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     

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     

Inspiratory Muscle Training in Patients with Heart Failure: A Systematic Review

Purpose

The purpose of this review was to assess the quality of evidence on inspiratory muscle training (IMT) in patients with heart failure and to provide an overview on subject selection, training protocols, and outcome achieved with IMT.

Methods

Literature search was first performed via the PubMed database, and additional references were identified from the Scopus citation index. Articles of the review type and of clinical trials published in English were included. Quality of the articles was assessed using Sackett''s levels of evidence and rigor of methodology was assessed using PEDro (Physiotherapy Evidence Database) criteria for randomized controlled trials and the Downs & Black tool for cohort studies.

Results

Twelve articles of clinical trials were included. Typical training protocols involved daily training with intensity greater than 30% of maximal inspiratory pressure (PImax), duration of 20 to 30 minutes (continuous or incremental) and using a pressure threshold muscle trainer. The effect sizes of PImax, walk test distance, and dyspnea were moderate to large across these studies. Effects on quality of life scores were inconsistent.

Conclusion

Inspiratory muscle training is beneficial for improving respiratory muscle strength, functional capacity, and dyspnea in patients with stable heart failure and respiratory muscle weakness.Key Words: inspiratory muscle training, heart failure, maximal inspiratory pressure     

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     

脑卒中患者核心肌群功能训练研究进展

脑卒中已成为威胁人类生命安全的常见疾病,运动功能障碍严重制约患者的生存质量。临床康复以肢体功能恢复为主,躯干核心肌群功能训练容易被忽略,随着核心训练成为临床康复的研究热点,越来越多研究证明其对脑卒中患者有益。本文综述了近年来国内外近年来国内外有关脑卒中患者核心肌群训练的最新研究进展,从训练机制、训练方法、功能应用等方面进行论述,完善核心肌群训练的临床理论基础,为今后的研究提供参考,以期为治疗师和研究人员提供康复治疗新思路。     

Effects of Exercise Training versus Attention on Plasma B-type Natriuretic Peptide, 6-Minute Walk Test and Quality of Life in Individuals with Heart Failure

Purpose

The purpose of this study was to compare an Exercise Training Group (EX) with an Attention-Control Group (AT-C) to more specifically assess the impact of exercise training on individuals with heart failure (HF).

Methods

Forty-two individuals with HF were randomized to AT-C or EX that met with the same frequency and format of investigator interaction. Baseline, 12- and 24-week measurements of B-type naturetic peptide (BNP), 6-minute walk test (6-MWT), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) were obtained.

Results

BNP tended to increase in the AT-C while remaining stable in the EX over time. A clinically significant increase in 6-MWT was demonstrated by the EX but not the AT-C. The EX achieved a clinically significant change on the KCCQ at 12 weeks, with further improvement by 24 weeks, while the AT-C demonstrated a clinically significant change at 24 weeks.

Conclusions

Attention alone was inadequate to positively impact BNP levels or 6-MWT distances, but did have a positive impact on quality of life after 24 weeks. Although exercise offers enhanced benefits, individuals with HF unable to participate in an exercise program may still gain quality of life benefits from participation in a peer-support group that discusses topics pertinent to HF.Key Words: heart failure, attention, exercise     

慢性心衰病人的运动能力与骨骼肌改变

通过文献综述法,对慢性心衰中存在的骨骼肌病变进行总结。结果表明：慢性心衰病人的主要症状下肢疲劳,运动能力下降,不仅是心功能下降导致的,同时还有骨骼肌本身的病变。心衰病人的预后与心功能指标的相关性较差,而与运动能力下降的程度相关性较高。改善病人的心输出量并不能很快提高心衰病人的运动能力,说明除了心功能的改变,也存在着骨骼肌本身的改变。建议：重视心衰病人的骨骼肌病变,进行合理的运动康复,设计以骨骼肌为靶点的药物将有助于提高心衰病人的生活质量,改善心功能。     

Early Mobilization in the Intensive Care Unit: A Systematic Review

Purpose

The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety.

Methods

We searched the electronic databases of PubMed, CINAHL, Medline (Ovid), and The Cochrane Library for a period spanning 2000–2011. Articles used in this review included randomized and nonrandomized clinical trials, prospective and retrospective analyses, and case series in peer-reviewed journals. Sackett''s Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported.

Results

Fifteen studies met inclusion criteria and were reviewed. According to Sackett''s Levels of Evidence, 9 studies were level 4 evidence, one study was level 3, 4 studies were level 2, and one study was level one evidence. Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories.

Conclusion

A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit. However, literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes.Key Words: mobilization, exercise, intensive care unit, critical illness, physical therapy     

Facilitators and Barriers to Movement Integration in Elementary Classrooms: A Systematic Review

Purpose: A systematic review was conducted to identify facilitators and barriers to movement integration (MI) in elementary school classrooms. Method: Online databases (Educational Resources Information Center, Google Scholar, PsycINFO, and PubMed) served as data sources for the study. Following the PRISMA guidelines, relevant published research on MI was identified and screened for inclusion in a qualitative synthesis. Content analysis of the included articles (N = 28) was used to identify themes of MI facilitators and barriers. Facilitators and barriers were then categorized using a social-ecological framework. Results: A total of 12 themes of MI facilitators and barriers were identified and categorized into two social-ecological levels: institutional factors (e.g., administrative support, resources) and intrapersonal factors (e.g., teacher confidence, ease of implementation). Conclusion: This review can inform research and practice aimed at supporting the implementation of MI in elementary classrooms.     

球类项目灵敏测试的实践应用:基于信度与效度评价的系统综述

目的：对国内外经检验的球类运动灵敏测试方法的设计结构、信度和效度进行系统综述,为球类运动灵敏素质的评价提供更科学的测试方法。方法：通过数据库对相关关键词进行检索并搜集符合标准的文献,运用PE-Dro评分系统对文献进行质量评估。结果：共纳入33篇文献,质量评价平均得分15分,得分范围13~17分。所有搜集文献共包含59种测试方法,37种为改变方向速度测试（CODT）,22种为反应灵敏测试（RAT）。结果：CODT设计的移动距离相对更长,改变方向的次数相对更多,两类测试方法的变向角度主要采用45°、90°和180° ;CODT的组内相关系数（ICC）范围为0.5~0.99,RAT的ICC为0.33~0.99,3篇文献发现较低的信度且均为RAT ;效度检验主要通过区分运动员水平、比赛位置以及年龄段来实现。结论：球类项目灵敏素质评价主要应用CODT与RAT两类测试方法。由于设计结构的差异,两类方法在信度和效度上各有优劣。CODT具有相对更高的信度,RAT则具有相对更高的效度。认知与决策能力作为高水平球类运动员的关键指标,建议未来在球类项目灵敏素质测量评价中加入刺激源组件     

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     

阶段变化模型在身体活动领域应用研究的综述:1998年至2012年

阶段变化模型于1998年首次引入我国,至今尚没有对基于该模型的身体活动研究成果进行过系统综述。对1998—2012年间,我国以此模型为基础进行的身体活动研究进行了综述;并论证了基于该模型,制订促进青少年每天锻炼一小时干预策略的可行性。在对知网等数据库的期刊论文进行计算机检索,并对符合检索条件论文的全文和参考文献进行人工检索后,114篇论文进入综述。论文被编码、分类,并使用半定量方法进行了分析。结果显示:阶段变化模型虽是我国锻炼心理学领域内备受关注的理论模型之一,但前期基于整体模型的研究和干预(或纵向)研究较少,模型在我国的适用性和应用性仍有待进一步检验。12项涉及青少年身体活动的研究中,基于整体模型的研究和干预研究各占不到一成,为后续研究提供的可参考结果极其有限。与青少年身体活动具有稳定关系的因素是性别、年级(年龄)和均衡决策。后续应考虑关注纵向设计、检验测量工具、针对不同性质被试以及基于整体模型进行研究;研究需明确界定身体活动和变化阶段的划分标准。基于阶段变化模型制定促进青少年参与体育锻炼干预策略的证据有限。     

太极运动对健康老年人群运动功能影响的META分析

目的：系统评价太极运动对健康老年人运动表现、平衡、肌力等运动功能的影响。方法：检索国内外医学数据库文献,收集相关的随机对照实验（RCTs）,按照改良Jadad方法评价纳入研究的质量,采用RevMan5.3软件进行Meta分析。结果：共纳入20篇临床实验,共4 455例老年人。结果：太极运动组在起立行走测试（TUG）(MD=2.62,95%CI [-4.00,1.24],P <0.000 01)、5次“坐-站”试验（5tSS）(MD=-1.74,95%CI[-2.77,-0.70],P=0.001)、30 s坐站测试（30 sCST）(MD=4.02,95%CI[-0.20,8.24],P=0.06)、Berg平衡量表评分（BBS）(MD=1.41,95%CI[-0.06,2.87],P=0.06)、功能性前伸试验（FRT）(MD=2.16,95%CI[0.94,3.38],P=0.000 5)、闭眼单腿站立时间（MD=3.18,95%CI [0.70,5.67],P=0.01）、睁眼单腿站立时间（MD=10.08,95%CI [4.62,-15.55],P=0.000 3）等指标...     

下肢功能测试在评估前十字韧带重建术后安全返回赛场中的应用

下肢功能测试（单脚跳远、单脚侧向跳、单脚箱跳和单脚8字跳）可较好评估前十字韧带功能不良,但目前相关应用研究较少。本研究对15名接受前十字韧带重建术重返赛场的女子运动员,平均年龄（22.3±3.5） 岁,重返时间为术后9~12个月依次完成KOOS量表、等速肌力测试和下肢功能测试,采用配对T检验比较手术腿与健侧腿的下肢功能测试和等速肌力成绩的差异。采用皮尔逊积差相关系数检验全部测试结果的相关性。结果发现,单脚跳远成绩患侧腿明显低于健侧腿,箱跳成绩患侧腿低于健侧腿,8字跳和侧向跳成绩两侧无差异; 60°/s伸展、180°/s屈曲峰力矩患侧腿与健侧腿存在差异;单腿跳远成绩与60°/s伸展峰力矩具有相关性（r=0.605）,箱跳成绩与180°/s屈曲峰力矩具有相关性（r=0.560）。表明ACLR术后9~12个月重返赛场的女子运动员仍普遍存在股四头肌力量和腘绳肌力量耐力对称性不良,应避免全力的制动和起跳落地动作;运动员重返赛前应该通过膝关节等速肌力和下肢功能测试完整了解膝关节功能的恢复情况;而KOOS评分量表用于运动员ACLR术后重返赛场决策敏感度不佳。     

热环境下的降温时机与降温部位对运动表现的影响:系统评价与Meta分析

目的：通过系统评价与Meta分析对36项降温方法的不同降温时机和降温部位进行定量合成与分析,为热环境下运动员降温策略的制定提供科学依据。方法：依据PRISMA声明控制研究过程,对国内外数据库进行文献检索,对纳入文献进行质量评价、定量合成、亚组分析、敏感分析等。结果：共纳入文献36篇,合并365名受试者;Meta分析结果发现混合降温（运动前与运动中）的合并效应量最大（SMD=1.28）,其次为运动中降温（SMD=0.85）和运动前降温（SMD=0.51）;躯干降温（SMD=1.45）>体内降温（SMD=0.75）>下肢降温（SMD=0.74）>颈部降温（SMD=0.44）>全身降温（SMD=0.42）>口腔降温（SMD=0.31）>手部降温（SMD=0.17）>面部降温（SMD=-0.54）。结论：在降温时机的选择方面,采取连续性降温措施更有利于运动员的运动表现,尤其是在运动中以及间歇期间采取降温措施能更好延续降温效果,从而维持或提高运动表现;在降温部位的选择方面,采取不同的降温部位进行降温对运动表现提升的效果有所不同,身体局部降温和体内降温均能...     

运动康复锻炼对PCI术后患者心功能及生活质量影响的系统综述

目的 探讨并评估运动康复锻炼对PCI术后患者心功能、运动耐力、不良心血管事件、生活质量的影响.方法 检索运动康复锻炼对PCI术后患者心功能及生活质量的影响的相关研究文献.将运动干预后患者心功能相关指标、不良心血管事件发生情况、生活质量各维度评分与干预前、常规治疗对照组进行对比.结果 较多研究显示,参加运动康复锻炼可改善...