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Suesada MM, Martins MA, Carvalho CRF: Effect of short-term hospitalization on functional capacity in patients not restricted to bed. Am J Phys Med Rehabil 2007;86:455-462. OBJECTIVE:: It has been suggested that long-term bed rest induces significant changes in most organ systems. However, few studies have focused on the effect of short-term hospitalization. The aim of the present study was to evaluate the effect of short-term hospitalization on functional capacity in patients not restricted to bed. DESIGN:: We evaluated 78 patients before and after a 5-day hospitalization. RESULTS:: The following differences were observed between pre- and posthospitalization outcomes: upper-limb muscle strength, 30 +/- 7.9 vs. 28.4 +/- 7.7 kg (P < 0.001); maximal inspiratory pressure, -83.3 +/- 25.0 vs. -70.9 +/- 23.1 cm H2O (P < 0.001); distance covered in the 6-min walk test, 476.2 +/- 93.1 vs. 437.7 +/- 89.5 m (P < 0.001); forced vital capacity, 3.25 +/- 0.95 vs. 2.95 +/- 0.93 liters (P < 0.001); spinal mobility, 4.3 +/- 0.9 vs. 3.7 +/- 0.9 cm (P < 0.001); and trunk mobility, 8.1 +/- 1.9 vs. 7.3 +/- 1.6 cm (P < 0.001). None of the anthropometric or clinical data collected at admission were predictive of these losses. CONCLUSION:: Our results suggest that short-term hospitalization reduces functional capacity, even in patients who are not restricted to bed, regardless of age or initial functional status. [ABSTRACT FROM AUTHOR]

Objectives: The scant data about non-cystic fibrosis bronchiectasis, including tuberculosis sequelae and impairment of lung function, can bias the preoperative physiological assessment. Our goal was to evaluate the changes in lung function and exercise capacity following pulmonary resection in these patients; we also looked for outcome predictors., Methods: We performed a non-randomized prospective study evaluating lung function changes in patients with non-cystic fibrosis bronchiectasis treated with pulmonary resection. Patients performed lung function tests and cardiopulmonary exercise tests preoperatively and 3 and 9 months after the operation. Demographic data, comorbidities, surgical data and complications were collected., Results: Forty-four patients were evaluated for lung function. After resection, the patients had slightly lower values for spirometry: forced expiratory volume in 1 s preoperatively: 2.21 l ± 0.8; at 3 months: 1.9 l ± 0.8 and at 9 months: 2.0 l ± 0.8, but the relationship between the forced expiratory volume in 1 s and the forced vital capacity remained. The gas diffusion measured by diffusing capacity for carbon monoxide did not change: preoperative value: 23.2 ml/min/mmHg ± 7.4; at 3 months: 21.5 ml/min/mmHg ± 5.6; and at 9 months: 21.7 ml/min/mmHg ± 8.2. The performance of general exercise did not change; peak oxygen consumption preoperatively was 20.9 ml/kg/min ± 7.4; at 3 months: 19.3 ml/kg/min ± 6.4; and at 9 months: 20.2 ml/kg/min ± 8.0. Forty-six patients were included for analysis of complications. We had 13 complications with 2 deaths. To test the capacity of the predicted postoperative (PPO) values to forecast complications, we performed several multivariate and univariate analyses; none of them was a significant predictor of complications. When we analysed other variables, only bronchoalveolar lavage with positive culture was significant for postoperative complications (P = 0.0023). Patients who had a pneumonectomy had a longer stay in the intensive care unit (P = 0.0348)., Conclusions: The calculated PPO forced expiratory volume in 1 s had an excellent correlation with the measurements at 3 and 9 months; but the calculated PPO capacity for carbon monoxide and the PPO peak oxygen consumption slightly underestimated the 3- and 9-month values. However, none of them was a predictor for complications. Better tools to predict postoperative complications for patients with bronchiectasis who are candidates for lung resection are needed., Clinical Trial Registration Number: Clinicaltrials.gov: NCT01268475., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: To evaluate the impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer., Methods: Breast cancer patients in whom thoracic radiotherapy was indicated after surgical treatment and chemotherapy were submitted to HRCT, respiratory evaluation, and exercise capacity evaluation before radiotherapy and at three months after treatment completion. Respiratory muscle strength testing, measurement of chest wall mobility, and complete pulmonary function testing were performed for respiratory evaluation; cardiopulmonary exercise testing was performed to evaluate exercise capacity. The total radiotherapy dose was 50.4 Gy (1.8 Gy/fraction) to the breast or chest wall, including supraclavicular lymph nodes (SCLN) or not. Dose-volume histograms were calculated for each patient with special attention to the ipsilateral lung volume receiving 25 Gy (V25), in absolute and relative values, and mean lung dose., Results: The study comprised 37 patients. After radiotherapy, significant decreases were observed in respiratory muscle strength, chest wall mobility, exercise capacity, and pulmonary function test results (p < 0.05). DLCO was unchanged. HRCT showed changes related to radiotherapy in 87% of the patients, which was more evident in the patients submitted to SCLN irradiation. V25% significantly correlated with radiation pneumonitis., Conclusions: In our sample of patients with breast cancer, thoracic radiotherapy seemed to have caused significant losses in respiratory and exercise capacity, probably due to chest wall restriction; SCLN irradiation represented an additional risk factor for the development of radiation pneumonitis.

Background: Pulmonary arterial hypertension is a progressive disease that is characterized by dyspnea and exercise intolerance. Impairment in skeletal muscle has recently been described in PAH, although the degree to which this impairment is solely determined by the hemodynamic profile remains uncertain. The aim of this study was to verify the association of structural and functional skeletal muscle characteristics with maximum exercise in PAH., Methods: The exercise capacity, body composition, CT area of limb muscle, quality of life, quadriceps biopsy and hemodynamics of 16 PAH patients were compared with those of 10 controls., Results: PAH patients had a significantly poorer quality of life, reduced percentage of lean body mass, reduced respiratory muscle strength, reduced resistance and strength of quadriceps and increased functional limitation at 6MWT and CPET. VO2 max was correlated with muscular variables and cardiac output. Bivariate linear regression models showed that the association between muscular structural and functional variables remained significant even after correcting for cardiac output., Conclusion: Our study showed the coexistence of ventilatory and quadriceps weakness in face of exercise intolerance in the same group of PAH patients. More interestingly, it is the first time that the independent association between muscular pattern and maximum exercise capacity is evidenced in PAH, independently of cardiac index highlighting the importance of considering rehabilitation in the treatment strategy for PAH.

Background: Bronchiectasis is a significant cause of morbidity. Surgical resection is a treatment option, but its main outcomes regarding quality of life (QOL) and physiologic consequences have not been addressed previously, to our knowledge. We aimed to evaluate the effect of surgical procedures on QOL, exercise capacity, and lung function in patients with bronchiectasis in whom medical treatment was unsuccessful., Methods: Patients with noncystic fibrosis in whom medical treatment was unsuccessful and who were candidates for lung resection were enrolled in a prospective study. The main measurements before lung resection and 9 months afterward were QOL according to the Short Form 36 Health Survey and World Health Organization Quality of Life Questionnaires, lung function test results, and the results of maximal cardiopulmonary exercise testing on a cycle ergometer., Results: Of 61 patients who were evaluated, 53 (50.9% male, age 41.3 ± 12.9 years) underwent surgical resection (83% lobectomies), and 44 completed the 9-month follow-up. At baseline, they had low QOL scores, mild obstruction, and diminished exercise capacity. After resection, 2 patients died and adverse events occurred in 24.5%. QOL scores improved remarkably at the 9-month measurements, achieving values considered normal for the general population in most dimensions. Functionally, resection caused mild reduction of lung volume; nevertheless, exercise capacity was not decreased. In fact, 52% of the patients improved their exercise performance. Multiple linear regression analysis showed that low QOL before resection was an important predictor of QOL improvement after resection (p = 0.0001)., Conclusions: Lung resection promotes a significant improvement in the QOL of patients with noncystic fibrosis bronchiectasis without compromising their exercise capacity., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)