Comparison of the Sit-to-Stand Test with 6 min walk test in patients with chronic obstructive pulmonary disease

Sit-to-stand test in children with bronchiectasis: Does it measure functional exercise capacity?

BACKGROUND

Similar to six-minute walk test (6MWT), sit-to-stand test (STST) is a self-paced test which elicits sub-maximal effort; therefore, it is suggested as an alternative measurement for functional exercise capacity in various pulmonary conditions including COPD and cystic fibrosis. We aimed to investigate the association between 30-second STST (30s-STST) and 6MWT in both children with bronchiectasis (BE) and their healthy counterparts, as well as exploring cardiorespiratory burden and discriminative properties of both tests.

METHODS

Sixty children (6 to 18-year-old) diagnosed with non-cystic fibrosis BE and 20 age-matched healthy controls were included. Both groups performed 30s-STST and 6MWT. Test results, and heart rate, SpO₂ and dyspnea responses to tests were recorded.

RESULTS

Univariate analysis revealed that 30s-STST was able to explain 52% of variance in 6MWT (r = 0.718, p<0.001) in BE group, whereas 20% of variance in healthy controls (r = 0.453, p = 0.045). 6MWT elicited higher changes in heart rate and dyspnea level compared to 30s-STST, indicating it was more physically demanding. Both 30s-STST (21.65±5.28 vs 26.55±3.56 repetitions) and 6MWT (538±85 vs 596±54 m) were significantly lower in BE group compared to healthy controls (p<0.01). Receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve (UAC) of 0.765 for 30s-STST and 0.693 for 6MWT in identifying the individuals with or without BE (p<0.05). Comparison between AUCs of 30s-STST and 6MWT yielded no significant difference (p = 0.466), indicating both tests had similar discriminative properties.

CONCLUSIONS

30s-STST is found to be a valid alternative measurement for functional exercise capacity in children with BE.

Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review

Objectives:

To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease.

Methods:

Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric (measurement) properties.

Results:

84 studies were included. Tests used at home were the 6-minute walk test (6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go (TUG, 4 studies) and step tests (two studies). Exercise tests administered remotely were the 6MWT (two studies) and step test (one study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (two studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients >0.80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported.

Discussion:

The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.

Metabolic Effects of Breaking Prolonged Sitting With Standing or Light Walking in Older South Asians and White Europeans: A Randomized Acute Study

Background

Prolonged sitting is common in older adults and is associated with insulin resistance and poor cardiometabolic health. We investigate whether breaking prolonged sitting with regular short bouts of standing or light walking improves postprandial metabolism in older white European and South Asian adults and whether effects are modified by ethnic group.

Methods

Thirty South Asian (15 women) and 30 white European (14 women) older adults (aged 65–79 years) undertook three experimental conditions in random order. (a) Prolonged sitting: continuous sitting during an observation period if 7.5 hours consuming two standardized mixed meals. (b) Standing breaks: sitting interrupted with 5 minutes of standing every 30 minutes (accumulating 60 minutes of standing over the observation period). (c) Walking breaks: sitting interrupted with 5 minutes of self-paced light walking every 30 minutes (accumulating 60 minutes of walking). Blood samples (glucose, insulin, triglycerides) and blood pressure were sampled regularly throughout each condition.

Results

Compared with prolonged sitting, walking breaks lowered postprandial insulin by 16.3 mU/L, (95% CI: 19.7, 22.0) with greater reductions (p = .029) seen in South Asians (22.4 mU/L; 12.4, 32.4) than white Europeans (10.3 mU/L; 5.9, 14.7). Glucose (0.3 mmol/L; 0.1, 0.5) and blood pressure (4 mm Hg; 2, 6), but not triglycerides, were lower with walking breaks, with no ethnic differences. Standing breaks did not improve any outcome.

Conclusions

Breaking prolonged sitting with short bouts of light walking, but not standing, resulted in clinically meaningful improvements in markers of metabolic health in older adults, with South Asians gaining a greater reduction in postprandial insulin.

Trial Registration

NCT02453204

Reliability and validity of Five Times Sit to Stand Test in pregnancy-related pelvic girdle pain

BACKGROUND

Pelvic girdle pain (PGP) is a common musculoskeletal disorder during pregnancy, and functional mobility evaluation is very important in reflecting the treatment effects.

OBJECTIVES

To investigate reliability and validity of Five Times Sit-to-Stand (5TSS) test in pregnant women with and without PGP.

DESIGN

A cross-sectional observational study.

METHODS

One hundred sixty-seven women in the second or third trimester of pregnancy participated in two assessments one week apart. The 5TSS and Timed Up & Go (TUG) tests were used to assess functional mobility, in a randomized sequence, by two independent raters. Time to complete the tests were recorded. Perceived pain and difficulty during functional mobility tests were marked on two Visual Analogue Scales. Following tests of functional mobility, seven clinical tests were used to classify the subjects as with or without PGP.

RESULTS

The 25% of subjects had PGP. Inter-rater reliability of 5TSS was excellent for subjects with and without PGP (ICC = 0.999, 95% CI = 0.999-1.000; ICC = 0.999, 95% CI = 0.999-0.999, respectively). Test-retest reliability of 5TSS was also very high for subjects with and without PGP (ICC = 0.986, 95% CI = 0.959-0.995; ICC = 0.828, 95% CI = 0.632-0.920, respectively). The 5TSS scores were positively correlated with TUG scores (r = 0.420, p = 0.006 and r = 0.404, p = 0.000, respectively). The subjects reported higher pain (95% CI = 0.322-0.824) and difficulty (95%Cl = 0.500-1.042) during 5TSS than the TUG test.

CONCLUSIONS

The 5TSS test is a reliable and valid functional mobility outcome measure in pregnant women with and without PGP. Further psychometric properties of the measure such as responsiveness, should be investigated in the future.

The Utility of the Sit-to-Stand Test for Inpatients in the Acute Hospital Setting After Lung Transplantation

OBJECTIVE

Measurement of physical function is important to guide physical therapy for patients post-lung transplantation (LTx). The Sit-to-Stand (STS) test has proven utility in chronic disease, but psychometric properties post-LTx are unknown. The study aimed to assess reliability, validity, responsiveness, and feasibility of the 60-second STS post-LTx.

METHODS

This was a measurement study in 62 inpatients post-LTx (31 acute postoperative; 31 medical readmissions). Interrater reliability was assessed with 2 STS tests undertaken by different assessors at baseline. Known group validity was assessed by comparing STS repetitions in postoperative and medical groups. Content validity was assessed using comparisons to knee extensor and grip strength, measured with hand-held dynamometry. Criterion validity was assessed by comparison of STS repetitions and 6-minute walk distance postoperatively. Responsiveness was assessed using effect sizes over inpatient admission.

RESULTS

Median (interquartile range) age was 62 (56-67) years; time post-LTx was 5 (5-7) days postoperative and 696 (244-1849) days for medical readmissions. Interrater reliability was excellent (intraclass correlation coefficient type 2,1 = 0.96), with a mean learning effect of 2 repetitions. Repetitions were greater for medical at baseline (mean 18 vs 8). More STS repetitions were associated with greater knee extensor strength (postoperative r = 0.57; medical r = 0.47) and 6-minute walk distance (postoperative r = 0.68). Effect sizes were 0.94 and 0.09, with a floor effect of 23% and 3% at baseline (postoperative/medical) improving to 10% at discharge. Patients incapable of attempting a STS test were excluded, reducing generalizability to critical care. Physical rehabilitation was not standardized, possibly reducing responsiveness.

CONCLUSIONS

The 60-second STS demonstrated excellent interrater reliability and moderate validity and was responsive to change postoperatively.

IMPACT

The 60-second STS represents a safe, feasible functional performance tool for inpatients post-LTx. Two tests should be completed at each time point.

Evaluation of the 3-minute chair rise test as part of preoperative evaluation for patients with non-small cell lung cancer

Background

Peak oxygen uptake (V˙O2peak) measured by a cardiopulmonary exercise test (CPX) is the gold‐standard for predicting surgical risk in patients with non‐small cell lung cancer (NSCLC). The 3‐minute chair rise test (3CRT) is a simple test requiring minimal resources. This study aimed to determine the ability of 3CRT to predict V˙O2peak in patients with NSCLC.

Methods

Retrospective data from CPX and 3CRT carried out in 36 patients with NSCLC between March 2018 and February 2019 were included. A multivariate analysis was undertaken to derive a predictive V˙O2peak equation based on performance on the 3CRT. In addition, sensitivity‐specificity analysis was carried out to estimate a threshold 3CRT value for the prediction of V˙O2peak ≥ 15 mL/kg/minute.

Results

The following equation was obtained: V˙O2peak predicted = (0.04765 × FEV1) ‐ (0.207 59 × BMI) ‐ (0.115 89 × age) + (0.386 09 × vertical distance) + 16.628 69; r² = 0.75, P < 0.01. The bias between the V˙O2peak values predicted and measured during CPX was 0.0 ± 1.7 mL/kg/minute (95% limits of agreement [−3.5 to 3.5]). A performance ≥49 chair rises predicted V˙O2peak ≥ 15 mL/kg/minute with a sensitivity of 0.75 and a specificity of 0.81.

Conclusions

The level of error in the prediction of V˙O2peak from 3CRT performance was too great to recommend that 3CRT should replace CPX as the sole measurement of V˙O2peak. Nevertheless, the 3CRT could help to identify those patients that require CPX prior to lung resection surgery for NSCLC, larger prospective study is needed to confirm this hypothesis.

Key points

Significant findings of the study

Cardiopulmonary exercise tests can stratify the surgical risk. Prediction of the peak oxygen uptake (V˙O2peak) value from the 3CRT yields an unacceptable level of error. However, a performance of 49 chair rises or more during the 3CRT could indicate a V˙O2peak ≥ 15 mL / kg / minute.

What this study adds

The 3CRT is a useful screening tool to determine the necessity for a comprehensive cardiopulmonary exercise test, whose access is limited in clinical practice. It could also allow early screening of patients requiring specific prehabilitation programs.

One-minute sit-to-stand test as an alternative tool to assess the quadriceps muscle strength in children

BACKGROUND

Clinical tools for assessment of the skeletal muscle strength are scarce and have rarely been validated in children. The aims of this study were to verify the construct validity of the one-minute sit-to-stand test (1-MSTST) to evaluate the quadriceps strength in healthy children between 12 and 18 years old and to correlate these outcomes with the anthropometric parameters.

METHODS

Healthy children were recruited and consecutively performed 1-MSTST and maximal voluntary contraction of the quadriceps (QMVC).

RESULTS

Eighty-three children (15±2 years old) were analyzed. Contrarily to the QMVC, neither the number of 1-MSTST repetitions nor the sit-to-stand work (1-MSTST expressed as the product of body weight) differed between genders. The QMVC was not correlated with the number of repetitions (rho=-0.056; P=0.617) but correlated with 1-MSTST when expressed as a product of body weight (r=0.491; P<0.001). The QMVC was also correlated with age (r=0.314; P=0.004), height (r=0.672; P<0.001), weight (r=0.721; P<0.001) and BMI (r=0.451; P<0.001) whereas 1-MSTST did not correlate with any of these parameters. The leg length was related to the results of both tests.

CONCLUSION

We demonstrated that the one-minute sit-to-stand test can be considered as a valid and valuable alternative to evaluate the muscle strength when expressed as the product of body weight.

Therapeutic pulmonary telerehabilitation protocol for patients affected by COVID-19, confined to their homes: study protocol for a randomized controlled trial

Background

In December 2019, 27 cases of pneumonia, of unknown cause, were identified in the province of Hubei (China). The WHO declared the situation as a Public Health Emergency of International Concern, and it was finally declared a global pandemic on March 11, 2020. The Spanish Government obliges the entire population to remain confined to their homes, with the exception of essential basic services, to stop the spread of COVID-19. Home isolation implies a notable physical deconditioning. Telerehabilitation methods have reported positive experiences, and we propose to study in affected patients of COVID-19, due to the general house confinement of the entire Spanish population.

Methods

Patients will be recruited in the regions of Andalusia, Murcia, and Valencia (Spain). Patients will remain confined to their homes, and there, they will carry out their assigned exercise program, which will be controlled telematically. Evaluators will attend to carry out all measurements at the beginning, during, and end of the study, telematically controlled. The patients will be randomly divided into three groups, two of them will perform a home exercise program (breathing exercises or non-specific exercises for muscle toning) and the third group will perform sedentary activities, using mental activation techniques, and will act as a sham group. We will evaluate respiratory variables and other variables of the physical state through physical tests, effort, and perceived fatigue. The data will be statistically analyzed, and the hypotheses will be tested between the groups, using the SPSS software, v.24, considering a 95% confidence interval.

Discussion

We will analyze the results, in terms of the level of fatigue and perceived exertion, physical health, and maintenance of respiratory activity of two types of exercise programs, toning and respiratory, applied in patients affected by COVID-19 during the period of home confinement. We intend to investigate a field not previously studied, such as the repercussion of carrying out a toning and respiratory exercise program in these patients, in historical circumstances that no one had previously observed in Spain, since the general population has never been forced to remain confined in their homes, due to a pandemic infection, by a coronavirus (COVID-19). Observing the effects that these two home exercise programs could produce in patients infected with COVID-19, we will try to better analyze and understand the mechanisms that are associated with the worsening of breathing in this type of patient.

Trial registration

Brazilian Clinical Trial Registry RBR-6m69fc. Registered on March 31, 2020.

Phenotypic Characteristics of Patients With Chronic Obstructive Pulmonary Disease After Stratification for the Short Physical Performance Battery Summary Score

OBJECTIVE

To assess the phenotypic characteristics of patients with chronic obstructive pulmonary disease (COPD) after stratification for Short Physical Performance Battery (SPPB) summary scores and to determine phenotypic characteristics of the SPPB summary score at the start of pulmonary rehabilitation (PR).

DESIGN

Retrospective, cross-sectional.

SETTING

Baseline assessment for PR program.

PARTICIPANTS

Patients with COPD (n=900; age 65±8y, 52% male, forced expiratory volume in the first second of expiration, 43% [interquartile range, 31%-62%] predicted).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Patients were stratified according to their SPPB summary scores into low-performance (LP), moderate-performance (MP), or high-performance (HP) groups. Furthermore, lung function, arterial blood gases, body composition, physical capacity, lower limb muscle strength and endurance, and symptoms of anxiety and depression were assessed.

RESULTS

Generally, physical capacity and muscle function were lower and scores for symptoms of anxiety and depression were higher in LP patients than MP and HP patients (all values, P<.01). However, 25% of HP patients with COPD scored high on symptoms of anxiety and/or depression (≥10 points), and HP patients still had on average an impaired physical capacity (median, 6-minute walk test [6MWT] distance of 69% predicted). Furthermore, age and 6MWT distance (m) were the only independent predictors in a multivariate regression model, explaining 29% of the variance in SPPB summary score.

CONCLUSIONS

In COPD, LP patients have the worst physical and emotional functioning. However, HP patients can still exhibit physical and emotional impairments. Because the explained variance in SPPB summary score is low, SPPB should not be considered as a test to discriminate between patients with COPD with a low or preserved physical capacity and emotional status.

Decreased handgrip strength can predict lung function impairment in male workers: a cross sectional study

BACKGROUND

Spirometry is useful for evaluating respiratory health status and predicting health-related outcomes. As spirometry requires skilled technician and takes time, it is useful to find simple way for predicting lung function impairment. The aim of this study was to investigate which tests could predict lung function impairment among workers.

METHODS

This prospective study included workers of manufacturing industry who underwent health check-ups in 2017. Subjects underwent the chronic obstructive pulmonary disease (COPD) assessment test (CAT), spirometry, and physical fitness assessments, including handgrip strength (HGS). Lung function impairment was defined as a decline in any of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), or a FEV1/FVC ratio less than the lower limit of normal (LLN).

RESULTS

Complete data on 475 workers (366 men, 50.4% ever smokers) were available. Lung function impairment was observed in 99 subjects (64 men). Men with lung function impairment had significantly higher rate of ever-smoking, passive smoking at home in childhood, high CAT scores, and decreased HGS, compared with those without. On multivariate analyses, ever-smoking (odds ratio [OR], 2.50; 95% confidence intervals [CI], 1.25-4.97), passive smoking at home in childhood (OR, 2.71; 95% CI, 1.16-6.32), CAT scores (OR, 1.06; 95% CI, 1.01-1.12), and HGS (OR, 0.73; 95% CI, 0.57-0.92) were independently associated with lung function impairment in men.

CONCLUSIONS

Ever-smoking, passive smoking at home in childhood, high CAT scores, and decreased HGS are significantly associated with lung function impairment in men.

TRIAL REGISTRATION

Registration number: UMIN000028011. Date of registration: July 1, 2017.

Stability and Predictors of Poor 6-min Walking Test Performance over 2 Years in Patients with COPD

Poor performance in the 6-min walk test (6MWT < 350 m) is an important prognostic indicator of mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Little is known about the stability of this state over time and what factors might predict a poor 6MWT performance. To determine the stability of 6MWT performance over a 2-year period in COPD patients participating in annual medical follow-up visits, and to assess the ability of several clinical, pulmonary, and non-pulmonary factors to predict poor 6MWT performance, we prospectively included 137 patients with stable COPD (mean age, 66.9 ± 8.3 years). The 6MWT was scored at baseline and 2-year follow-up. To evaluate clinical, pulmonary, and non-pulmonary variables as potential predictors of poor 6MWT performance, we used multiple logistic regression models adjusted for age, sex, weight, height, and 6MWT performance at baseline. Poor 6MWT performance was stable over 2 years for 67.4% of patients. Predictors of poor 6MWT performance included a five-repetition sit-to-stand test score ≤2 (OR, 3.01; 95% CI, 1.22-7.42), the percentage of mobility activities with limitations (OR, 1.03; 95% CI, 1.00-1.07), and poor 6MWT performance at baseline (OR, 4.64; 95% CI, 1.88-11.43). Poor 6MWT performance status was stable for the majority of COPD patients. Lower scores on the five-repetition sit-to-stand test and a higher number of mobility activities with limitations were relevant predictors of poor 6MWT performance over 2 years. Prognostic models based on these non-pulmonary factors can provide non-inferior discriminative ability in comparison with prognostic models based on only pulmonary factors.

Validation of 4-meter-gait-speed test and 5-repetitions-sit-to-stand test in patients with pulmonary fibrosis: a clinimetric validation study

Background and objective: Patients with pulmonary fibrosis (PF) have a clear exercise intolerance. The 4-meter-gait-speed (4MGS) test and the 5-repetitions-sit-to-stand (5STS) test are easy, inexpensive and reliable measures of functional performance. Both tests have been validated in healthy adults and patients with chronic obstructive pulmonary disease. 4MGS test and 5STS test have not been studied in patients with PF. Methods: In this cross-sectional clinimetric validation study 51 PF patients conducted in random order the 4MGS test, 5STS test and the 6-min walk test (6MWT) on a single day. Additionally, body weight, height, lean body mass, health-related quality of life, disease severity, handgrip strength, dyspnoea and leg fatigue were assessed. The setting was a tertiary referral center for Interstitial Lung Diseases. Results: Patients had a diagnosis of idiopathic pulmonary fibrosis (IPF, 37%), PF other than IPF (47%), or unclassified (16%). Patients walked 453±111m in six minutes. Moreover, it took the patients 2.0±0.5s to walk 4 m, and 12.0±3.8s for the 5STS test. The 4MGS test (r = 0.77; p<0.01) and the 5STS test (r = -0.41; p<0.01) correlated significantly with the distance walked in 6MWT. Indeed, 4MGS combined with handgrip strength and Medical Research Council dyspnoea grade could explain 75% of the variance in 6MWD. Conclusions: 4-meter-gait-speed and 5-repetitions sit-to-stand are significantly and independently correlated with the 6-minute walk distance in patients with pulmonary fibrosis. Indeed, 4-meter-gait-speed test may serve as a simple initial field test to assess exercise performance in patients with pulmonary fibrosis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 317-326)

Short Physical Performance Battery: What Does Each Sub-Test Measure in Patients with Chronic Obstructive Pulmonary Disease?

Objective

To identify phenotypic factors associated with the Short Physical Performance Battery (SPPB) and its individual sub-tests: standing balance, 4‑meter gait speed (4mGS) and 5-repetition sit-to-stand (5STS).

Methods

The Evaluation of the Role of Inflammation in non-pulmonary disease manifestations in Chronic Airways disease (ERICA) study recruited adult participants with stable chronic obstructive pulmonary disease (COPD). Proportional odds models identified factors associated with the SPPB, and a principal component analysis (PCA) evaluated how much SPPB variance was explainable by each of its 3 sub-tests.

Results

Of 729 enrolled participants, 717 (60% male, mean age 67 years) had full SPPB data. Overall, 76% of patients had some evidence of functional limitations (SPPB total score < 12). Scores < 4 were observed in 71%, 31%, and 22% of participants for the 5STS, 4mGS, and balance sub-tests, respectively. A longer 6-minute walk test and greater quadriceps maximal voluntary contraction decreased the odds of being in a lower score category for SPPB total score and for all 3 sub-tests. Aging, self-reported hypertension and higher dyspnea increased the odds, and being married decreased the odds of being in a lower category for total score. All sub-tests contributed equally to total score.

Conclusion

Each of the 3 sub-tests contributed independent information to the SPPB, demonstrating their usefulness for assessing COPD when considered together rather than individually. The 5STS sub-test had the greatest variation in scores and may thus have the best discriminatory power for clinical COPD studies of lower limb performance where only one SPPB test is feasible.

Patterns and predictors of low physical activity in patients with stable COPD: a longitudinal study

BACKGROUND

Despite the frequency and negative impact of low physical activity among patients with chronic obstructive pulmonary disease (COPD), little is known about how it persists and remits over time or the factors predicting new states of low physical activity. The aim of the study was to determine the probability of a transition between states of low and nonlow physical activity in a cohort of patients with stable COPD followed for 2 years. We also investigated different potentially modifiable factors to determine whether they can predict new states of low physical activity.

METHODS

We prospectively included 137 patients with stable COPD (mean age 66.9 ± 8.3 years). Physical activity was measured at baseline and at 1 and 2 years of follow up. Low physical activity was defined according to energy expenditure by cut-off points from the Fried frailty model. The likelihood of annual transition towards new states and recovery was calculated. We evaluated demographic, frailty, nonrespiratory, and respiratory variables as potential predictors, using generalized estimating equations.

RESULTS

At baseline, 37 patients (27%) presented with low physical activity. During the study period, a total of 179 annual transitions were identified with nonlow physical activity at the beginning of the year; 17.5% transitioned to low physical activity. In contrast, 34.3% of the 67 transitions that started with low physical activity recovered. Predictors of transition to new states of low physical activity were dyspnea ⩾2 (odds ratio = 3.21; 95% confidence interval: 1.20-8.61) and poor performance on the five sit-to-stand test (odds ratio = 4.75; 95% confidence interval: 1.30-17.47).

CONCLUSIONS

The change between levels of low and nonlow physical activity is dynamic, especially for recovery. Annual transitions toward new states of low physical activity are likely among patients with dyspnea or poor performance on the five sit-to-stand test. The reviews of this paper are available via the supplemental material section.

Compliance, adherence and effectiveness of a community-based pre-operative exercise programme: a pilot study

BACKGROUND

Pre-operative exercise training improves HR components of fitness and HRQoL following hospital-based programmes.

OBJECTIVE

To assess compliance and adherence of a pragmatic community-based preoperative exercise programme and its effect on health-related (HR) components of fitness and health-related quality of life (HRQoL).

METHODS

Thirty-two surgical oncological participants (15 prostate cancer and 17 colorectal cancer (CRC)) were recruited and assessed to measure HR components of fitness (strength and functional exercise capacity) and HRQoL. An exercise programme was prescribed in the time available prior to surgery with repeat assessments pre-operatively.

RESULTS

Twenty-four participants (14 prostate cancer and 10 CRC) completed the full study (75% compliance). Exercise training was delivered over a median interquartile range (IQR) of 4 (3-4) weeks and 2 (1-3) weeks for the prostate cancer and CRC participants, with > 80% adherence. From baseline to post-exercise intervention, there were significant improvements in lower body strength in the prostate cancer group (p = 0.045), the CRC group (p = 0.001), and in both groups overall (p = .001). Additionally, there were statistically significant improvements in HRQoL: global health status for CRC group (p = 0.025) and for both groups overall (p = 0.023); emotional health subscale for the prostate cancer group (p = 0.048) and for both groups overall (p = 0.027); nausea/vomiting/pain subscale for the CRC group (p = 0.005) and for both groups overall (p = 0.030); and for health scale status for the prostate cancer group (p = 0.019) and for both groups overall (p = 0.006).

CONCLUSION

This community-based pre-operative exercise programme showed acceptable compliance and adherence rates, and significantly increased upper and lower body strength and HRQoL. Pre-operative exercise training should be considered as early as possible in the surgical-oncology pathway and respected within patient scheduling.

Detection of collagens by multispectral optoacoustic tomography as an imaging biomarker for Duchenne muscular dystrophy

Biomarkers for monitoring of disease progression and response to therapy are lacking for muscle diseases such as Duchenne muscular dystrophy. Noninvasive in vivo molecular imaging with multispectral optoacoustic tomography (MSOT) uses pulsed laser light to induce acoustic pressure waves, enabling the visualization of endogenous chromophores. Here we describe an application of MSOT, in which illumination in the near- and extended near-infrared ranges from 680-1,100 nm enables the visualization and quantification of collagen content. We first demonstrated the feasibility of this approach to noninvasive quantification of tissue fibrosis in longitudinal studies in a large-animal Duchenne muscular dystrophy model in pigs, and then applied this approach to pediatric patients. MSOT-derived collagen content measurements in skeletal muscle were highly correlated to the functional status of the patients and provided additional information on molecular features as compared to magnetic resonance imaging. This study highlights the potential of MSOT imaging as a noninvasive, age-independent biomarker for the implementation and monitoring of newly developed therapies in muscular diseases.

An exploratory study of vibration therapy on muscle function in patients with peripheral artery disease

OBJECTIVE

The purpose of this exploratory study was to determine whether a single session of vibration therapy (VT) would improve muscular and functional performance in individuals with symptomatic peripheral artery disease (PAD).

METHODS

In a randomized, balanced cross-over design fourteen PAD participants with intermittent claudication (mean ± standard deviation; age, 73.9 ± 4.6 years; height, 172.6 ± 68.4 cm; body mass, 85.2 ± 15.7 kg) performed VT and control that involved repeated chair rises, timed up-and-go test, and 6-minute walk test. Each intervention was separated by at least 2 days. Wearable VT devices were positioned on the right and left lower limbs that were turned on during functional testing but were turned off for the control intervention.

RESULTS

VT significantly improved (P < .05) repeated chair rises and timed up-and-go test compared with control with a small effect size of 0.46 and 0.45, respectively. Similarly, a significant (P < .01) and meaningful change in 6-minute walk test was noted in VT compared with control.

CONCLUSIONS

This exploratory study suggest that VT may enhance functional strength, mobility, and walking performance by extending the onset of claudication and increasing walking distance in PAD with intermittent claudication. However, further study is required to confirm and extend these preliminary findings and determine the potential mechanisms of action in VT.

Assessment of Validity and Reliability of the 1-Minute Sit-to-Stand Test to Measure the Heart Rate Response to Exercise in Healthy Children

This study examines the concurrent validity and reliability of the sit-to-stand test to quantify heart rate response during submaximal exercise in healthy Belgian children.

What is the optimal chair stand test protocol for older adults? A systematic review

Purpose: To determine the chair stand test protocol that is most suitable for older adults in clinical settings by reviewing the currently available methods.Methods: Five electronic English databases were searched and details of methods used on individuals aged ≥65 years in the included studies were compared, including the instrument used to record time, units of measurement, chair characteristics (seat height, armrests), footwear, permission to use upper extremities and walking aids, pace of performance, total number of chair stands, timing points, total number of recorded and practice tests.Results: A total of 23 eligible studies were identified. The type of instrument to record performance time, characteristics of the chair and footwear were not frequently mentioned. A majority of studies did not permit the use of the upper extremities or walking aids during assessment. The performance of five chair stands at a fast pace recorded in seconds was most common, with the majority of studies recording the initial and end time point in a seated position. The total number of performed tests and practice tests was not specified in a majority of studies.Conclusion: A feasible and safe protocol for the chair stand test is proposed for assessment of older adults.Implications for RehabilitationThe chair stand test may provide valuable information on declines in mobility in older adults.The use of the chair stand test within clinical settings of older adults may provide a measure to identify frail individuals and to determine their level of frailty.Using the proposed protocol for the chair stand test may allow for the comparability of results.

A phase 3 randomized study evaluating sialic acid extended-release for GNE myopathy

Objective

To investigate the efficacy and safety of aceneuramic acid extended-release (Ace-ER), a treatment intended to replace deficient sialic acid, in patients with GNE myopathy.

Methods

UX001-CL301 was a phase 3, double-blind, placebo-controlled, randomized, international study evaluating the efficacy and safety of Ace-ER in patients with GNE myopathy. Participants who could walk ≥200 meters in a 6-minute walk test at screening were randomized 1:1, and stratified by sex, to receive Ace-ER 6 g/d or placebo for 48 weeks and assessed every 8 weeks. The primary endpoint was change in muscle strength over 48 weeks measured by upper extremity composite (UEC) score. Key secondary endpoints included change in lower extremity composite (LEC) score, knee extensor strength, and GNE myopathy–Functional Activity Scale (GNEM-FAS) mobility domain score. Safety assessments included adverse events (AEs), vital signs, and clinical laboratory results.

Results

Eighty-nine patients were randomized (Ace-ER n = 45; placebo n = 44). Change from baseline to week 48 for UEC score between treatments did not differ (least square mean [LSM] Ace-ER −2.25 kg vs placebo −2.99 kg; LSM difference confidence interval [CI] 0.74 [−1.61 to 3.09]; p = 0.5387). At week 48, there was no significant difference between treatments for the change in key secondary endpoints: LEC LSM difference (CI) −1.49 (−5.83 to 2.86); knee extension strength −0.40 (−2.38 to 1.58); and GNEM-FAS mobility domain score −0.72 (−2.01 to 0.57). Gastrointestinal events were the most common AEs.

Conclusions

Ace-ER was not superior to placebo in improving muscle strength and function in patients with GNE myopathy.

Classification of evidence

This study provides Class I evidence that for patients with GNE myopathy, Ace-ER does not improve muscle strength compared to placebo.

1-Minute Sit-to-Stand Test: SYSTEMATIC REVIEW OF PROCEDURES, PERFORMANCE, AND CLINIMETRIC PROPERTIES

PURPOSE

Tests for quantifying exercise capacity that are applicable in diverse settings are needed. The 1-min sit-to-stand test (1-MSTST) is such a test. This systematic review summarizes the literature addressing 1-MSTST procedures, performance, and clinimetric properties.

METHODS

Three online databases, hand searches, and an expert consultant were used to identify literature relevant to the aims of this review. Inclusion required that studies addressed the 1-MSTST, focused on adults, and were written in English.

RESULTS

Seventeen articles were identified that met the inclusion criteria. The populations assessed included adults without identified pathologies and adults with lung disease, renal disease, stroke, osteoporosis, or receiving palliative care. The 1-MSTST typically involves an armless chair and the performance of as many sit-to-stand actions as possible in 1 min without using the upper limbs. The mean number of 1-MSTST repetitions reported in the literature achieved ranged from 8.1 (patients with stroke) to 50.0 (young men). Numerous studies supported the convergent and known-groups validity and the test-retest reliability of the test. The test has been shown to be responsive. Normative reference values are available.

CONCLUSIONS

The literature provides considerable support for using the 1-MSTST to quantify exercise capacity. Broader use of this test may be indicated, particularly where space and time are limited.

A comparative study of the five-repetition sit-to-stand test and the 30-second sit-to-stand test to assess exercise tolerance in COPD patients

Purpose

The sit-to-stand test (STST) has been used to evaluate the exercise tolerance of patients with COPD. However, mutual comparisons to predict poor exercise tolerance have been hindered by the variety of STST modes used in previous studies, which also did not consider patients’ subjective perceptions of different STST modes. Our aim was to compare the five-repetition sit-to-stand test (5STS) with the 30-second sit-to-stand test (30STS) for predicting poor performance in the six-minute walking test and to evaluate patients’ subjective perceptions to determine the optimal mode for clinical practice.

Patients and methods

Patients with stable COPD performed 5STS, 30STS and the 6MWT and then evaluated their feelings about the two STST modes by Borg dyspnea score and a questionnaire. Moreover, we collected data through the pulmonary function test, mMRC dyspnea score, COPD assessment test and quadriceps muscle strength (QMS). A receiver operating characteristic curve analysis of the 5STS and 30STS results was used to predict 6-minute walk distance (6MWD) <350 m.

Results

The final analysis included 128 patients. Similar moderate correlations were observed between 6MWT and 5STS (r=−0.508, P<0.001) and between 6MWT and 30STS (r=0.528, P<0.001), and there were similar correlations between QMS and 5STS (r=−0.401, P<0.001) and between QMS and 30STS (r=0.398, P<0.001). The 5STS and 30STS score cutoffs produced sensitivity, specificity and positive and negative predictive values of 76.0%, 62.8%, 56.7% and 80.3% (5STS) and 62.0%, 75.0%, 62.0% and 75.0% (30STS), respectively, for predicting poor 6MWT performance. The 5STS exhibited obvious superiority in terms of the completion rate and the subjective feelings of the participants.

Conclusion

As a primary screening test for predicting poor 6MWD, the 5STS is similar to the 30STS in terms of sensitivity and specificity, but the 5STS has a better patient experience.

Effects of long-term home-based Liuzijue exercise combined with clinical guidance in elderly patients with chronic obstructive pulmonary disease

Purpose

This study was designed to investigate the effects of long-term home-based Liuzijue exercise combined with clinical guidance in elderly patients with chronic obstructive pulmonary disease (COPD).

Methods

Forty patients with COPD at stages II–III of the Global Initiative for Chronic Obstructive Lung Disease were enrolled. The subjects were randomly allocated to the Liuzijue exercise group (LG) or control group (CG) in a 1:1 ratio. Participants in the LG performed six Liuzijue training sessions, including 4 days at home and 2 days in the hospital with clinical guidance for 60 minutes/day for 6 months. Participants in the CG conducted no exercise intervention. In addition, lung function test, 6-minute walking test (6MWT), 30-second sit-to-stand test (30 s SST), and the St George’s Respiratory Questionnaire (SGRQ) were conducted at the baseline and at the end of the intervention.

Results

Thirty-six patients completed the study. The patients’ lung function improved significantly (p < 0.05) in the LG as well as the 6MWT, 30 s SST, and SGRQ score (p < 0.01). While the SGRQ total score, activity, and impact scores increased significantly (p < 0.05) in the CG. In addition, there were significant differences between the groups (p < 0.01) in regard to the values of forced expiratory volume in 1 second as a percentage of the predicted volume, 6MWT, 30 s SST, and SGRQ.

Conclusions

Long-term home-based Liuzijue exercise combined with clinical guidance can effectively improve the pulmonary function, exercise capacity, and quality of life of elderly patients with moderate to severe COPD.

Muscle strength, functional endurance, and health-related quality of life in active older female golfers

Background

Grip strength is a reliable predictor of whole body strength in older adults, but muscle characteristics of people with different activity levels have not been studied previously. The present study examined the relationship between grip strength (GS), quadriceps peak torque (QPT), functional endurance, and health-related quality of life (HRQoL) in older female golfers.

Methods

Twenty-nine healthy female golfers (mean age 69.1 years, SD 3.4) participated. The ISOCOM and JAMAR dynamometers were used to assess QPT and GS, respectively. Functional endurance tests included 1-min sit-to-stand test (1MSTS), 30-s wall press (30SWP), and 2-min stair climb (2MSC). HRQol was assessed using the SF-36 questionnaire.

Results

Mean GS and QPT were 27.5 ± 4 kg/f and 103.7 ± 25.1 N m, respectively. Mean scores for the 1MSTS, 30SWP, and 2MSC were 31 ± 7.7, 17.4 ± 3.5, and 237.5 ± 48.6 repetitions, respectively. GS was moderately correlated with QPT (r = 0.44), 1MSTS (r = 0.36), and 2MSC (r = 0.36), but had weak correlation with 30SWP (r = 0.003). Moderate correlation was observed between quadriceps peak torque and the 1MSTS (r = 0.50; p = 0.01), 2MSC (r = 0.44; p = 0.02) and 30SWP (r = 0.33). 30SWP and 2MSC had moderate correlations with PF r = 0.41 (p = 0.03) and r = 0.61 (p < 0.0005) and general physical well-being r = 0.47 (p = 0.01) and r = 0.39 (p = 0.04), respectively.

Conclusion

Quadriceps strength was more closely associated with functional endurance than grip strength. A single strength measure may not reflect overall muscle characteristics in active older females, and hence, assessment of both upper and lower limb strengths may be appropriate.

Effect of Liuzijue Exercise Combined with Elastic Band Resistance Exercise on Patients with COPD: A Randomized Controlled Trial

OBJECTIVES

This study aimed to investigate the effect of Liuzijue exercise combined with elastic band resistance exercise on patients with chronic obstructive pulmonary disease (COPD) to provide a convenient, safe, and cost-effective exercise.

METHODS

Subjects were randomly divided into the control group (CG), the Liuzijue exercise group (LG), and the Liuzijue exercise combined with elastic band resistance exercise group (LEG), with 20 patients in each group. The LG performed Liuzijue exercise six times a week (two exercise sessions in the hospital and four exercise sessions at home). The LEG includes Liuzijue exercise similar to the LG and elastic band resistance exercise three times a week, with elastic band exercise implemented after Liuzijue exercise. Spirometry, 6-minute walking test (6MWT), 30-second sit-to-stand test (30 s SST), handgrip strength test, and St. George's Respiratory Questionnaire (SGRQ) were performed at baseline and at the end of intervention.

RESULTS

After six-month intervention, the forced expiratory volume in 1 second (% predicted), 6-minute walking distance (6MWD), 6MWD%pred, 30 s SST, and SGRQ were significantly improved in the intervention groups (p < 0.01) and handgrip strength was increased significantly in the LG and LEG (p = 0.03 and p = 0.001, respectively). Furthermore, improvements in 6MWD and SGRQ were distinguished in the intervention groups compared with the CG (p < 0.01). No difference was significant in all of the outcomes between the LG and the LEG.

CONCLUSIONS

The intervention program of Liuzijue exercise combined with elastic band resistance exercise and Liuzijue exercise only has beneficial effects on COPD patients especially in the aspect of exercise capacity and quality of life.

Physical Inactivity, Functional Status and Exercise Capacity in COPD Patients Receiving Home-Based Oxygen Therapy

Chronic obstructive pulmonary disease (COPD) has systemic consequences that lead to reduced physical activity in daily life (PADL). Little is known about PADL and its associations in individuals with COPD on home-based long-term oxygen therapy (LTOT). The objective of the study was to determine whether there is an association between severe physical inactivity and pulmonary function, fatigue, dyspnea, functional status and exercise capacity in individuals with COPD on home-based LTOT using electric oxygen concentrators and to investigate which of these variables could influence inactivity in these individuals. The population sample included 39 individuals with COPD who were on LTOT (69 ± 8 years, FEV₁: 32 ± 14% predicted). They were assessed in terms of PADL (number of steps/day), fatigue (Fatigue Severity Scale - FSS), dyspnea (Medical Research Council - MRC scale), functional status (London Chest ADL scale [LCADL] and Timed Up and Go [TUG] test) and functional exercise capacity (Six-Minute Step test [6MST] and Sit-to-Stand test [STST]). PADL was markedly low (1444 ± 1203 steps/day) and associated with daily duration of LTOT (r = -0.50), fatigue (r = -0.36), LCADL (r = -0.41), 6MST (r = 0.48), and STST (r = 0.53) (p < .05 for all). Multiple linear regression revealed that daily duration of LTOT and STST explained 39% of the variability of PADL. Longer daily duration of LTOT, fatigue, worse functional status and exercise capacity were all associated with physical inactivity in individuals with COPD on LTOT, whereas daily duration of LTOT and the STST were determinants of reduced physical activity.

The relationship of sit-to-stand tests with 6-minute walk test in healthy young adults

The aim of this study was to evaluate the timed sit-to-stand (STS) test performances of healthy young adults and to investigate the relationship of timed STS tests with 6-minute walk test (6MWT). A cross-sectional study was performed. A total of 40 healthy volunteers (mean age: 21.7 ± 1.2 years) were evaluated with 10, 30, and 60 seconds STS tests and 6MWT. Fatigue and shortness of breath were rated using Borg category-ratio scale (CR10) before and after each test. Weekly energy expenditures of volunteers were calculated using International Physical Activity Questionnaire. 30 and 60 seconds STS tests were moderately (r = 0.611 and r = 0.647, respectively) (P < .001) and 10 seconds STS test was weakly (r = 0.344) (P = .028) correlated with 6MWT. Among correlations of each STS test with 6MWT, none of them was statistically stronger to one another (P > .05). Borg fatigue scores after 10, 30, and 60 seconds STS tests were weakly correlated with fatigue score after 6MWT (r = 0.321, r = 0.378, and r = 0.405, respectively) (P < .05). Weekly energy expenditure (MET-min/week) was moderately correlated with 10, 30, and 60 seconds STS tests and 6MWT (r = 0.533, r = 0.598, r = 0.598, and r = 0.547, respectively) (P < .001). Considering the statistically significant relationship between timed STS tests and 6MWT, any of the timed STS tests may be used for a quick and alternative measurement of physical performance and functional capacity in healthy young adults.

The 1-minute sit-to-stand test to detect exercise-induced oxygen desaturation in patients with interstitial lung disease

BACKGROUND

Although the 6-min walk test (6MWT) is the gold standard for assessing exercise-induced impairment of gas exchange, it cannot easily be performed in a clinical office environment. The aim of this study was to compare the 1-min sit-to-stand test (1STST) with the 6MWT for the ability to assess exercise-induced oxygen desaturation in patients with interstitial lung diseases (ILDs).

METHODS

A total of 107 patients were enrolled and classified into three groups: sarcoidosis, fibrotic idiopathic interstitial pneumonia (f-IIP), and other forms of ILD. The 6MWT and 1STST were performed on the same day, and pulmonary function tests, pulse oxygen saturation (SpO2), and dyspnea and fatigue (modified Borg scale) were assessed. SpO2 desaturation was evaluated by intraclass correlation coefficient (ICC), Bland-Altman analysis, and kappa (κ) coefficient in the whole population and the patient subgroups.

RESULTS

The SpO2 nadir during the 1STST and 6MWT showed good consistency [mean ± standard deviation: 92.5% ± 5% and 90% ± 7%, respectively; ICC 0.77, 95% confidence interval (CI) 0.71-0.83] and correlated strongly ( r = 0.9, p < 0.0001). The frequency of patients with oxygen desaturation ⩾4% was also consistent for the two exercise tests ( κ = 0.68, 95% CI 0.54-0.82). The number of repetitions in the 1STST correlated with the 6MWT distance ( r = 0.5, p < 0.0001), but the dyspnea scores were higher during the 1STST than the 6MWT ( p < 0.0001). These findings did not differ for the three patient subgroups.

CONCLUSION

The 1STST can measure exercise-induced desaturation in ILD patients and could be used as an alternative test to the 6MWT in office practice.

A partially supervised physical activity program for adult and adolescent survivors of childhood cancer (SURfit): study design of a randomized controlled trial [NCT02730767]

BACKGROUND

Beyond survival of nowadays >80%, modern childhood cancer treatment strives to preserve long-term health and quality of life. However, the majority of today's survivors suffer from short- and long-term adverse effects such as cardiovascular and pulmonary diseases, obesity, osteoporosis, fatigue, depression, and reduced physical fitness and quality of life. Regular exercise can play a major role to mitigate or prevent such late-effects. Despite this, there are no data on the effects of regular exercise in childhood cancer survivors from randomized controlled trials (RCTs). Primary outcome of the current RCT is therefore the effect of a 12-months exercise program on a composite cardiovascular disease risk score in childhood cancer survivors. Secondary outcomes are single cardiovascular disease risk factors, glycaemic control, bone health, body composition, physical fitness, physical activity, quality of life, mental health, fatigue and adverse events (safety).

METHODS

A total of 150 childhood cancer survivors aged ≥16 years and diagnosed ≥5 years prior to the study are recruited from Swiss paediatric oncology clinics. Following the baseline assessments patients are randomized 1:1 into an intervention and control group. Thereafter, they are seen at month 3, 6 and 12 for follow-up assessments. The intervention group is asked to add ≥2.5 h of intense physical activity/week, including 30 min of strength building and 2 h of aerobic exercises. In addition, they are told to reduce screen time by 25%. Regular consulting by physiotherapists, individual web-based activity diaries, and pedometer devices are used as motivational tools for the intervention group. The control group is asked to keep their physical activity levels constant.

DISCUSSION

The results of this study will show whether a partially supervised exercise intervention can improve cardiovascular disease risk factors, bone health, body composition, physical activity and fitness, fatigue, mental health and quality of life in childhood cancer survivors. If the program will be effective, all relevant information of the SURfit physical activity intervention will be made available to interested clinics that treat and follow-up childhood cancer patients to promote exercise in their patients.

TRIAL REGISTRATION

Prospectively registered in clinicaltrials.gov [ NCT02730767 ], registration date: 10.12.2015.

Measurement Properties of Short Lower Extremity Functional Exercise Tests in People With Chronic Obstructive Pulmonary Disease: Systematic Review

BACKGROUND

An increasing variety of short functional exercise tests are reported in people with chronic obstructive pulmonary disease (COPD). Systematic review of the psychometric properties of these exercise tests is indicated.

PURPOSE

The aim of this study was to determine the reliability, validity, and responsiveness of short (duration < 6 min) lower extremity functional exercise tests in people with COPD.

DATA SOURCES

Five databases were searched: MEDLINE, Embase, Scopus, AMED, and CINAHL.

STUDY SELECTION

Studies reporting psychometric properties of short functional exercise tests in people with COPD were included.

DATA EXTRACTION

Two reviewers independently extracted data and rated the quality of each measurement property using the COnsensus-based Standards for the Selection of Health Measurement INstrument (COSMIN).

DATA SYNTHESIS

Twenty-nine studies were identified reporting properties of 11 different tests. Four-meter gait speed [4MGS] and 5 repetition sit-to-stand [5STS] demonstrated high reliability (ICC = .95-.99; .97) with no learning effect (COSMIN study ratings = good--excellent). Their validity for use as a stratification tool anchored against an established prognostic indicator (area under receiver operator characteristics curve [AUC] = 0.72-0.87; 0.82) and responsiveness to change after pulmonary rehabilitation was greatest in more frail people with COPD. Studies of the Timed "Up and Go" [TUG] test support use of a practice test and show discriminative ability to detect falls history and low six-minute walk distance (AUC = 0.77; 0.82, COSMIN ratings = fair-excellent).

LIMITATIONS

Earlier studies were limited by small sample size. Limited data of lower study quality was identified for step tests and the Two-Minute Walk Test.

CONCLUSIONS

Selected short functional exercise tests can complement established exercise capacity measures, in stratification and measuring responsiveness to change especially in people with COPD and lower functional ability.

Characterization of Strength and Function in Ambulatory Adults With GNE Myopathy

Objective:

To characterize the pattern and extent of muscle weakness and impact on physical functioning in adults with GNEM.

Methods:

Strength and function were assessed in GNEM subjects (n = 47) using hand-held dynamometry, manual muscle testing, upper and lower extremity functional capacity tests, and the GNEM-Functional Activity Scale (GNEM-FAS).

Results:

Profound upper and lower muscle weakness was measured using hand-held dynamometry in a characteristic pattern, previously described. Functional tests and clinician-reported outcomes demonstrated the consequence of muscle weakness on physical functioning.

Conclusions:

The characteristic pattern of upper and lower muscle weakness associated with GNEM and the resulting functional limitations can be reliably measured using these clinical outcome assessments of muscle strength and function.

Determinants of each domain of the Short Physical Performance Battery in COPD

BACKGROUND

The Short Physical Performance Battery (SPPB) is an assessment tool with good prognostic value in COPD. It includes the following: standing balance, 4 m gait speed test (4MGS), and the timed five-repetition sit-to-stand test (5STS). The specific differences in determinants between these three tasks have not been adequately characterized in COPD patients. We aimed to identify health-related, functional, and psychological determinants of each SPPB test.

METHODS

We conducted a cross-sectional analysis of 137 patients with stable COPD. Patients performed the SPPB, quadriceps muscle strength (QMS), exercise tolerance test (6-min walk test [6MWT]), and pulmonary function; and health-related and psychological factors, physical activity, the COPD assessment test (CAT), body mass index, age, and depression were assessed.

RESULTS

Separate multivariable regression models predicting the 4MGS, 5STS, and balance test results described 31%, 39.1%, and 12.1% of the variance for each test, respectively. QMS was negatively associated with all three tests. The 6MWT was negatively associated with the 4MGS and 5STS. Depression and age were positively associated with 4MGS scores, whereas CAT and age were positively associated with 5STS scores.

CONCLUSION

The three SPPB tests did not provide equivalent information regarding a COPD patient's status. The 5STS was associated with health status factors, while the 4MGS was associated with psychological factors.

ANALYSIS OF FUNCTIONAL CAPACITY IN INDIVIDUALS WITH AND WITHOUT CHRONIC LOWER BACK PAIN

OBJECTIVE

The objective of this study was to analyze the functional status of adult and older adult individuals with lower back pain .

METHODS

Eighty-three individuals were recruited, 42 older adults (20 with lower back pain and 22 control group) and 41 younger adults (21 with lower back pain and 20 control group). Functional capacity was assessed using the following tests: Timed Up and Go (TUG), Five Times Sit-to-Stand (FTSTS), six-minute walking test (SMWT), and sitting-rising test (SRT) .

RESULTS

In the younger adults, there was no difference in functional capacity between the groups (p>0.05). On the other hand, when statistical analysis was adjusted using body mass index (BMI) as a covariate, the lower back pain group performed more poorly on the SRT (p<0.004). Furthermore, poorer physical capacity was seen in the older adults with back pain via the SRT test (p=0.001), and when the BMI was adjusted, a statistical difference was seen in the SRT as well as the SMWT (p<0.05) .

CONCLUSION

Older individuals with lower back pain have poorer physical performance, and the sitting-rising test is the most discerning for assessment of functional status in individuals with lower back pain. Level of Evidence III, Retrospective Comparative Study.

Aging effect on the instrumented Timed-Up-and-Go test variables in nursing home women aged 80-93 years

Although the total “Timed-Up-and Go” test (TUG) performance time can characterize an age-related decline of general mobility, this result alone doesn’t give any detailed information about the test subtasks. The primary objective of the study was to identify in nursing home women a variable extracted from instrumented TUG (iTUG) that is the best predictor of age. The secondary objective was to assess whether this variable is associated with the results of the isometric knee extension peak torque (IKEPT); lower limb strength measured by the 30-s chair stand test (30sCST), and walking capacity measured by the 6-min walk test (6MWT). Twenty-six women (mean ± SD: age—85.8 ± 3.6 years; body weight—59.4 ± 12.3 kg; body height—151.0 ± 7.3 cm; BMI—26.0 ± 4.9 kg/m²) performed iTUG (while wearing a body-fixed inertial sensor) and functional tests. Total iTUG performance time significantly correlated with age (r = 0.484; p < 0.05), 30sCST (r = −0.593; p < 0.01), and 6MWT (r = −0.747; p < 0.001) but not with absolute nor relative IKEPT (p > 0.05). Additionally, the subjects’ age correlated with 30sCST (r = −0.422; p < 0.05), 6MWT (r = −0.482; p < 0.05), IKEPT (r = −0.392; p < 0.05) and IKEPT/FFM (r = −0.407; p < 0.05). Five out of 16 analyzed iTUG variables were significantly related to age, and multiple regression analysis showed the best correlation with the sit-to-stand vertical acceleration range (STSVAR) (r² = 0.430; SEE = 3.041; β = −0.544 ± 0.245; B = −1.204 ± 0.543; p < 0.05). Moreover, STSVAR was significantly associated with %Fat (r = 0.415; p < 0.05), 30sCST (r = 0.519; p < 0.01), 6MWT (r = 0.585; p < 0.01) but not with absolute nor relative IKEPT (p > 0.05). The obtained results suggest that in the oldest old group of nursing home women an age-related decline in TUG performance is mainly associated with a reduction of “explosive” strength of lower limb muscles.

Prediction of long-term clinical outcomes using simple functional exercise performance tests in patients with COPD: a 5-year prospective cohort study

The 1-min sit-to-stand (1-min STS) test and handgrip strength test have been proposed as simple tests of functional exercise performance in chronic obstructive pulmonary disease (COPD) patients. We assessed the long-term (5-year) predictive performance of the 1-min sit-to-stand and handgrip strength tests for mortality, health-related quality of life (HRQoL) and exacerbations in COPD patients. In 409 primary care patients, we found the 1-min STS test to be strongly associated with long-term morality (hazard ratio per 3 more repetitions: 0.81, 95% CI 0.65 to 0.86) and moderately associated with long-term HRQoL. Neither test was associated with exacerbations. Our results suggest that the 1-min STS test may be useful for assessing the health status and long-term prognosis of COPD patients. This study was registered at http://www.clinicaltrials.gov/ (NCT00706602, 25 June 2008).

Integrating culturally informed approaches into the physiotherapy assessment and treatment of chronic pain: protocol for a pilot randomised controlled trial

INTRODUCTION

There is strong evidence that biopsychosocial approaches are efficacious in the management of chronic pain. However, implementation of these approaches in clinical practice is known not to account for the beliefs and values of culturally and linguistically diverse (CALD) patients. This limitation in translation of research contributes to the disparities in outcomes for CALD patients with chronic pain adding to the socioeconomic burden of this prevalent condition. Cultural adaptation of chronic pain assessment and management is urgently required. Thus, the aim of this pilot randomised controlled trial (RCT) is to determine the feasibility, participant acceptance with and clinical effectiveness of a culturally adapted physiotherapy assessment and treatment approach when contrasted with 'usual evidence based physiotherapy care' for three CALD communities.

METHODS AND ANALYSIS

Using a participant-blinded and assessor-blinded randomised controlled pilot design, patients with chronic pain who self-identify as Assyrian, Mandaean or Vietnamese will be randomised to either 'culturally adapted physiotherapy assessment and treatment' or 'evidence informed usual physiotherapy care'. We will recruit 16 participants from each ethnocultural community that will give a total of 24 participants in each treatment arm. Both groups will receive physiotherapy treatment for up to 10 sessions over 3 months. Outcomes including feasibility data, acceptance with the culturally adapted intervention, functional and pain-related measures will be collected at baseline and 3 months by a blinded assessor. Analysis will be descriptive for feasibility outcomes, while measures for clinical effectiveness will be explored using independent samples t-tests and repeated measures analysis of variance. This analysis will inform sample size estimates while also allowing for identification of revisions in the protocol or intervention prior to a larger scale RCT.

ETHICS AND DISSEMINATION

This trial has full ethical approval (HREC/16/LPOOL/194). The results from this pilot RCT will be presented at scientific meetings and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12616000857404.

Whole-Body Vibration Training During a Low Frequency Outpatient Exercise Training Program in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Trial

BACKGROUND

The aim of the study was to investigate whether whole-body vibration training (WBVT) can be applied beneficially within an outpatient low frequency exercise program.

METHODS

In a prospective, controlled, randomized study, WBVT effectiveness and safety were investigated in COPD stage II-IV patients undergoing a 3-month training program. Participants took part in a 90-min circuit training once a week. On top patients were randomized to either perform squats with WBVT, or without (conventional training group (CTG)). Before and after the intervention, a sit-to-stand test (STST), a 6-min walk test (6-MWT), the COPD assessment test (CAT), and the chronic respiratory disease questionnaire (CRQ) were evaluated.

RESULTS

Twenty-eight out of 55 patients completed the study (n = 12 WBTV, n = 16 CTG). The STST time remained nearly constant for the CTG (Δ -0.8 ± 3.1 s) and the WBVT (Δ 1.4 ± 3.2 s; P = 0.227), respectively. Similarly, for both WBVT and CTG, the 6-min walk distance remained unchanged (Δ 7 ± 55 m vs. 9 ± 45 m, P = 0.961). In three out of four categories, the CRQ scores showed a significant improvement within WBVT, and in one category when comparing across groups. The CAT score dropped by -0.8 ± 2.9 points within CTG and by 2.4 ± 2.7 points within WBVT (P = 0.105). There were no adverse events related to WBVT.

CONCLUSION

The implementation of WBVT in the context of an outpatient low frequency exercise program did not significantly improve the patients' exercise capacity. An improvement in CAT and partially in CRQ was shown within WBVT. However, regarding the high dropout rate (49%), these results must be interpreted with caution.

A multicentre validation of the 1-min sit-to-stand test in patients with COPD

Our aim was to comprehensively validate the 1-min sit-to-stand (STS) test in chronic obstructive pulmonary disease (COPD) patients and explore the physiological response to the test.We used data from two longitudinal studies of COPD patients who completed inpatient pulmonary rehabilitation programmes. We collected 1-min STS test, 6-min walk test (6MWT), health-related quality of life, dyspnoea and exercise cardiorespiratory data at admission and discharge. We assessed the learning effect, test-retest reliability, construct validity, responsiveness and minimal important difference of the 1-min STS test.In both studies (n=52 and n=203) the 1-min STS test was strongly correlated with the 6MWT at admission (r=0.59 and 0.64, respectively) and discharge (r=0.67 and 0.68, respectively). Intraclass correlation coefficients (95% CI) between 1-min STS tests were 0.93 (0.83-0.97) for learning effect and 0.99 (0.97-1.00) for reliability. Standardised response means (95% CI) were 0.87 (0.58-1.16) and 0.91 (0.78-1.07). The estimated minimal important difference was three repetitions. End-exercise oxygen consumption, carbon dioxide output, ventilation, breathing frequency and heart rate were similar in the 1-min STS test and 6MWT.The 1-min STS test is a reliable, valid and responsive test for measuring functional exercise capacity in COPD patients and elicited a physiological response comparable to that of the 6MWT.

The 1-min sit-to-stand test in cystic fibrosis - Insights into cardiorespiratory responses

BACKGROUND

We aimed to characterize the cardiopulmonary response during a 1-min sit-to-stand (STS) test and compare peak exercise cardiorespiratory variables to a maximal cardiopulmonary exercise test (CPET) in cystic fibrosis (CF). We further aimed to assess the validity of the STS power index (Power_STS) as a measure of exercise capacity.

METHODS

Fifteen adult CF patients performed spirometry, CPET and the 1-min STS test with respiratory gas analysis.

RESULTS

Peak-exercise cardiorespiratory variables during the 1-min STS test correlated strongly (r=0.69-0.98) with those measured during the CPET. Oxygen uptake, carbon dioxide production, heart rate, ventilation, and tidal volume at peak exercise were 24%, 26%, 9%, 10% and 21% lower in the 1-min STS test, while respiratory frequencies were 14% higher. Power_STS showed strong to very strong correlations with CPET-derived absolute peak oxygen uptake and maximal workload.

CONCLUSIONS

The 1-min STS test elicits a substantial but lower cardiorespiratory response compared to a maximal cycle ergometry CPET. While Power_STS and STS repetitions are both valid outcome measures of functional capacity, STS repetitions are clinically more practical.

Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD

BACKGROUND

Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients' ability to work.

METHODS

Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients.

RESULTS

In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60-64 years vs 30-49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12-0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19-0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR =0.10; 95% CI =0.03-0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12-0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment.

CONCLUSION

This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD.

Is the 1-minute sit-to-stand test a good tool for the evaluation of the impact of pulmonary rehabilitation? Determination of the minimal important difference in COPD

Background

The 1-minute sit-to-stand (STS) test could be valuable to assess the level of exercise tolerance in chronic obstructive pulmonary disease (COPD). There is a need to provide the minimal important difference (MID) of this test in pulmonary rehabilitation (PR).

Methods

COPD patients undergoing the 1-minute STS test before PR were included. The test was performed at baseline and the end of PR, as well as the 6-minute walk test, and the quadriceps maximum voluntary contraction (QMVC). Home and community-based programs were conducted as recommended. Responsiveness to PR was determined by the difference in the 1-minute STS test between baseline and the end of PR. The MID was evaluated using distribution and anchor-based methods.

Results

Forty-eight COPD patients were included. At baseline, the significant predictors of the number of 1-minute STS repetitions were the 6-minute walk distance (6MWD) (r=0.574; P<10⁻³), age (r=−0.453; P=0.001), being on long-term oxygen treatment (r=−0.454; P=0.017), and the QMVC (r=0.424; P=0.031). The multivariate analysis explained 75.8% of the variance of 1-minute STS repetitions. The improvement of the 1-minute STS repetitions at the end of PR was 3.8±4.2 (P<10⁻³). It was mainly correlated with the change in QMVC (r=0.572; P=0.004) and 6MWD (r=0.428; P=0.006). Using the distribution-based analysis, an MID of 1.9 (standard error of measurement method) or 3.1 (standard deviation method) was found. With the 6MWD as anchor, the receiver operating characteristic curve identified the MID for the change in 1-minute STS repetitions at 2.5 (sensibility: 80%, specificity: 60%) with area under curve of 0.716.

Conclusion

The 1-minute STS test is simple and sensitive to measure the efficiency of PR. An improvement of at least three repetitions is consistent with physical benefits after PR.

The accuracy with which the 5 times sit-to-stand test, versus gait speed, can identify poor exercise tolerance in patients with COPD: A cross-sectional study

Identifying those patients who underperform in the 6-minute walk test (6MWT <350 m), and the reasons for their poor performance, is a major concern in the management of chronic obstructive pulmonary disease.To explore the accuracy and relevance of the 4-m gait-speed (4MGS) test, and the 5-repetition sit-to-stand (5STS) test, as diagnostic markers, and clinical determinants, of poor performance in the 6MWT.We recruited 137 patients with stable chronic obstructive pulmonary disease to participate in our cross-sectional study. Patients completed the 4MGS and 5STS tests, with quantitative (in seconds) and qualitative ordinal data collected; the latter were categorized using a scale of 0 to 4. The following potential covariates and clinical determinants of poor 6MWT were collated: age, quadriceps muscle-strength (QMS), health status, dyspnea, depression, and airflow limitation. Area under the receiver-operating characteristic curve data (AUC) was used to assess accuracy, with logistic regression used to explore relevance as clinical determinants.The AUCs generated using the 4MGS and 5STS tests were comparable, at 0.719 (95% confidence interval [CI] 0.629-0.809) and 0.711 (95% CI 0.613-0.809), respectively. With ordinal data, the 5STS test was most accurate (AUC of 0.732; 95% CI 0.645-0.819); the 4MGS test showed poor discriminatory power (AUC <0.7), although accuracy improved (0.726, 95% CI 0.637-0.816) when covariates were included. Unlike the 4MGS test, the 5STS test provided a significant clinical determinant of a poor 6MWT (odds ratio 1.23, 95% CI 1.05-1.44).The 5STS test reliably predicts a poor 6MWT, especially when using ordinal data. Used alone, the 4MGS test is reliable when measured with continuous data.