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There are limitations to perform the cardiopulmonary exercise test (CPET) and the six-minute walking test (6MWT) in clinical settings. The incremental shuttle walking test (ISWT) might be an alternative assessment of exercise capacity and an estimation of cardiopulmonary fitness after stroke.To investigate the test-retest and inter-rater reliabilities, the standard error of measurement (SEM) and the minimal detectable change (MDC) of the ISWT, its construct validity to assess exercise capacity and its concurrent validity to estimate cardiopulmonary fitness after stroke.Prospective diagnostic accuracy study. Fifty-one individuals (54 ± 11 years) at the chronic phase (65 ± 73 months after stroke) were included. The distance walked, in meters, during the 12-stage-ISWT and the 6MWT and the peak oxygen uptake (VOSignificant and high to very high magnitude test-retest and inter-rater reliabilities (0.88≤ICC≤0.93) of the ISWT was found. The SEM for both reliabilities was small (-23.35 m≤ SEM≤41.47 m). The MDC for test-retest and inter-rater reliabilities were 114.63 m and 64.53 m, respectively. For construct validity, a significant and high magnitude correlation between the ISWT and the 6MWT was found (ICC = 0.82). For the concurrent validity, a significant, but low magnitude correlation was found between the ISWT and the VOThe ISWT demonstrated adequate reliabilities and construct validity for exercise capacity assessment. However, the concurrent validity of the ISWT as an estimation of cardiopulmonary fitness still requires further research.

Introduction: Pulmonary rehabilitation improves the physical condition of patients with chronic respiratory disease; however, there are patients who cannot leave the hospital because of their low activities of daily living (ADLs), despite the completion of primary respiratory disease treatment and rehabilitation during treatment. Therefore, this study demonstrated that those patients recovered their ADLs through in-hospital pulmonary rehabilitation after treatment completion. Methods: We prospectively studied 24 hospitalized patients who had some remaining symptoms and showed low ADL scores of 9 points or less on the short physical performance battery after undergoing treatment for respiratory disease in Fukujuji Hospital from October 2018 to October 2019, excluding 2 patients who had re-exacerbation and 1 patient who could not be examined using the incremental shuttle walk test (ISWT). After completion of the primary respiratory disease treatment, patients moved to the regional comprehensive care ward, and they received pulmonary rehabilitation for 2 weeks. In the ward, patients who could not yet leave the hospital could undergo pulmonary rehabilitation for up to 60 days. Data were evaluated three times: upon treatment completion (baseline), postrehabilitation, and 3 months after baseline. The main outcome was an improvement in the incremental shuttle walk test (ISWT) postrehabilitation. Results: The median age of the patients was 80 (interquartile range (IQR): 74.8–84.5), and 14 patients (58.3%) were male. The ISWT distance significantly increased postrehabilitation (median [IQR]: 60 m [18–133] vs 120 m [68–203], P

INTRODUÇÃO: A doença arterial periférica (DAP) associa-se a alto risco de claudicação intermitente, sintoma que pode ser limitador da capacidade funcional do indivíduo. Nesse contexto, o Incremental Shuttle Walking Test (ISWT) representa o padrão-ouro para avaliação da capacidade funcional, entretanto possui limitações técnicas. O Duke Activity Status Index (DASI) é um questionário simples que abrange domínios relacionados à execução de tarefas diárias. OBJETIVO: avaliar a relação dos escores do DASI com a distância, a velocidade e o tempo atingidos no ISWT por indivíduos com DAP. MÉTODOS: Estudo observacional de corte transversal com amostra não probabilística. Os indivíduos com DAP foram selecionados e aplicou-se o ISWT e o DASI. Procedeu-se a análise descritiva dos dados utilizando o teste de Spearman para distribuição não normal adotando nível de significância de 5%. RESULTADOS: A análise estatística mostrou alta correlação entre ISWT e DASI em indivíduos com DAP. As variáveis distância percorrida, velocidade de marcha e tempo apresentaram forte correlação com o score DASI evidenciando o potencial de aplicabilidade do teste na prática clínica. CONCLUSÕES: Os resultados sugerem que o DASI pode ser utilizado na avaliação da capacidade funcional de indivíduos com diagnóstico de DAP, especialmente os que apresentam claudicação intermitente.

Patients with lasting symptoms of COVID-19 should be offered a comprehensive recovery programme. Patients that completed a six week, twice supervised adapted pulmonary rehabilitation programme demonstrated statistically significant improvements in exercise capacity, respiratory symptoms, fatigue and cognition. Participants improved by 112m on the Incremental Shuttle Walking Test and 544 seconds on the Endurance Shuttle Walking Test. There were no serious adverse events recorded, and there were no dropouts related to symptom worsening. COVID-19 rehabilitation appears feasible and significantly improves clinical outcomes.

The peripheral arterial obstructive disease (PAOD) is a chronic illnes that has as main symptom intermittent claudication and causes a progressive functional impairment of the patient. The literature is still inconclusive when it addresses the relationship among functional capacity, endurance, muscle contraction speed, and degree of blood flow impairment in patients with PAOD. The objective of this study was to evaluate the physical fitness individuals with bilateral PAOD, claudication and ankle-brachial index between 0.8 and 0.9, to verify the impact of the disease in this outcome and to analyze the association among the tests. Forty individuals, with mean age 56 years were divided in: group PAOD (n=20) and control group (n=20) were subjected to the following tests: Five-Times-Sit-to-Stand Test (FTSST), Heel-rise test (HRT), test of gait speed usual (UV) and maximum (MV), shuttle walking test (SWT). There was a significant difference among the variables obtained through HRT, UV, MV and SWT, showing a worse performance of the group with PAOD compared to the control. The FTSST test showed no differences among the groups. Analyzing the whole sample, the presence of PAOD is an indicator of poor performance in TDBP. This study suggests that people with mild PAOD present reduced performance in functional endurance tests of the lower limbs and that there is a direct relationship between walking speed and patency of local arterial flow, demonstrating in an unprecedented way the need for evaluation of this public, considering the possibility of initial identification of the symptoms and giving greater efficiency in the therapeutic planning of maintenance of the functionality.Keywords: Physical Fitness. Intermittent Claudication. Peripheral Vascular Diseases.ResumoA doença arterial obstrutiva periférica (DAOP) é uma doença crônica que tem como sintoma principal a claudicação intermitente e causa um progressivo comprometimento funcional do paciente. A literatura ainda é inconclusiva quando aborda a relação entre a capacidade funcional, endurance, velocidade de contração muscular e grau de comprometimento de fluxo sanguíneo em pacientes com DAOP. O objetivo deste estudo foi avaliar a aptidão física de indivíduos com DAOP bilateral, claudicantes e Índice tornozelo-braço entre 0,8 e 0,9, verificar o impacto da doença neste desfecho e analisar a associação entre os testes. Quarenta indivíduos, com faixa etária média de 56 anos, divididos em grupo DAOP (n=20) e grupo controle (n=20), foram submetidos aos testes: Teste senta-levanta (TSL), teste ponta de pé (TPP), testes de velocidade usual (VU) e máxima (VM), teste de deslocamento bidirecional progressivo (TDBP). Houve diferença significativa entre as variáveis do TPP, VU, VM e TDBP, mostrando pior performance do grupo com DAOP comparado ao controle. O teste TSL não apresentou diferença entre os grupos. Analisando os grupos em conjunto a presença de DAOP foi indicadora de pior desempenho no TDBP. Este estudo sugere que pacientes com DAOP leve apresentam redução da performance nos testes funcionais de endurance dos membros inferiores e que existe uma relação direta entre a velocidade da marcha e a patência do fluxo arterial local, demonstrando de forma inédita, a necessidade de avaliação deste público, considerando a possibilidade de identificação inicial dos sintomas e conferindo maior eficiência no planejamento terapêutico de manutenção da funcionalidade.Palavras-chave: Aptidão Física. Claudicação Intermitente. Doenças Vasculares Periféricas.

Individuals with lasting symptoms of COVID-19 should be offered a comprehensive recovery programme. 30 individuals (mean[SD] age 58[16]) that completed a 6 week, twice supervised rehabilitation programme demonstrated statistically significant improvements in exercise capacity, respiratory symptoms, fatigue and cognition. Participants improved by 112 m on the Incremental Shuttle Walking Test and 544 seconds on the Endurance Shuttle Walking Test. There were no serious adverse events recorded, and there were no dropouts related to symptom worsening. COVID-19 rehabilitation appears feasible and significantly improves clinical outcomes.

Orientadores: Ilma Aparecida Paschoal, Mônica Corso Pereira Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: O mecanismo de limitação ao exercício na Hipertensão Arterial Pulmonar Idiopática (HAPI) não é totalmente compreendido. Embora as alterações hemodinâmicas sejam reconhecidamente importantes nesta limitação ao exercício, fatores mecânicos, ventilatórios e gasométricos também podem contribuir para a redução da capacidade de exercício nesses indivíduos. A capnografia volumétrica (VCap), a espirometria e a análise de gases no sangue podem revelar diferentes aspectos do padrão ventilatório, e hipotetizamos que essas variáveis de repouso possam ter alguma correlação com as variáveis hemodinâmicas coletadas durante o ecocardiograma de estresse (SDE). Objetivos: Avaliar o padrão ventilatório de pacientes com HAPI e correlacionar os achados com algumas variáveis do ecodopplercardiograma de estresse (SDE). Métodos: Trata-se de um estudo transversal com 14 pacientes com HAPI e 14 controles pareados por idade. Todos os indivíduos foram submetidos a Vcap, espirometria, teste de caminhada de seis minutos e SDE. A gasometria arterial foi realizada somente nos pacientes. HAPI e o grupo controle foram comparados para as variáveis referidas. Além disso, os pacientes com HAPI foram comparados de acordo com a magnitude da elevação do PSAP ("delta"PSAP) no máximo de esforço na SDE. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição Resultados: Os pacientes com HAPI apresentaram hipocapnia; Na espirometria, 57,1% dos pacientes com HAPI apresentaram CVF abaixo do limite inferior de normalidade. No Vcap, os pacientes com HAPI apresentaram taxas respiratórias mais altas e menor CO2/respiração. Na análise de correlação, a CVF reduzida esteve associada a menores aumentos na velocidade de regurgitação tricúspide ("delta"VRT). Embora os pacientes com HAPI tenham níveis de CO2 arterial mais baixos no repouso, o Vcap mostrou volumes correntes similares, mas um frequência respiratória (RR) mais elevada. A expansão dos pulmões parece ser fácil para os pacientes com HAPI, uma vez que a redução da quantidade de sangue nos pulmões aumenta a complacência e reduz a elasticidade pulmonar. A maioria dos pacientes com HAPI teve CVF reduzida, e quanto menor a CVF, menor o aumento da VRT. Conclusão: é possível que as alterações mecânicas nos pulmões dos pacientes com HAPI tenham um papel na redução da CVF. Além disso, esta variável esteve relacionada com redução do débito cardíaco The mechanism of exercise function in Idiopathic Pulmonary Arterial Hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mecanic, ventilatory and gasometric factors may also contribute to the reduction of exercise capacity in these individuals. Volumetric Capnography (VCap), spirometry and blood gas analysis can reveal aspects of ventilatory pattern, and we hipothezed that these resting variables could have some correlation with hemodynamic variables collected during stress echocardiogram (SDE). Objectives: To evaluate the ventilatory pattern of PAH patients and to correlate the findings with some stress echocardiography (SE) variables. Methods: This a cross-sectional study with 14 IPAH patients, and 14 age and sex matched controls. All individuals were submitted to VCap, spirometry, six-minute walk test and SDE. Arterial blood gases were determined in patients. IPAH and control subjects were compared for the refered variables. Also, IPAH patients were compared according to the magnitude of SPAP elevation at peak effort ("delta"SPAP) on SDE. This study was approved by the Research Ethics Committee. Results and discussion: IPAH patients had hypocapnia; in spirometry, 57.1% of IPAH patients showed FVC below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower CO2/breath. In correlation analysis, reduced FVC was associated with lesser increases in tricuspid regurgitation velocity. Although IPAH patients had lower arterial CO2 levels, VCap showed similar tidal volumes but a higher RR. Expanding the lungs seems to be easy for IPAH patients, as the reduction of the amount of blood in the lungs increases pulmonar compliance and reduces pulmonary elasticity. Most of IPAH patients had reduced FVC, and the smaller FVC the lesser the increase in TRV. Conclusion: Mechanical alterations in the lungs of IPAH patients may contribute to explain the reduced FVC. Also FVC was associated with cardiac output reduction Mestrado Clínica Médica Mestre em Clínica Médica

Rationale: Exercise capacity predicts mortality in pulmonary arterial hypertension (PAH), but limited data exist on the routine use of maximal exercise testing.Objectives: This study evaluates a simple-to-perform maximal test (the incremental shuttle walking test) and its use in risk stratification in PAH.Methods: Consecutive patients with pulmonary hypertension were identified from the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) registry (2001-2018). Thresholds for levels of risk were identified at baseline and tested at follow-up, and their incorporation into current risk stratification approaches was assessed.Results: Of 4,524 treatment-naive patients with pulmonary hypertension who underwent maximal exercise testing, 1,847 patients had PAH. A stepwise reduction in 1-year mortality was seen between levels 1 (≤30 m; 32% mortality) and 7 (340-420 m; 1% mortality) with no mortality for levels 8-12 (≥430 m) in idiopathic and connective tissue disease-related PAH. Thresholds derived at baseline of ≤180 m (>10%; high risk), 190-330 m (5-10%; intermediate risk), and ≥340 m (

The objective of this study was to compare incremental shuttle walking test (ISWT) performance between South Asian and Caucasian British adults, identify predictors of ISWT distance and produce ethnicity-specific reference equations. Data from a mixed gender sample aged 40–75 years from Leicestershire, United Kingdom, were selected for analyses. Analysis of covariance determined differences in ISWT performance between South Asian and Caucasian British ethnic groups. Linear regressions identified predictors of ISWT distance, which determined the reference equations. In total, 144 participants took part in the study (79 South Asian (54 ± 8 years, 71% female) and 65 Caucasian British (58 ± 9 years, 74% female)). Distance walked for the ISWT was shorter for South Asian individuals compared with Caucasian British (451 ± 143 vs. 575 ± 180 m, p < 0.001). The ethnicity-specific reference equations for ISWT distance explained 33–50% of the variance (standard error of the estimate (SEE): 107–119 m) for South Asians and explained 14–58% of the variance (SEE: 121–169 m) for Caucasian British. Ethnicity univariately explained 12.9% of the variance in ISWT distance and was significantly associated with ISWT distance after controlling for age, gender, height, weight, dyspnoea and lung function ( B = −70.37; 1 = Caucasian British, 2 = South Asian), uniquely explaining 3.7% of the variance. Predicted values for ISWT performance were lower in South Asian people than in Caucasian British. Ethnicity-specific reference equations should account for this.

Background: Breathlessness is common in patients with thoracic cancer but difficult to manage. The Incremental Shuttle Walking Test (ISWT) can help assess new treatments, but its repeatability has not been described in this group. Aim: To examine within and between day repeatability of the ISWT in this setting. Methods: Patients with incurable thoracic cancer were recruited from outpatient clinics at a University Hospital. Two ISWTs were completed one hour apart on two consecutive days, with the first test for familiarization purposes only. Repeatability of distance walked was examined using Bland and Altman plots and assessed as the single determination (within subject) standard deviation of the difference between tests and its 95% range. Results: Forty-one patients participated and completed all tests. Mean (SD) distance walked was 333 (134), 349 (129) and 353 (130) m over the three tests, with the mean difference significantly different from zero between days (16 m, 95% CI 8–24 m, P = 0.043) but not within days (5 m, 95% CI –2 to 12 m, P = 0.47). Within and between day single determination SD and 95% ranges were 30 (−31 to 91) m and 36 (−37 to 109) m respectively. Conclusions: These data help inform the design of studies making use of the ISWT and the interpretation of their findings.

This study was planned to investigate the relationship of obesity with exercise capacity, quality of life, and fatigue level in Chronic Obstructive Pulmonary Disease (COPD). 109 individuals with COPD were included in the study. Individuals were stratified into three groups as normal (18.5≤, ≤24.9 kg/m2, n=34), overweight (25≤, ≤29.9 kg/m2, n=43) and obese (>30 kg/m2, n=32). After taking socio-demographic information of the individuals, The Shuttle Walking Test was used to measure exercise capacity, St. George Respiratory Questionnaire to measure quality of life, and the Fatigue Severity Scale to measure fatigue levels. The average age and BMI of normal, overweight and obese individuals participating in the study were 60.58±13.21 years, 21.48±1.83 kg/m2; 61.83±11.33 years, 26.98±1.50 kg/m2 and 57.55±12.85 years, 33.46±3.93 kg/m2 respectively with age being similar between the groups (p>0.05). In the correlation analysis, there was a significant relationship between exercise capacity and fatigue severity (r= -0.532, p= 0.007), SGRQ activity parameter (r= -0.508, p= 0.011) in individuals with obesity (p 0.05). There was a relationship between fatigue severity and all sub-parameters of SGRQ in all 3 groups (p [Med-Science 2021; 10(3.000): 816-21]

To investigate if cardiovascular and metabolic responses to the six-minute walk test (6MWT) and incremental shuttle walking test (ISWT) are in agreement with cardiopulmonary exercise testing (CPX) and determine if both submaximal tests are interchangeable in obese and eutrophic individuals.Observational and cross-sectional study included 51 obese women (ObG) and 21 controls (CG) (20-45 years old). Subjects underwent clinical evaluation, CPX, the 6MWT and ISWT. We applied Bland-Altman plots to assess agreement between walking tests and CPX. Correlation analysis assessed relationships between key variables.There was an agreement between CPX and both the 6MWT [oxygen uptake (VO2 mL kg(-1) min(-1)) = 6.9 (CI: 5.7-8.1), and heart rate (bpm) = 37.0 (CI: 33.3-40.7)] and ISWT [VO2 (mL kg(-1) min(-1)) = 6.1 (CI: 4.9-7.3), and heart rate (bpm) = 36.2 (CI: 32.1-40.3)]. We found similar cardiovascular and metabolic responses to both tests in the ObG but not in the CG. Strong correlations were demonstrated between 6MWT and ISWT variables: VO2 ( r = 0.70); dyspnoea (r = 0.80); and leg fatigue (r = 0.70).6MWT and ISWT may both hold interchangeable clinical value when contrasted with CPX in obese women and may be a viable alternative in the clinical setting when resources and staffing are limited. Implications for Rehabilitation Obesity is a worldwide epidemic, with high prevalence in women, and it is associated to impaired cardiorespiratory fitness and functional capacity as well as high mortality risk. Assessing oxygen uptake by means of cardiopulmonary exercise testing is the gold standard method for evaluating and stratifying cardiorespiratory fitness, however it is not ever applied due to costs and staffing. Walking field tests may be a cost-effective approach that provides valuable information regarding the functional capacity in agreement to metabolic and cardiovascular responses of cardiopulmonary exercise testing.

The shuttle walking test (SWT) is a simple, widely used method for assessing endurance performance in the elderly. Despite widespread community use, its associated factors are unclear.We aim to identify previously undefined SWT association factors in community-dwelling elderly people.Herein, 149 healthy elderly Japanese subjects performed the SWT, and were assessed for height, weight, smoking history, 10-m walk time, Timed Up and Go (TUG) scores, handgrip strength, skeletal mass index (SMI), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), cardio-ankle vascular index, and ankle brachial index. We divided men and women into higher and lower SWT score groups, compared between-group parameters, and performed stepwise multivariate logistic regression analysis to identify factors independently associated with SWT scores.Age, BMI, 10-m walk time, TUG score, SMI, FVC (L; %-predicted), and FEV1 (L; %-predicted) were significantly different between SWT score groups for men, while in women, significant differences were observed in age, TUG score, handgrip strength, FVC (L; %-predicted), and FEV1 (L; %-predicted) (p 0.05). In the multivariate logistic regression model, 10-m walk time, and FEV1 showed significant associations with SWT results in men; among women, age was the only significantly associated factor (p 0.05).Results indicate that better lung function and shorter walk time independently associate with SWT results in community-dwelling men; in women, age is the only association. Our findings may offer insight when considering the focus of community exercise programs among the elderly.

Bioelectrical impedance analysis (BIA) provides a simple method to assess changes in body composition. Raw BIA variables such as phase angle provide direct information on cellular mass and integrity, without the assumptions inherent in estimating body compartments, e.g. fat-free mass (FFM). Phase angle is a strong functional and prognostic marker in many disease states, but data in COPD are lacking. Our aims were to describe the measurement of phase angle in patients with stable COPD and determine the construct and discriminate validity of phase angle by assessing its relationship with established markers of function, disease severity and prognosis.502 outpatients with stable COPD were studied. Phase angle and FFM by BIA, quadriceps strength (QMVC), 4-m gait speed (4MGS), 5 sit-to-stand time (5STS), incremental shuttle walk (ISW), and composite prognostic indices (ADO, iBODE) were measured. Patients were stratified into normal and low phase angle and FFM index.Phase angle correlated positively with FFM and functional outcomes (r = 0.35-0.66, p0.001) and negatively with prognostic indices (r = -0.35 to -0.48, p0.001). In regression models, phase angle was independently associated with ISW, ADO and iBODE whereas FFM was removed. One hundred and seventy patients (33.9% [95% CI, 29.9-38.1]) had a low phase angle. Phenotypic characteristics included lower QMVC, ISW, and 4MGS, higher 5STS, ADO and iBODE scores, and more exacerbations and hospital days in past year. The proportion of patients to have died was significantly higher in patients with low phase angle compared to those with normal phase angle (8.2% versus 3.6%, p = 0.02).Phase angle relates to markers of function, disease severity and prognosis in patients with COPD. As a directly measured variable, phase angle offers more useful information than fat-free mass indices.

Background: Exercise tolerance is an important endpoint in chronic obstructive pulmonary disease (COPD) clinical trials. Little is known about the comparative measurement properties of constant work rate cycle ergometry (CWRCE) and the endurance shuttle walking test (ESWT). The objective of this sub-analysis of the TORRACTO® study was to directly compare the endurance measurement properties of CWRCE and ESWT in patients with COPD in a multicentre, multinational setting. We predicted that both tests would be similarly reliable, but that the ESWT would be more responsive to bronchodilation than CWRCE. Methods: This analysis included 151 patients who performed CWRCE and ESWT at baseline and week 6 after receiving once-daily placebo, tiotropium/olodaterol (T/O) 2.5/5 μg or T/O 5/5 μg. Reproducibility was assessed by comparing their respective performance at baseline and week 6 in the placebo group. Responsiveness to bronchodilation was assessed by comparing endurance time at week 6 with T/O with baseline values and placebo. The locus of symptom limitation and end-exercise Borg scales for breathing and leg discomfort for both tests were also analysed. Results: The intraclass correlation coefficients for CWRCE and ESWT were 0.56 [95% confidence interval (CI) 0.37–0.71] and 0.75 (95% CI 0.63–0.84). More patients were limited by breathing discomfort during the ESWT than during CWRCE, whereas more patients were limited by leg discomfort or breathing/leg discomfort during CWRCE than the ESWT ( p Conclusions: Both exercise tests performed well in a multicentre clinical trial. Although the locus of symptom limitation differed between the two tests, both were reliable and responsive to bronchodilation. For future clinical trials, the choice of test should depend on the study requirements. ClinicalTrials.gov identifier: NCT01525615. The reviews of this paper are available via the supplemental material section.

Purpose: A good reaction time allows us to be agile and effective in responding to situations. The aim of this study was to reaction time and exercise tolerance between patients with cystic fibrosis (CF) and healthy subjects. Methods: Sixteen patients with CF (10.63±2.75 years) and 16 age-matched healthy controls (11.00±2.56 years) participated. 9Fitlight Trainer (TM)9 was used to evaluate the reaction time. The patient was asked to turn off a total of 29 led lights on the wall in a random order as quickly as possible. Total and average scores were determined in seconds. Exercise capacity was assessed by the incremental shuttle walking test (ISWT). Heart rate, oxygen saturation, dyspnea and fatigue perception using modified Borg Scale was recorded before and after the tests. Results: The reaction time of CF patients (165.38±17.89 sec) was significantly higher than healthy controls (154.31±6.63 sec) (p Conclusion: The reaction time is lower in patients with CF than controls. Increased reaction time is associated with decreased exercise capacity and oxygen saturation, increased dyspnea and fatigue perception during exercise in children with CF. The reaction time may provide an input for exercise programs aimed at improving the performance of patients with CF.

Background: There is increasing interest in screening for and diagnosing pulmonary hypertension earlier in the course of disease. However, there is limited data on cardiopulmonary abnormalities in patients with pulmonary hypertension newly diagnosed in World Health Organisation Function Class I. Methods: Data were retrieved from the ASPIRE registry (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) for consecutive treatment naive patients diagnosed with pulmonary hypertension by cardiac catheterisation between 2001-10 who underwent incremental shuttle walk exercise testing. Results: Eight hundred and ninety-five patients were diagnosed with Group 1-5 pulmonary hypertension. Despite the absence of symptoms, patients in WHO FC I (n=9) had a significant reduction in exercise capacity as assessed by incremental shuttle walking test adjusted for age and sex and body mass index (ISWD%pred) 65±13 % and moderate pulmonary hypertension with a mean pulmonary artery pressure 38±12mmHg and pulmonary vascular resistance 4.7±6.5 Wood Units, despite a normal diffusion of carbon monoxide adjusted for age and sex (DLco%pred) 88±36%. Compared to patients in WHO FC I, patients in WHO FC II (n=162) had a lower ISWD%pred 43±22 % and lower DLco%pred 65±21% despite having similar pulmonary haemodynamics. Conclusion: Our results demonstrate that patients with newly diagnosed pulmonary hypertension with no or minimal symptomatic limitation have a significant reduction of exercise capacity.

The aim of this study was to evaluate the acute effects of low-level laser therapy (LLLT) on the functional capacity to exercise tested by incremental shuttle walking test (ISWT) after coronary artery bypass graft (CABG) surgery.Fifteen male patients (60 ± 9 years) were crossed over during the experiment, to compare the outcomes after active LLLT and placebo LLLT treatments. LLLT (850 nm, 200 mW, 30 J to each point, resulting in a total of 240 J per quadriceps muscle), using a multidiode cluster (five spots; 6 J/spot) in eight points per leg was performed 3 min before the ISWT. We analyzed distance walked, Borg scale of perceived exertion, heart rate, and brachial arterial blood pressure. Markers of tissue damage [lactate dehydrogenase (LDH)] and oxidative stress [lipid peroxidation, total thiol levels, and antioxidant enzyme activity of superoxide dismutase (SOD) and catalase (CAT)] were also measured in peripheral blood.Comparison of the distances walked revealed no significant differences between the LLLT and placebo LLLT groups (p = 0.779). Regarding the Borg scale (p = 0.567), heart rate (p = 0.506) as well as systolic and diastolic blood pressure (p = 0.164 and p = 0.140, respectively), no differences were observed between LLLT and placebo LLLT groups. Application of LLLT was not able to change levels of LDH (p = 0.214), oxidative lipid damage (p = 0.733), total thiol levels (p = 0.925), SOD (p = 0.202), and CAT (p = 0.825) enzyme activities.Acute LLLT improved neither functional capacity to exercise nor the markers of oxidation after CABG.Registered as a clinical trial (NCT02688426).

INTRODUCTION COPD is among the most common causes for secondary pulmonary hypertension (PH). Pulmonary rehabilitation (PR) is recommended in the standard treatment of COPD. In this study, efficiency of multidisciplinary PR in COPD patients with PH was examined. PATIENTS AND METHODS 88 patients stable COPD patients who applied to our center between 2008-2013 were enrolled. Un-likely PH patients were grouped as Group 1 while possible and likely PH cases were accepted as Group 2. There were no other cause for PH. All the patients received patient-specific, multidisciplinary 8-week PR. Dyspnea perception was assessed via MRC dyspnea scale, health-related quality of life with S. George life quality questionnaire, exercise capacity via incremental shuttle walking test and endurance shuttle walking test and body composition via bioelectrical impedance test before and after PR program. RESULTS In all the patients there were significant improvements in body composition (BMI p= 0.013), quality of life (SGRQ semp., activity, total p< 0.001), dyspnea perception (MRC p< 0.001) and exercise capacity (ISWTT, ESWT, VO2 peak p< 0.001) after PR program. Improvements in Group 2 were observed to be significantly greater. CONCLUSION PR is an effective and safe option in COPD patients with PH. These patients should be directed to PH programs for supervised exercise training and chronic disease management and patient-specific PR programs should be established.

To evaluate if the Incremental Shuttle Walking Test (ISWT) requires maximal effort in healthy subjects of different ages.Cross-sectional.University-based research laboratory.331 healthy subjects separated into six groups according to age: G1, 18 to 28 years; G2, 29 to 39 years; G3, 40 to 50 years; G4, 51 to 61 years; G5, 62 to 72 years and; G6, 73 to 83 years.Two ISWTs were performed and participants were permitted to run and to exceed 12 levels during the test, if necessary. Heart rate (HR) and symptoms of dyspnoea and fatigue were recorded before and after the test, and the percentage of age-predicted maximal HR (HRmax) was calculated. Maximal effort was defined as HRmax90% of age-predicted HRmax.Almost 31% of the subjects exceeded 12 levels in the ISWT. At the end of the test, all groups presented a median [interquartile range] HR greater than 90% of HRmax (G1: 100 [95 to 104]; G2: 100 [96 to 105]; G3: 103 [97 to 108]; G4: 99 [91 to 106]; G5: 96 [87 to 106] and G6: 96 [91 to 109]% HRmax). Regarding symptoms, all groups showed higher values after the test (P0.05). A multiple logistic regression analysis identified female gender, older age and a lower HR before the test as determinants of not achieving 90% of HRmax at the end of the test.The ISWT requires maximal effort in healthy individuals, but for that it is necessary to extend the test beyond twelve levels. Female gender, older age and lower heart rate before the test are the determinants of not reaching maximal effort.

Introduction: It is still unknown how best to maintain effects of exercise programmes in COPD in the long-term. We present the long-term effects of a community-based exercise programme incorporated in a self-management programme, compared to a self-management programme only in patients with COPD.Methods: All included patients participated in four self-management sessions. Additionally, patients in the intervention group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained three times/week for six months and two times/week during the subsequent five months. To encourage a behavioural change towards exercise, one of these weekly training sessions was home-based (unsupervised). No formal exercise training was offered to intervention patients in the second year.Results: The intervention was assigned to 80 patients, and the control condition to 79 patients. 82.5% and 78.5% of the intervention and control group, respectively, completed 24 months follow-up. Modified intention-to-treat analyses were performed. Although statistically significant after 12 months (35.1 m (95%Cl: 8.4-61.8)), the between-group difference on maximal exercise capacity was not statistically significant after 24 months (12.2 m (95%Cl: -16.6 to 41.0). Nevertheless, the between-group difference in daily physical activity was maintained after 24 months (1193 steps/day (95%Cl: 203-2182)). A beneficial effect was also found on CRQ dyspnoea score but not on other CRQ domains, CCQ and HADS.Conclusions: Our intervention was effective in achieving a behavioural change reflected by a sustained increase in daily physical activity, not accompanied by a sustained increase in maximal exercise capacity after two years of follow-up (ISRCTN81447311). (C) 2014 Elsevier Ltd. All rights reserved.

Heart rate recovery (HRR) after exercise is an independent predictor for cardiovascular and all-cause mortality. To investigate the usefulness of HRR in cardiorespiratory exercise testing in older adults with intellectual disabilities (ID), the aims of this study were (a) to assess HRR in older adults with ID after the 10-m incremental shuttle walking test (isvvr) and (b) its association with personal characteristics (gender, age, distance walked on the ISWT, level of ID, genetic syndrome causing ID, autism, behavioral problems, and peak heart rate (HRpeak)). HRR was assessed after the 10-m incremental shuttle walking test in 300 older adults (>50 years) with borderline to profound ID. HRR was defined as the change from HRpeak during the ISWT to heart rate measured after 1, 2, 3, 4, and 5 min of passive recovery. The largest decrease in heart rate was in the first minute of recovery leveling off toward the fifth minute of recovery. An abnormal HHR (

A high incidence of limitations in daily functioning is seen in older adults with intellectual disabilities (ID), along with poor physical fitness levels. The aim of this study was to assess the predictive value of physical fitness for daily functioning after 3 years, in 602 older adults with borderline to profound ID (>= 50 years). At baseline, physical fitness levels and daily functioning (operationalized as basic activities of daily living [ADL] and mobility) were assessed. After 3 years, the measurements of daily functioning were repeated. At follow-up, 12.6% of the participants were completely independent in ADL and 48.5% had no mobility limitations. More than half of the participants (54.8%) declined in their ability to perform ADL and 37.5% declined in their mobility. Manual dexterity, visual reaction time, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in ADL. For a decline in mobility, manual dexterity, balance, comfortable and fast walking speed, grip strength, muscular endurance, and cardiorespiratory fitness were all significant predictors. This proves the predictive validity of these physical fitness tests for daily functioning and stresses the importance of using physical fitness tests and implementing physical fitness enhancing programs in the care for older adults with ID. (C) 2014 Elsevier Ltd. All rights reserved.

It is unclear whether participation in exercise programs specifically developed for elderly translates into a more active lifestyle.To compare the objectively measured level of physical activity in daily life (PADL) between physically independent elderly who participate or do not participate in community-based exercise programs; and to evaluate which factors are associated with the higher level of PADL in these subjects.134 elderly participants in community-based exercise programs (PG) and 104 non-participants (NPG) had their level of PADL measured using pedometers during 7 days.6-minute walking test (6MWT), incremental shuttle walking test (ISWT), muscle strength, flexibility and balance.The PG had higher 1-week mean daily step count than NPG (8314 [IQR 5971-10060] vs. 6250 [IQR 4346-8207] steps/day, p0.0001), as well as higher step count in any day of the week. There was a higher proportion of physically active subjects (8000 steps/day) in PG than in NPG (37% vs. 16%, respectively; p0.001), as well as the proportion of sedentary subjects (5000 steps/day) (14% vs. 33%, respectively; p0.001). Participation in exercise programs, 6MWT and ISWT explained a higher daily steps count (model r(2)=0.56, p0.0001).In physically independent elderly, a higher level of physical activity in daily life occurs in those who participate in community-based exercise programs, regardless of the weekday and including non-program days. Participation of elderly in community-based exercise programs should be more systematically available and encouraged due to its close link to higher activity levels and better exercise capacity.

Although physical fitness is relevant for well-being and health, knowledge on the feasibility of instruments to measure physical fitness in older adults with intellectual disability (ID) is lacking. As part of the study Healthy Ageing with Intellectual Disabilities with 1,050 older clients with ID in three Dutch care services, the feasibility of 8 physical fitness tests was expressed in completion rates: box and block test, response time test, Berg balance scale, walking speed, grip strength, 30-s chair stand, 10-m incremental shuttle walking test, and the extended modified back saver sit and reach test. All tests had moderate to good feasibility in all subgroups, except for the participants with profound ID (all tests), severe ID (response time test and Berg balance scale), and wheelchair users (all tests that involve the legs). We conclude that the 8 tests are feasible to measure physical fitness in most older adults with ID.

PURPOSE: To evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence.METHODS: Seventy patients with COPD were referred to a home-care maintenance exercise program after completing pulmonary rehabilitation (PR) in the rehabilitation center. Adherence (yes/no) to the maintenance program was assessed by a self-reported questionnaire, where adherence was defined as attending the maintenance program 1 year after PR. Early dropouts received a self-reported questionnaire after 6 months and the remaining patients after 12 months. Lung function, exercise capacity, exercise self-efficacy, illness perceptions, health-related quality of life, levels of anxiety and depression, duration of PR, and the number of exacerbations were studied as possible predictors of adherence.RESULTS: Ten patients died or were lost to followup. Of the remaining 60 patients, 73.3% and 63.3% were adherent to the maintenance exercise program after 6 and 12 months, respectively. Forced expiratory volume in 1 second (FEV1) (P = .021), Hospital Anxiety and Depression Scale depression score (P = .025), and duration of PR (P = .018) were significant predictors of adherence to the maintenance program.CONCLUSION: Adherence to the maintenance exercise program included a 36.7% drop-out rate during the first year after completing PR. Experiencing exacerbations was the most reported reason for dropout. Poorer lung function, shorter initial PR course measured by reviewing patient records, and higher level of depressive symptoms were predictive of drop-out to the maintenance program. Adherence to the maintenance program needs to be improved for patients with lower FEV1, with signs of depression, or with a shorter initial PR course.

Introduction: O 2 desaturation frequently occurs during exercise in COPD patients on long-term oxygen therapy (LTOT) due to unadjusted O 2 flow rates. We evaluated a new closed-loop system (FreeO 2 ) that automatically and continuously adjusts the O 2 flows to the patient9s needs based on the recorded SpO 2 . In hypercapnic LTOT COPD, the impact of such a strategy on PaCO 2 is of particular interest. We hypothesized that continuous O 2 titration would reduce desaturation and improve exercise tolerance. Methods: 8 patients (FEV 1 = 0.8 ± 0.3 L; PaCO 2 = 49.5 ± 3.2 mmHg) were included in a double blind cross-over study. After assessment of maximal aerobic capacity and being familiarized with endurance shuttle walking test (ESWT, 85% peakVO 2 ), patients performed 2 ESWT, one with FreeO 2 (SpO 2 target set at 94%) and the other with constant O 2 flows (resting O 2 flow + 1L/min), in a random order. PCO 2 was measured through earlobe blood capillary samplings. Results: Mean O 2 flows during exercise were 5.9 ± 3.1 vs. 3.3 ± 1.4 L/min with FreeO 2 vs. constant O 2 , respectively. All patients improved O 2 saturation at the end of ESWT with FreeO 2 vs. constant O 2 (96 [93;97] vs. 85 [77;94]%, p = 0.03, respectively). Six patients out of 8 improved their walking distance leading to a trend toward significant increase in walking distance with FreeO 2 as compared to constant O 2 (383 [291;610] vs. 334 [208;485] m, p = 0.07). PCO 2 was similar between groups at the end and 10 min post ESWT. Conclusion: Automatic adjustment of O 2 during exercise was associated with improvement in O 2 saturation and a trend to significant increase in walking distance without change in PaCO 2 in hypercapnic LTOT COPD.

Item does not contain fulltext INTRODUCTION: Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up. METHODS: All included COPD patients participated in four self-management sessions. Additionally, patients in the COPE-active group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained 3 times/week for 6 months and two times/week during the subsequent 5 months. In both periods, one of these weekly training sessions was home-based (unsupervised). No formal physiotherapy sessions were offered to COPE-active patients in the second year. A decision analytical model with a 24-month perspective was used to evaluate cost-effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated and cost-effectiveness planes were created. RESULTS: Data of 77 patients participating in the exercise programme and 76 patients in the control group were analysed. The ICER for an additional patient prevented from deteriorating at least 47.5 meters on the ISWT was euro6257. The ICER for an additional patient with a clinically relevant improvement (>/= 500 steps/day) in physical activity was euro1564, and the ICER for an additional quality-adjusted life year (QALY) was euro10 950. CONCLUSION: Due to a lack of maintenance of beneficial effects on our primary outcome exercise capacity after 2 years of follow-up and higher costs of the programme, the community-based exercise programme cannot be considered cost-effective compared to self-management programmes only. Nevertheless, the ICERs for the secondary outcomes physical activity and QALY are generally considered acceptable.

Background Physical fitness is relevant for wellbeing and health, but knowledge on the feasibility and reliability of instruments to measure physical fitness for older adults with intellectual disability is lacking.Methods Feasibility and test-retest reliability of a physical fitness test battery (Box and Block Test, Response Time Test, walking speed, grip strength, 30-s chair stand, 10-m Incremental Shuttle Walking Test and the Extended Modified Back-Saver Sit-and-Reach Test) were investigated in older adults with ID in a convenience sample of 36 older adults (mean 65.9, range 50-89 years), with differing levels of intellectual disability and mobility.Results and conclusion All tests to measure physical fitness in older adults with ID had moderate to excellent feasibility and had sufficient test-retest reliability (ICCs .63-.96). No statistically significant learning effects were found.

The incremental and endurance shuttle walking tests (ISWT and ESWT) are measures of exercise tolerance commonly used in pulmonary rehabilitation (PR). A practice ISWT is advocated but often omitted by PR centres. We aimed to investigate the effect of such an omission within a clinical PR service. Between October 2002 and October 2008, 392 patients attending PR completed a practice ISWT and an ISWT. Results showed that patients walked significantly further on ISWT compared to practice ISWT (p ≤ 0.001). A significant difference in ESWT level was found between those calculated from practice ISWT and those calculated from ISWT (p ≤ .001). Despite a visual trend towards a negative relationship between distance walked at baseline (practice ISWT) and magnitude of the difference between the two walks, this did not meet statistical significance (p = 0.409). Absence of a practice ISWT could lead to possible clinical misjudgements.

Problems encountered in epidemiologic health research in older adults with intellectual disabilities (ID) are how to recruit a large-scale sample of participants and how to measure a range of health variables in such a group. This cross-sectional study into healthy ageing started with founding a consort of three large care providers with a total client population of 2322 clients of 50 years and over, and two academic institutes. This consort made formal agreements about a research infrastructure and research themes: (1) physical activity and fitness, (2) nutrition and nutritional state, and (3) mood and anxiety. Subsequently, preparation was started by carefully reviewing and selecting instruments to measure a wide set of health variables to answer the research questions. Specific demands of these instruments were that they could be executed efficiently and accurately on-site in a large sample of participants and that the burden of these measurements for participants as well as their caregivers was as minimal as possible. Then, preparation was continued by designing and executing a thorough communication plan for clients, legal representatives and staff of the care providers, preceding the informed consent procedure. In this plan. which had a top-down structure, specific attention was given to personally informing and motivating of key stakeholders: the professional care givers. This preparation led to a recruitment of 1050 participants (45.2%) and to high participation rates in key parts of the assessment. A detailed description is provided about the recruitment and organization and the selected instruments. (C) 2011 Elsevier Ltd. All rights reserved.

Objective The incremental shuttle walking test (ISWT) is a valuable tool for assessing changes in patients’ functional capacity during cardiac rehabilitation. However, studies have only assessed its test–retest reliability in the short term. The purpose of this study was to examine long-term test–retest reliability of the ISWT in clinically stable cardiac patients. Design Test–retest reliability assessment. Setting Continuous, community-based phase IV cardiac rehabilitation centre. Participants Thirty patients with cardiovascular disease (15 males, 15 females; age 55 to 80 years) volunteered to participate in the study. Interventions Participants undertook two ISWTs, a minimum of 8 weeks apart. Main outcome measures ISWT performance in metres. Results Overall, the mean distance walked in the pre-test was 502 ± 161 m and this did not differ from test to retest. The intraclass correlation coefficient was 0.80, indicating good test–retest reliability. Using the Bland and Altman method, there was a small mean test–retest difference (−7 m). The 95% limits of agreement were large, ranging from −203 m to 189 m. Conclusions Over long test–retest durations, there appears to be no learning effect in the ISWT, negating the need for a practice walk. The long-term random variation in the ISWT test is larger than in previous studies, probably due to greater physiological and psychological variation in the participants over 8 weeks compared with that seen in day-to-day testing. Factors influencing long-term test–retest reliability of the ISWT require further elucidation.

INTRODUCTION Pulmonary rehabilitation (PR) is an established component of COPD management. The lack of exercise performance improvement (EPI) in severely dyspnoeic patients (Medical Research Council [MRC] score 5) has been questioned. The data on the gender impact on EPI after PR remain scarce. OBJECTIVES The impact of dyspnea severity on PR outcomes was investigated and a question was raised whether severe dyspnea at training onset limits the profit from PR in COPD patients. Additionally, the impact of gender on PR results was analyzed. PATIENTS AND METHODS 263 consecutive COPD patients underwent outpatient PR. Exercise capacity was assessed by the incremental shuttle walking test (SWT) and dyspnea with the MRC dyspnea score at inclusion (preSWT, preMRC) and at the end of PR (postSWT, postMRC). The data were analyzed in groups according to preMRC. The grade of improvement (deltaSWT, deltaSWT% and deltaMRC) was compared between groups. The influence of gender was analyzed in 138 men and 125 women. RESULTS A significant absolute increase in SWT and a decrease in MRC score were shown in all groups and for both sexes (p 0.05). deltaSWT% rose significantly with preMRC score and exceeded the values of a clinically important increase (exception: group 2 with preMRC score 2). No significant differences between men and women were observed (deltaMRC: -0.6 vs. -0.7, deltaSWT: 66.7 vs. 56.0 m, deltaSWT%: 63.7 vs. 58.1%, p > 0.05, respectively). CONCLUSIONS Patients with severe dyspnea did not benefit less from PR. Gender did not influence PR outcome in this study.