume and training intensity was not a significant risk factor for injuries (p > 0.05). Training intensity was found to be a significant risk factor for illnesses in the same week (β = 0.348; p = 0.044; R² = 0.121) and training volume represents a risk factor for illnesses in the following week (β = 0.397; p = 0.027; R² = 0.157).ConclusionA higher training intensity and volume were associated with increased illnesses, but not with a higher risk of injury. Monitoring training and ensuring appropriate progression of training load between weeks may decrease incidents of illness in-season.     

Impaired eye tracking is associated with symptom severity but not dynamic postural control in adolescents following concussion

Purpose:The purpose of the study was to(1)examine the relationship between self-reported symptoms and concussion-related eye tracking impairments,and(2)compare gait performance between(a)adolescents with a concussion who have normal eye tracking,(b)adolescents with a concussion who have abnormal eye tracking,and(c)healthy controls.Methods:A total of 30 concussed participants(age:14.4±2.2 years,mean±SD,50%female)and 30 controls(age:14.2±2.2 years,47%female)completed eye tracking and gait assessments.The BOX score is a metric of pupillary disconjugacy,with scores<10 classified as normal and≥10 abnormal.Symptoms were collected using the Post-Concussion Symptom Scale(PCSS),and gait speed was measured with triaxial inertial measurement units.We conducted a linear regression to examine the relationship between PCSS and BOX scores and a two-way mixed effects analysis of variance to examine the effect of group(abnormal BOX,normal BOX,and healthy control)on single-and dual-task gait speed.Results:There was a significant association between total PCSS score and BOX score in the concussion group(β=0.16,p=0.004,95%confidence interval(95%CI):0.06‒0.27),but not in the control group(β=0.21,p=0.08,95%CI:
0.03 to 0.45).There were no significant associations between PCSS symptom profiles and BOX scores in the concussion or control groups.There were also no significant differences in singletask(Abnormal:1.00±0.14 m/s;Normal:1.11§0.21 m/s;Healthy:1.14±0.18 m/s;p=0.08)or dual-task(Abnormal:0.77±0.15 m/s;Normal:0.84±0.21 m/s;Healthy:0.90±0.18 m/s;p=0.16)gait speed.Conclusion:The concussed group with impaired eye tracking reported higher total symptom severity,as well as worse symptom severity across the 5 PCSS symptom domain profiles.However,eye tracking deficits did not appear to be driven by any particular symptom domain.While not statistically significant,the slower gait speeds in those with abnormal BOX scores may still be clinically relevant since gait-related impairments may persist beyond clinical recovery.     

Parasympathetic activity delayed after self-paced exercise

The main purpose of this study was to compare the effect of the constant load and self-paced exercise with similar total work on autonomic control after endurance exercise. Ten physically active men were submitted to (i) a maximal incremental exercise test, (ii) a 4-km cycling time trial (4-km TT), and (iii) a constant workload test with identical total external work performed at 4-km TT. Gas exchange was measured throughout the tests, while blood lactate, heart rate, and heart rate variability (HRV) were measured during the passive recovery. Power output measured at the last lap (i.e. 3600–4000?m) of 4-km TT (316?±?89?W) was statistically higher than power output measured at the end of the constant workload exercise (211?±?42?W). The 4-km TT produced higher values of blood lactate concentration (8.8?±?2.1?mmol?L^?1) than the constant workload test (7.8?±?2.1?mmol?L^?1). The heart rate recovery measured at 60?s (constant workload: 37?±?7?bpm; 4-km TT: 30?±?6) and 120?s (constant workload: 57?±?9?bpm; 4-km TT: 51?±?9?bpm) were higher in the constant workload than in the self-paced exercise. The HRV (i.e. RMSSD30s) was statistically higher in the constant load exercise measured at 120, 420, 450, 480, 540, and 570?s than the self-paced exercise. These findings suggest that the autonomic control responses were dependent of the endurance exercise modalities, with parasympathetic activity being delayed after self-paced exercise, as evidenced by post-exercise heart rate indices.     

Longitudinal monitoring of power output and heart rate profiles in elite cyclists

Abstract

Power output and heart rate were monitored for 11 months in one female ([Vdot]O_2max: 71.5 mL · kg^?1 · min^?1) and ten male ([Vdot]O_2max: 66.5 ± 7.1 mL · kg^?1 · min^?1) cyclists using SRM power-meters to quantify power output and heart rate distributions in an attempt to assess exercise intensity and to relate training variables to performance. In total, 1802 data sets were divided into workout categories according to training goals, and power output and heart rate intensity zones were calculated. The ratio of mean power output to respiratory compensation point power output was calculated as an intensity factor for each training session and for each interval during the training sessions. Variability of power output was calculated as a coefficient of variation. There was no difference in the distribution of power output and heart rate for the total season (P = 0.15). Significant differences were observed during high-intensity workouts (P < 0.001). Performance improvements across the season were related to low-cadence strength workouts (P < 0.05). The intensity factor for intervals was related to performance (P < 0.01). The variability in power output was inversely associated with performance (P < 0.01). Better performance by cyclists was characterized by lower variability in power output and higher exercise intensities during intervals.     

Six Minute Walk Test in People with Tuberculosis Sequelae

Background & Purpose: Tuberculosis is an infectious disease that affects the lungs and results in poor lung compliance secondary to diffuse fibrotic changes to lung tissue. Consequently, people with pulmonary tuberculosis experience impaired gas exchange resulting in a decline in functional capacity. The purpose of this study was to evaluate the physical functional capacity (VO₂max) in a group of older (50 – 65 years) people with pulmonary tuberculosis and to compare them to an age-matched healthy group. A secondary purpose was to develop reference equations that could be used to predict 6 minute walk test (6MWT) distance in older, healthy people in India. Methods: Sixty healthy subjects (30 male and 30 female) and 60 subjects with a diagnosis of pulmonary tuberculosis (30 male and 30 female) participated in the study. All subjects underwent a 6MWT. Walk-work was calculated and used for evaluating functional capacity. Group comparison for functional capacity was done using 2-tailed t-tests. Pearson product correlation was used to examine for significant relationships and regression analysis was used to derive reference equations. Results: There was a significant difference between groups in regard to functional capacity and 6MWT distance (p < 0.001). Reference equations were developed that use age, height, and weight as predictors for 6MWT distance in the healthy group. Conclusion: The sequelae from pulmonary tuberculosis have considerable impact on functional capacity in older people in India.Key Words: six minute walk test, tuberculosis, functional capacity     

The effect of pre-exercise carbohydrate feedings on the intensity that elicits maximal fat oxidation

The aim of the present study was to examine the effect of ingesting 75?g of glucose 45?min before the start of a graded exercise test to exhaustion on the determination of the intensity that elicits maximal fat oxidation (Fat_max). Eleven moderately trained individuals ( V?O_2max: 58.9±1.0?ml?·?kg^?1?·?min^?1; mean±s_x¯ ), who had fasted overnight, performed two graded exercise tests to exhaustion, one 45?min after ingesting a placebo drink and one 45?min after ingesting 75?g of carbohydrate in the form of glucose. The tests started at 95?W and the workload was increased by 35?W every 3?min. Gas exchange measures and heart rate were recorded throughout exercise. Fat oxidation rates were calculated using stoichiometric equations. Blood samples were collected at rest and at the end of each stage of the test. Maximal fat oxidation rates decreased from 0.46±0.06 to 0.33±0.06?g?·?min^?1 when carbohydrate was ingested before the start of exercise (P?<0.01). There was also a decrease in the intensity which elicited maximal fat oxidation (60.1±1.9% vs 52.0±3.4% V?O_2max) after carbohydrate ingestion (P?<0.05). Maximal power output was higher in the carbohydrate than in the placebo trial (346±12 vs 332±12?W) (P?<0.05). In conclusion, the ingestion of 75?g of carbohydrate 45?min before the onset of exercise decreased Fat_max by 14%, while the maximal rate of fat oxidation decreased by 28%.     

Carbohydrate ingestion and soccer skill performance during prolonged intermittent exercise

Abstract

The aim of this study was to investigate the effect of ingesting a carbohydrate-electrolyte solution, during the 90-min Loughborough Intermittent Shuttle Test, on soccer skill performance. Seventeen male soccer players ingested either a 6.4% carbohydrate-electrolyte solution or placebo solution equivalent to 8 ml · kg^?1 body mass before exercise and 3 ml · kg^?1 body mass after every 15 min of exercise, in a double-blind randomized cross-over design, with the trials separated by 7 days. The evening before the main trial, the participants performed glycogen-reducing exercise on a cycle ergometer (80 min at 70%[Vdot]O_2max) and were then fed a low-carbohydrate meal. After a 12-h overnight fast, they performed The Loughborough Soccer Passing Test before and after every 15 min of exercise. Analysis of the combined skill test data showed a significant time effect (P = 0.001) with differences between 0–45 and 75–90 min (P < 0.05). There was a 3% reduction in skill performance from before to after exercise in the carbohydrate-electrolyte trial, whereas in the placebo trial the decrease was 14% (P = 0.07). In conclusion, skill performance during the simulated soccer activity appeared to deteriorate in the last 15–30 min of exercise. However, providing 52 g · h^?1 carbohydrate during exercise showed a tendency to better maintain soccer skill performance than a taste-matched placebo.     

The diagnostic and prognostic utility of the dual-task tandem gait test for pediatric concussion

Background:The tandem gait test has gained interest recently for assessment of concussion recovery.The purpose of our study was to determine the prognostic and diagnostic use of the single-and dual-task tandem gait test,alongside other clinical measures,within 10 days of pediatric concussion.Methods:We assessed 126 patients post-concussion(6.3§2.3 days post-injury,mean§SD)at a pediatric sports medicine clinic and compared them to 58 healthy controls(age:15.6§1.3 years;43%female).We also compared the 31 patients with concussion who developed persistent post-concussion symptoms(PPCS)(age=14.9§2.0 years;48%female)to the 81 patients with concussion who did not develop PPCS following the initial assessment(age:14.1§3.0 years;41%female).All subjects completed a test battery,and concussion patients were monitored until they experienced concussion-symptom resolution.The test battery included tandem gait(single-task,dual-task(performing tandem gait while concurrently completing a cognitive test)conditions),modified Balance Error Scoring System(mBESS),and concussion symptom assessment(Health and Behavior Inventory).We defined PPCS as symptom resolution time>28 days post-concussion for the concussion group.Measurement outcomes included tandem gait time(single-and dual-task),dual-task cognitive accuracy,mBESS errors(single/double/tandem stances),and symptom severity.Results:The concussion group completed the single-task(mean difference=9.1 s,95%confidential interval(95%CI):6.1-12.1)and dual-task(mean difference=12.7 s,95%CI:8.7
16.8)tandem gait test more slowly than the control group.Compared to those who recovered within 28 days of concussion,the PPCS group had slower dual-task tandem gait test times(mean difference=7.9 s,95%CI:2.0-13.9),made more tandem-stance mBESS errors(mean difference=1.3 errors,95%CI:0.2-2.3),and reported more severe symptoms(mean difference=26.6 Health and Behavior Inventory rating,95%CI:21.1-32.6).Conclusion:Worse dual-task tandem gait test time and mBESS tandem stance performance predicted PPCS in pediatric patients evaluated within 10 days of concussion.Tandem gait assessments may provide valuable information augmenting common clinical practices for concussion management.