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[Abstract] Background. The measurement of maximal respiratory pressures (MRPs) is commonly used to assess respiratory muscle strength. However, in Spain, there is no consensus on which is the most adequate measurement protocol, as the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) protocol differs from the one endorsed by the American Thoracic Society/European Respiratory Society (ATS/ERS). This study compared the absolute and predictive values of maximal expiratory and inspiratory pressures (MEP and MIP) in healthy adults obtained with the two protocols. Methods. A cross-sectional study with a sample of healthy adults was conducted. Lung function and MRPs were assessed. MEP and MIP were measured using a digital manometer according to the SEPAR and ATS/ERS. Protocols were applied in random order by the same trained physiotherapist. The comfort experienced with each protocol was assessed through a short questionnaire. Paired t-tests were used to compare the results from both protocols. Results. A total of 31 subjects (mean age 35.7±12.4 years; 14 females; FEV₁=108.3±10.5%; FVC=103.7±10%) were included. There was a significant difference between MRPs favouring the SEPAR protocol, with the mean difference being 34.9±28.1 cmH₂O (p˂0.001) for MEP and 8±11.6 cmH₂O (p=0.001) for MIP. ATS/ERS protocol was, however, considered more comfortable than SEPAR (p

[Abstract] Objective. To determine whether non-hospitalized adults post COVID-19 have impaired exercise capacity. Design. Retrospective analysis. Setting. Cardiovascular outpatients unit in Instituto Cardiovascular de Rosario, Argentina. Patients. Eighty non-hospitalized patients post-infection by COVID-19. Interventions. Participants completed an ergometry pre and post COVID-19 infection. Main outcome measures. The study's main variables were the metabolic equivalents of task (METs) and the indirect peak oxygen consumption (VO2 peak). Results. The median of METs was 11.7 (9.4-14.8) and 11.7 (11-11.7) in pre and post ergometry, respectively, (p = 0.022). The median VO2 (mL/Kg/min) was 21857 (16938-32761) and 21699 (17004-26467) in pre and post ergometry, respectively, without significant differences. Conclusions. We found slight differences in maximal physical capacity evaluated through exercise testing in non-hospitalized patients by COVID-19.

Background and purpose Sniff nasal inspiratory pressure (SNIP) is a voluntary inspiratory maneuver measured through a plug occluding one nostril. The investigation of the number of maneuvers necessary to reach the highest peak of SNIP in pediatric populations has been inconsistent. Thus, this study aimed to assess the reliability of SNIP in healthy children aged 6 to 11 years according to sex and age group, and to determine the optimal number of SNIP maneuvers for this age group. Methods This cross-sectional study included healthy children with normal pulmonary function. We performed 12 to 20 SNIP maneuvers, with a 30 s rest between each maneuver. The reliability was tested using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis for agreement. Results A total of 121 healthy children (62 girls [51%]) were included in this study. The ICC and corresponding confidence interval (CI) between the highest measure and the first reproducible maneuver were 0.752 (0.656–0.824), SEM = 10.37 cmH2O, and MDC = 28.74 cmH2O. For children aged 6 to 7 years, the ICC was 0.669 (0.427–0.822), SEM = 10.76 cmH2O and MDC = 29.82 cmH2O; for children aged 8 to 11 years, the ICC was 0.774 (0.662–0.852), SEM = 9.74 cmH2O, and MDC = 26.05 cmH2O. For girls, the ICC was 0.817 (0.706–0.889), SEM = 9.40 cmH2O and MDC = 26.05 cmH2O; for boys, the ICC was 0.671 (0.487–0.798), SEM = 11.51 cmH2O, and MDC = 31.90 cmH2O. Approximately 80% of the total sample reached the highest SNIP before the 10th maneuver. Conclusions SNIP demonstrated moderate reliability between the maneuvers in children aged 6 to 11 years; older children and girls reached the SNIP peak faster. Finally, results indicated that 12 maneuvers were sufficient for healthy children aged 6 to 11 years to achieve the highest SNIP peak.

This research was funded by the Spanish Ministry of Education Culture and Sport (FPU17/00939), the University of Granada Excellence Actions (Unit of Excellence in Exercise and Health)., We would like to thank Adrian Burton for his language assistance., The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need., Spanish Ministry of Education Culture and Sport FPU17/00939, University of Granada Excellence Actions (Unit of Excellence in Exercise and Health)

There are different instruments to assess the peak cough flow (PCF): pneumotachometer (PN) and portable peak expiratory flow-meter (PEF). On the other hand, this measure can be made using a mouthpiece or using a facemask. Aim: To compare both instruments and interfaces in the measurement of PCF in healthy adult population. Methods: A cross-sectional study was carried out in 31 healthy subjects. People with obesity, active smokers, athletes or with respiratory, severe cardiac and/or neurological pathologies, were excluded. Forced spirometry was performed to rule out altered ventilatory patterns. PCF values were taken using a PN and a PEF meter, each one connected to the two mentioned interfaces. Thus, four measurements were obtained for each individual. The order of maneuvers was randomized. Three technically acceptable maneuvers (variability Results: Seventeen males and 14 females were assessed (35.7±12.4 years). In the comparison of the instrument for PCF evaluation, 78L/min more were recorded with the PEF meter when mouthpiece was used. A difference of 34L/min was obtained in favor of the PEF meter using the facemask. In the comparison of the interface, only a significant difference of 22L/min was observed using PN connected to the facemask. Conclusions: The PCF value was higher when we used a PEF meter with a mouthpiece.

Objectives: To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery. Design: Randomized, single-blind controlled trial. Setting: Teaching hospital. Subjects: Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery. Intervention: Participants were randomized to either a prehabilitation group or a control group. Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week. Main measures: The primary outcome of the study was exercise capacity. Secondary outcomes were muscle strength (Senior Fitness Test), health-related quality of life (Short-Form 36) and the postoperative outcomes. Patients were evaluated at baseline (before randomization), presurgery (only the prehabilitation group), after surgery and three months post-operatively. Results: A total of 40 patients were randomized and 22 finished the study (10 in the prehabilitation group and 12 in the control group). Three patients were lost to follow-up at three months. After the training, there was a statistically significant improvement in exercise tolerance (+397 seconds, p = 0.0001), the physical summary component of the SF-36 (+4.4 points, p = 0.008) and muscle strength ( p Conclusions: A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients’ preoperative condition and may prevent functional decline after surgery. Clinical Registration Number: NCT01963923 (Registration date 10/10/2013)

Carta al director Letter

Introduction: Preoperative exercise training can improve the baseline status of patients undergoing open thoracic surgery and therefore improve surgical tolerability and enhance postoperative recovery. The aim of this study was to assess the feasibility and preliminary efficacy of a preoperative exercise-based programme (PEP) in patients undergoing Video-assisted thoracic surgery (VATS) for lung cancer. Materials and Methods: In a randomized, single blinded controlled trial, 20 patients were allocated to receive a PEP consisted of 3 - 5 sessions per week of interval endurance training, strength training with elastic bands and breathing exercises. Exercise capacity (endurance time), muscle strength (Senior Fitness Test) and health-related quality of life (SF-36) were assessed at the beginning and at the end of the training. Results: 10 patients completed the intervention attending a median of 16 sessions. Mean therapeutic delay was 54 days and no adverse events were recorded. There were statistically significant improvements in endurance time measured at 80% of the maximal workload (mean difference +396.6±197.9 seconds, p Conclusions: preoperative exercise training in patients with lung malignancies awaiting VATS is safe and can be achieved without any delay in the surgical management and results effective to improve exercise capacity, muscle strength and physical functioning, which could potentially enhance postoperative recovery.

The aim of this cross-sectional study was to compare dynamic lung volumes in chronic stroke survivors (SS) with a control group (CG) of healthy people matched by age and sex. Forced spirometries were performed, in line with the international statements. The reference values were calculated with the predictive equations proposed by Roca et al,1986. T test was used to determine differences in dynamic lung volumes between SS and CG.A cluster analysis was practiced to classify 2 different groups within the SS regarding to their dynamic lung volumes. The average age in SS (n=33) was 56.9±15.7 years. There were no significant differences between groups regarding age, weight and height. The average months since the stroke was 48.8±68.8. The SS present significantly lower values in dynamic lung volumes compared to the GC (n=33). The cluster analysis showed a trend towards a restrictive ventilatory pattern in SS since 19 subjects showed values of FVC and FEV1 below the mean registered for the whole group of SS. According to these findings we suggest that the assessment of pulmonary function should be considered in chronic SS.

[Abstract] Objectives. To compare respiratory muscle strength in stroke survivors (SS) with that in a control group (CG) of healthy people matched by age and sex, as well as to investigate any relation between respiratory muscle strength and the distance walked during the 6-minute walk test (6MWT). Design. Cross-sectional study. Setting. This study comprised patients from a private neurological rehabilitation center and a public association for patients with acquired brain injury. Participants. Chronic SS with a diagnosis of hemiplegia/hemiparesis who were able to walk (n=30) and healthy individuals matched by sex and age (n=30) (N=60). Interventions. Not applicable. Main Outcome Measures. Respiratory muscle strength was assessed using maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP) with a pressure transducer and a diver nozzle. The distance walked during the 6MWT was also registered for both groups. The motricity index and the Scale Impact of Stroke version 16.0 were also measured in SS. Results. The Student t test revealed significantly lower values of MIP and MEP in SS than in the CG (MEP, 95.93±43.12cmH2O in SS vs 158.43±41.6cmH2O in the CG; MIP, 58.7±24.67cmH2O in SS vs 105.7±23.14cmH2O in the CG; P