Changes in Borg scale for resistance training and test of exercise tolerance in patients undergoing allogeneic hematopoietic stem cell transplantation

A scale to measure perceived respiratory effort in dogs: the DeChant scale

The perceived respiratory effort (PRE) scale is a categorical psychophysical scale originally developed by Gunnar Borg and modified for numerous applications. We here propose a modification of the PRE scale with a 0-10 categorical scale for dogs, called the DeChant scale. A total of seventy-nine Labrador Retrievers were scored by video using the developed scale pre and post one of two different sprint exercise paradigms. The first exercise paradigm was 200 m in length and the second exercise paradigm was 1,200 m in length. PRE was reliably scored with an interclass correlation exceeding 0.8 for both exercise paradigms. The scale was further validated with moderate (r > 0.5) to strong correlations (r > 0.7) with core body temperature, rectal temperature, heart rate and respiration rate. The results suggest this PRE scale may be a useful, rapid and reliable visual measure of canine effort under exercise. Future research is needed for validation to other dog breeds and for use as a measure to predict detection performance or heat injury risk.

Impact of functional capacity before hematopoietic stem cell transplantation on the length of hospital stay

OBJECTIVE

To verify the association between pre-HSCT functional capacity and the variables of pulmonary function, fatigue, and length of hospital stay.

METHODS

This is a cohort study, involving patients admitted to the bone marrow transplantation. The individuals were submitted to an evaluation in the first 24 h of hospitalization. The length of stay variable was checked on the day of hospital discharge. Functional capacity was assessed through the six-minute walk test (6MWT), and the 30-second sit-to-stand test (SST30) was performed to assess the indirect strength of the lower limbs; moreover, the revised Piper Fatigue Scale was used for the evaluation of the pulmonary function.

RESULTS

The sample consisted of 35 individuals (19 male; 54%). Fourteen patients achieved a 6MWT ≥80% predicted. The mean age of the sample was 45.5 ± 15.2 years, and BMI 27.4 ± 5.4 kg/m2. Patients who completed a six-minute walking distance (6MWD) below the predicted value showed significantly lower pulmonary function values for the variables peak expiratory flow (PEF) (%) (p = 0.031), forced expiratory volume in one second (FEV1) (%) (p = 0.033), and FEV1/forced vital capacity (FVC) (%) (p = 0.027) in relation to the group with better functional capacity. This group showed significantly higher values in the assessment of lower limb fatigue using the Borg scale pre- (p = 0.008) and post- (p = 0.004) 6MWT, longer hospitalization time (p = 0.0014), but with no significant difference in lower limb muscle strength between groups (p = 0.21). A moderate correlation was found between the 6MWD% and FEV1% (p < 0.05).

CONCLUSION

Data indicate that starting HSCT treatment with lower-than-expected physical fitness is associated with lower lung function, greater fatigue in the lower limbs, and longer hospital stays.

Physical performance before and after hematopoietic stem cell transplantation in pediatric patients: a potential role for prehabilitation

The trajectory of hematopoietic stem cell transplantation (HSCT) is often accompanied by physically disabling complications that impair physical performance of pediatric patients. However, knowledge about when impairments in physical performance arise and the factors contributing to these impairments is limited. Therefore, we conducted a retrospective analysis of physical performance 100 days post-HSCT in patients aged 3-18 years. Additionally, we aim to elucidate the relationship between pre- and post-HSCT physical performance and to unravel the impact of intensive HSCT procedures on post-HSCT physical performance. To explore associations between physical performance outcomes post-HSCT and covariates, linear regression models were estimated. Seventy-seven patients were included with a median age of 11.8 years (interquartile range: 5.9, 14.8). Patients had lower hip flexion muscle strength and appendicular skeletal muscle mass and a slower rising from the floor time 100 days post-HSCT compared to average values of the normal population. Pre-HSCT physical performance was positively associated with physical performance post-HSCT, independent of age, the cumulative glucocorticoids dosage administered and the total duration of hospitalization during the HSCT trajectory. This explorative study highlights the potential role of prehabilitation in enhancing physical performance of pediatric HSCT patients.

Effect of rehabilitation in patients undergoing hematopoietic stem cell transplantation

Patients undergoing hematopoietic stem cell transplantation (HSCT) tend to experience decline in physical function, mental function, and quality of life (QOL) after HSCT due to low activity caused by adverse reactions to chemotherapy used in pre-transplantation treatment and post-transplant complications. Rehabilitation for HSCT patients is effective in preventing decline in physical function, reducing fatigue, and improving QOL. A combination of aerobic exercise and strength training is recommended for exercise therapy. Risk management is also important in the implementation of exercise therapy, and the exercise intensity should be determined according to the presence of anemia, low platelet counts, or post-transplant complications. On the other hand, post-transplant complications can decrease the patient's motivation and daily activity level. A multidisciplinary approach, which includes physicians and nurses, is important to achieve early discharge from the hospital and as quick a return to society as possible.

Effects of a physiotherapeutic protocol in cardiorespiratory, muscle strength, aerobic capacity and quality of life after hematopoietic stem cell transplantation

OBJECTIVE

To analyze the effects of hospital cardiorespiratory physical therapy protocol on the functional capacity and quality of life of patients submitted to hematopoietic stem cell transplantation (HSCT).

METHODS

From January to December 2019, bilateral dynamometry, Manovacuometry and Ventilometry, peak expiratory flow "Peak Flow", 6-min walk test (6MWT), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS) were applied in patients who have undergone an allogeneic or autologous hematopoietic stem cell transplantation (HSCT), pre-conditioning (initial evaluation) and pre-discharge (final evaluation). The patients were submitted to an intervention protocol, consisting of aerobic training, muscle strengthening and respiratory muscle training, between the two assessments.

RESULTS

29 patients were enrolled in the study and 24 (83%) completed all procedure. Myeloablative and reduced intensity conditioning were performed in 89.6% and 10.4%, respectively; 17 (58%) patients have undergone an autologous HSCT; 10 (35%) identical related allogeneic HSCT, and 2 (7%) haploidentical allogeneic HSCT. The median number of interventions per patient was 3 (1-9). A decreasing in the right and left dynamometry (p  ≤ 0.0001 and 0.002, respectively) and, also in the distance covered in the 6MWT (p  = 0.004), was observed after HSCT. There was no significant difference in respiratory muscle strength, quality of life and fatigue sensation.

CONCLUSION

Cardiorespiratory rehabilitation can preserve functional capacity and quality of life.

Effect of the Active Cycle of Breathing Technique on Perioperative Outcome in Individuals With Esophagectomy: A Quasi-Experimental Study

Background: The effect of active cycle of breathing technique (ACBT) on EC patients has not been well elucidated. In this research, we aim to explore the effect of ACBT on the perioperative outcomes in patients with esophageal carcinoma who underwent esophagectomy. Methods: Patients who underwent esophagectomy in an academic institution from December 2017 to July 2019 were included in this study. In a quasi-experimental study, participants were randomly divided into an experimental group (active cycle of breathing technique, n = 107) and an observational group (n = 106) by drawing lots. The chi-squared test, Cochran-Mantel-Haenszel test, Logistic regression analysis, and Kruskal-Wallis test were used to analyze data. A two-sided P value <0.05 was considered statistically significant. The primary observational endpoint was the mean weight of the sputum. Other outcomes included the six-min-walk test (6MWT), Borg scale, anastomotic leakage, and the length of hospital stay. Results: 95 patients underwent minimally invasive surgery, and 118 patients received open surgery. There were 16 patients with anastomotic leakage in the present study, and we found that patients in the observational group had higher odds of anastomotic leakage. The results showed that the mean weight of the sputum in the observation group was lighter than that of the experimental group. After esophagectomy, the experimental group had better outcomes than the observation group (Borg scale: 2.448 vs. 1.547; 6-MWT: 372.811 vs. 425.355m, all P < 0.05). The mean length of hospital stay was longer in the observation group (17.953 days) than that in the experimental group (12.037 days, P = 0.01). We also found that the observational group had a higher discharge ratio over 2 weeks in all cohort (adjusted OR 2.487, 95% confidence intervals 1.147-5.392, P = 0.021). Conclusion: Active cycle of breathing technique may improve the perioperative outcomes and decrease the length of hospital stay after surgery in patients with esophageal cancer. However, we need more researches to validate these findings.

Preoperative In-Hospital Rehabilitation Improves Physical Function in Patients with Pancreatic Cancer Scheduled for Surgery

Low preoperative physical function in cancer patients is associated with postoperative complications; however, there have been no reports on the benefits of in-hospital preoperative rehabilitation on preoperative physical function in patients with pancreatic cancer. Therefore, the aim of this study was to quantitatively determine the effects of preoperative in-hospital rehabilitation provided under the supervision of a physiotherapist, on preoperative physical function in patients with pancreatic cancer. The study subjects were 26 patients (15 males, 11 females; age 71.2 ± 8.5 years, range: 51-87 years), including four patients with preoperative chemotherapy, scheduled for surgery for pancreatic cancer. Muscle strengthening exercises and aerobic exercises were conducted 11.9 ± 5.1 days prior to surgery. Cardiopulmonary exercise testing, 6-minute walk distance, and the Functional Independence Measure score were measured before and after the rehabilitation program. We also investigated the relation between the rehabilitation program and incidence of postoperative complications. All 26 study patients completed the preoperative rehabilitation program and no adverse events were noted. Peak oxygen uptake during cardiopulmonary exercise testing and 6-minute walk distance increased significantly after the rehabilitation program. The Functional Independence Measure score remained constant throughout the intervention. No wound infection, delirium, deep vein thrombosis, or respiratory complications were encountered postoperatively. In-hospital preoperative rehabilitation under the supervision of a physiotherapist significantly improved physical function and maintained physical activity in patients with pancreatic cancer. Such improvements may contribute toward preventing serious postoperative complications, resulting in better outcomes.

Muscle oxygen extraction and lung function are related to exercise tolerance after allogeneic hematopoietic stem cell transplantation

PURPOSE

This study aimed to investigate the relationship between exercise intolerance, muscle oxidative metabolism, and cardiopulmonary function following allogeneic hematopoietic stem cell transplantation (allo-HSCT) in a sterile isolation room setting.

METHODS

This was a prospective observational cohort study conducted in a single center. Fourteen patients with hematopoietic malignancies who had undergone allo-HSCT were included in this study from June 2015 to April 2020. Patients received donor HSCT after high dose-chemotherapy and total-body irradiation. Physical activity was limited during treatments. Outcome measures included body anthropometric measurements, exercise tolerance tests using the ramp protocol, pulmonary function tests, and near-infrared spectroscopy (NIRS) measurements. Data of pre- and posttransplant measurements were compared using the paired t test or nonparametric Wilcoxon U test. Associations were assessed using the Pearson or nonparametric Spearman correlations.

RESULTS

NIRS showed reduced muscle consumption and extraction of oxygen in the posttransplant period compared to the pretransplant period (ΔStO_{2 min} pre: -18.6% vs. post: -13.0%, P = 0.04; ΔHHb _max pre: 4.21μmol/l vs. post: 3.31μmol/l: P = 0.048). Exercise tolerance had reduced following allo-HSCT (Peak workload pre: 70.3 W vs. post: 58.0 W: P = 0.014). Furthermore, exercise intolerance was associated with pulmonary function, muscle oxygen consumption, and muscle oxygen extraction (all P <0.05).

CONCLUSION

This analysis revealed that exercise intolerance following allo-HSCT was associated with pulmonary dysfunction and muscle oxidative dysfunction. These findings could help identify the physical function associated with impaired tissue oxygen transport leading to exercise intolerance following allo-HSCT.

Relationship between the face scale for rating of perceived exertion and physiological parameters in older adults and patients with atrial fibrillation

BACKGROUND

The Borg scale is used to determine exercise intensity in rehabilitation but can be difficult for older adults to understand. By contrast, face scale that are used to evaluate pain are much easier to understand thanks to the inclusion of illustrations. On the other hand, the prevalence of atrial fibrillation (AF) increases with age. This study aimed to determine the validity of the face scale for rating perceived exertion (RPE-face scale) in older adults and patients with AF during cardiopulmonary exercise test. Furthermore, the relationship between face scale and anaerobic threshold (AT) was also investigated.

METHODS

A total of 90 patients with sinus rhythm (SR) (74 men, 16 women) and 22 with AF were enrolled. Participants' responses were recorded using the RPE-face scale and compared with exercise intensity, heart rate, oxygen uptake, and minute ventilation during the exercise test. We determined the AT by the V-slope method.

RESULTS

Correlations between RPE-face scale and physiological parameters were significantly positive for men with SR and women with SR and AF. However, differences in the correlation coefficient between age and SR or AF were not statistically significant. The cutoff value for AT of the RPE-face scale was "4," showing high sensitivity and specificity.

CONCLUSIONS

The RPE-face scale can be used to determine the intensity of physical exercise, unaffected by age, gender, SR, or AF.

Relationship Between the Borg Scale Rating of Perceived Exertion and Leg-Muscle Deoxygenation During Incremental Exercise in Healthy Adults

INTRODUCTION

The Borg scale rating of perceived exertion is a reliable indicator and widely used to monitor and guide exercise intensity. We aimed to evaluate the relationships between the Borg scale score and oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb) concentrations in the leg muscle as measured by near-infrared spectroscopy (NIRS) during cardiopulmonary exercise testing (CPET) in healthy adult men. We also investigated the relationships between the Borg scale score and the work rate (WR), heart rate (HR), oxygen uptake (VO2), and minute ventilation (VE).

METHODS

Participants comprised 12 healthy men. Cardiopulmonary and NIRS parameters were assessed during each minute of CPET and at the end of the test.

RESULTS

The Borg scale score was significantly correlated with cardiopulmonary parameters including WR, HR, VO2, and VE during CPET (Rs = 0.87-0.95; p < 0.05). Furthermore, the Borg scale score was significantly correlated with NIRS parameters including O2Hb and HHb levels during CPET (Rs = -0.48 and 0.45, respectively; p < 0.05).

DISCUSSION

The Borg scale score is significantly correlated with cardiopulmonary parameters (WR, HR, VO2, and VE), as well as with leg-muscle oxygenation parameters as assessed by NIRS, during CPET in healthy adults. The correlation coefficients obtained from NIRS parameters were lower than those of cardiopulmonary parameters.

CONCLUSIONS

The Borg scale score might better reflect cardiopulmonary responses than muscle deoxygenation during exercise. These results can aid in the planning of rehabilitation programs for healthy adults.

The benefit of exercise in patients who undergo allogeneic hematopoietic stem cell transplantation

Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is increasingly used in the treatment of hematologic cancers such as leukemias, lymphomas, and myeloma, and for other hematologic disorders such as primary immunodeficiency, aplastic anemia, and myelodysplasia. Allo-HSCT entails a conditioning regimen of frequent high-dose chemotherapy in combination with total body irradiation, followed by infusion of donor-harvested bone marrow or peripheral blood stem cells. As an aggressive and demanding medical therapy that profoundly impacts patient quality of life (QOL), allo-HSCT is associated with numerous treatment-related physical, psychological, and psychosocial side effects. The procedure can result in decreased respiratory and balance function, skeletal muscle strength, and exercise capacity. Thus, as physical exercise has been shown to positively effect physical and psychosocial function and QOL in allo-HSCT patients, it is a recommended intervention for improving essential functions and offsetting lost exercise capacity after the procedure. Furthermore, recent evidence has shown that physical exercise can influence survival rate and mortality in allo-HSCT patients. This review provides an overview of the current research on the effectiveness of physical exercise for allo-HSCT patients.