Physical exercise improves functional capacity and quality of life in patients with acromegaly: a 12-week follow-up study

Assessment of sarcopenic obesity in patients with acromegaly

PURPOSE

Sarcopenic obesity (SO), a condition characterized by the coexistence of obesity and sarcopenia, has primarily been studied in elderly populations. However, it can also affect individuals with chronic diseases. This study aims to evaluate the prevalence of SO in patients with acromegaly.

METHODS

Observational, cross-sectional study, involving patients with acromegaly followed at a tertiary center and controls matched for age and sex. Health assessment questionnaire, physical tests, body composition and bone mineral density assessment, were performed in all participants. SO was diagnosed using criteria from ESPEN and EASO Consensus Statements.

RESULTS

48 patients with acromegaly (acromegaly group - AG, 26 women, mean age 56.3 ± 11.6, mean BMI 31.3 ± 4.9) were compared to 48 controls (control group - CG, 26 women, mean age 56.7 ± 13.7, BMI 25.5 ± 4.7). Despite having greater total and appendicular lean mass, AG showed significant impairments in physical performance, particularly in strength, gait speed and balance (p < 0.05). The prevalence of SO in the AG was 16.7%, compared to 0% in the CG (p = 0.006), and positively correlated with increased fat mass and impaired physical performance.

CONCLUSIONS

SO is present in patients with acromegaly and is associated with notable functional impairments despite increased muscle mass.

Changes in the Glittre-ADL test in patients with non-small cell lung cancer: Pre- and postoperative analysis after home-based rehabilitation: A preliminary study

Background and objective

Postoperative pulmonary rehabilitation in non-small cell lung cancer (NSCLC) patients following thoracic surgery can be an important strategy for restoring functional exercise capacity. This study aimed to evaluate the changes in the Glittre-ADL test (TGlittre) in patients with NSCLC undergoing thoracic surgery and early home-based pulmonary rehabilitation and, subsequently, to assess the associations of the test results with muscle strength and quality of life (QoL).

Methods

This observational study evaluated 18 patients with NSCLC before and after home-based pulmonary rehabilitation. Before thoracic surgery and 3 months after pulmonary rehabilitation, the participants underwent the following assessments: St. George's Respiratory Questionnaire (SGRQ), spirometry, measurement of the diffusion capacity of the lung for carbon monoxide (DLCO), respiratory muscle strength, handgrip strength (HGS), quadriceps muscle strength, and TGlittre.

Results

When comparing the preoperative and postpulmonary rehabilitation periods, there was a significant increase in HGS [21.6 (19-29) vs. 28.5 (26-33) kgf, p = 0.011] with preservation of TGlittre time [3.6 (3.2-4) vs. 3.6 (3-4.1) min, p = 0.87]. In addition, there was a significant decrease in lung function and SGRQ scores. Preoperative TGlittre time significantly correlated with maximum inspiratory pressure (MIP, r s  = -0.491, p = 0.038) and DLCO (r s  = -0.621, p = 0.006). TGlittre time measured in postpulmonary rehabilitation was significantly correlated with HGS (r s  = -0.664, p = 0.002) and the MIP (r s  = -0.478, p = 0.045).

Conclusion

In patients with NSCLC undergoing thoracic surgery and pulmonary rehabilitation, there was an increase in muscle strength and preservation of functional exercise capacity, although there was a decrease in lung function and QoL. There were interrelations of TGlittre time with MIP and pulmonary diffusion in the preoperative period and of TGlittre time with HGS and MIP following the home-based pulmonary rehabilitation. Although the results are promising, additional studies with a larger number of patients and a control group are needed to further support these findings.

Approach to the patient with controlled acromegaly and acromegalic arthropathy: clinical diagnosis and management

Following the description of an illustrative case of a 70-year-old female patient with longstanding active acromegaly and invalidating, progressive joint complaints, current insights regarding diagnosis, treatment, and long-term management of acromegalic arthropathy are summarized. Since clinical trials on this topic are lacking, the reported recommendations are based on extensive clinical and research experience with this clinical entity, and on established diagnostics and interventions in patients with other rheumatic diseases. The cornerstones of the management of acromegalic arthropathy remains normalization of growth hormone and insulin growth factor-1 levels. However, patients with severe or progressive acromegalic arthropathy require a multidisciplinary approach to determine adequate diagnostics and treatment options. Because of the high prevalence and invalidating character of acromegalic arthropathy, developing evidence-based effective prevention and treatment strategies, preferably by international collaboration within rare disease networks, e.g., Endo-ERN, is a clear unmet need.

Body Composition, Sarcopenia, and Serum Myokines in Acromegaly: A Narrative Review

Patients with active acromegaly have a higher percentage of lean body mass, a lower percentage of fat body mass, and an increase in their extracellular water compartment compared to healthy individuals. However, muscle function appears to be compromised in patients with acromegaly, with some experiencing worsened physical performance and sarcopenia. Myokine alterations, insulin resistance, dysregulation of protein metabolism, muscle oxidative stress, neuromuscular junction impairment, and increased ectopic intramuscular fat deposits may play roles in muscle dysfunction in patients with acromegaly.

Quality of life in patients with acromegaly: a scoping review

PURPOSE

To evaluate the available evidence regarding the quality of life (QoL) in patients with acromegaly, by synthesizing the psychosocial factors of QoL, QoL measures, and complementary interventions targeting QoL.

METHODS

A scoping review was conducted using the PRISMA-ScR guideline. We searched six English databases (PubMed, Embase, CINAHL, Scopus, Web of Science, and the Cochrane Library) from the inception to August 21, 2023. We included observational studies involving psychosocial factors and complementary interventions targeting QoL (concept) in patients with acromegaly (population) in any setting (context). The design characteristics, psychosocial factors, measures, details of interventions, and outcomes of included studies were described in detail.

RESULTS

Twenty-one studies were identified, including sixteen cross-sectional studies and five interventional studies. Ten categories of psychosocial factors that are associated with QoL in acromegaly. Depression and anxiety were the most frequent psychosocial factors. Seven different validated QoL measures were used. AcroQoL was the most common measure. Two categories of complementary interventions targeting QoL were identified including psychological and exercise interventions.

CONCLUSIONS

Our scoping review provides a reasonably clear picture of the current research status of QoL in acromegaly. However, this review also highlights the need to deepen understanding of QoL and psychosocial factors in the future, as well as conduct longitudinal research and qualitative research to clarify the changing trends of psychosocial factors and specific experiences of patients. Further, more potential clinical complementary interventions are needed to improve QoL for patients with acromegaly.

Prediction models for physical function in COVID-19 survivors

BACKGROUND

The burden of caring for patients who have survived COVID-19 will be enormous in the coming years, especially with respect to physical function. Physical function has been routinely assessed using the Post-COVID-19 Functional Status (PCFS) scale.

AIM

This study built prediction models for the PCFS scale using sociodemographic data, clinical findings, lung function, and muscle strength.

METHOD

Two hundred and one patients with post-COVID-19 syndrome (PCS) completed the PCFS scale to assess physical function. Their levels of general fatigue were also assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, handgrip strength (HGS), and spirometry.

RESULTS

The number of participants who scored 0 (none), 1 (negligible), 2 (slight), 3 (moderate), and 4 (severe) on the PCFS scale was 25 (12%), 40 (20%), 39 (19%), 49 (24%), and 48 (24%), respectively. The PCFS scale was significantly correlated with the following variables: FACIT-F score (r = -0.424, P < 0.001), HGS (r = -0.339, P < 0.001), previous hospitalization (r = 0.226, P = 0.001), body mass index (r = 0.163, P = 0.021), and sex (r = -0.153, P = 0.030). The regression model with the highest coefficient of regression (R = 0.559) included the following variables: age, sex, body mass index, FACIT-F, HGS, and previous hospitalization.

CONCLUSIONS

Worse general fatigue and HGS are associated with more severe physical function impairments in PCS patients. Furthermore, a history of prior hospitalization results in worse physical function. Thus, prediction models for the PCFS scale that incorporate objective measures enable a better assessment of the physical function of these patients, thus helping in the selection of candidates for a program of physical reconditioning.

Aerobic exercise interventions to address impaired quality of life in patients with pituitary tumors

Patients with pituitary tumors may experience persistent fatigue and reduced physical activity, based on subjective measures after treatment. These symptoms may persist despite gross total resection of their tumors and biochemical normalization of pituitary function. While reduced quality of life has been commonly acknowledged in pituitary tumor patients, there is a lack of studies on what interventions may be best implemented to ameliorate these issues, particularly when hormonal levels have otherwise normalized. Aerobic exercise programs have been previously described to ameliorate symptoms of chronic fatigue and reduced physical capacity across a variety of pathologies in the literature. As such, a prescribed aerobic exercise program may be an underrecognized but potentially impactful intervention to address quality of life in pituitary tumor patients. This review seeks to summarize the existing literature on aerobic exercise interventions in patients with pituitary tumors. In addition, future areas of study are discussed, including tailoring exercise programs to the hormonal status of the patient and incorporating more objective measures in monitoring response to interventions.

Assessment of short- and long-term functionality and quality of life in patients with post-acute COVID-19 syndrome

BACKGROUND

Although the number of new cases of coronavirus 2019 (COVID-19) has been drastically reduced worldwide, patients who demonstrate long-term symptoms need more attention from health systems, as these symptoms can negatively affect functionality and quality of life.

OBJECTIVE

To evaluate muscle function and quality of life at 3, 6, 9 and 12 months in patients with post-acute COVID-19 syndrome and to assess their associations with general fatigue and lung function.

METHODS

This observational and longitudinal study evaluated patients with post-acute COVID-19 syndrome. Participants were subjected to the following evaluations: Short Form-36; handgrip strength; Functional Assessment of Chronic Illness Therapy-Fatigue scale; and spirometry.

RESULTS

Among the 350 participants who were evaluated in the third month, 74.6%, 61.4% and 45.4% reported general fatigue, dyspnoea and cough, respectively. In the comparisons between the third month and the sixth month, there were significant increases in Functional Assessment of Chronic Illness Therapy-Fatigue scale, pulmonary function and several Short Form-36 domains. In the comparisons between the sixth month and the ninth month, there was a significant increase only in the social functioning domain of the Short Form-36. In the comparisons between the ninth month and the twelfth month, there was an increase only in some Short Form-36 domains. Significant correlations were observed between the Short Form-36 domains with Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength and pulmonary function.

CONCLUSION

In patients with post-acute COVID-19 syndrome, there was a progressive improvement in quality of life, general fatigue and pulmonary function during the 12 months of follow-up, with this improvement being more pronounced in the first 6 months. There was a relationship between functionality and quality of life in these patients.

Questionnaire and tools: clinical powerful instrument in acromegaly diagnosis and management

PURPOSE

Acromegaly is a rare chronic disease characterized by systemic comorbidity and reduced quality of life. Although achieving biochemical control has always been the primary goal of acromegaly therapy, recent evidence has shown that the traditional assessment does not adequately capture the complexity of symptoms and patients' perception. These findings result in the need to improve a fast decision-making process of the clinician, who should not only take into account biochemical-instrumental criteria, but also patients' symptoms. With the aim of supporting the clinician in the diagnostic and therapeutic decision-making process several disease-specific tools have been developed. The aim of this review is to provide a description of the acromegaly-specific tools, presenting their main features, their application in daily practice, and their efficacy and utility.

METHODS

A systematic search of Medline/PubMed, ISI-Web of Knowledge, and Google Scholar databases was done.

RESULTS

Specific instruments and questionnaires have recently been developed to assist clinicians in the assessment of acromegaly. These are either Patient-Reported Outcome tools, such as Acromegaly Quality of Life Questionnaire (AcroQoL) and Pain Assessment Acromegaly Symptom Questionnaire (PASQ), or Clinician-Reported Outcome tools, such as ACROSCORE, SAGIT^® and Acromegaly Disease Activity Tool (ACRODAT^®). Such tools are extremely flexible and, therefore, have been widely adopted by endocrinologists and other professionals, so much so that they have also been included as recommendations in the 2018 international guidelines.

CONCLUSION

Questionnaires and tools are useful in the management of acromegaly patients. They help clinicians evaluate patients' symptoms and could assist in the evaluation of disease activity.

Home-based rehabilitation improves functional capacity and quality of life in women with systemic sclerosis: A preliminary study

BACKGROUND

Recent initiatives, such as earlier diagnosis and treatment, have enhanced the survival of patients with systemic sclerosis (SSc). Despite these initiatives, there is extreme variability in rehabilitation strategies for these patients. In 2006, the Glittre-ADL test (TGlittre) was developed to evaluate functional capacity using multiple tasks similar to the activities of daily living (ADLs).

OBJECTIVES

To evaluate the impact of therapist-oriented home rehabilitation (TOHR) on functional capacity using TGlittre and to examine the effects of TOHR on physical function, hand function, and quality of life (QoL) among women with SSc.

METHODS

This quasi-experimental and longitudinal study included 12 women with SSc who underwent TOHR 3 times per week for 12 weeks. Before and after TOHR, functional capacity was assessed using TGlittre, physical function was examined by the Health Assessment Questionnaire Disability Index (HAQ-DI), hand function was evaluated using the Cochin Hand Functional Scale (CHFS) and handgrip strength (HGS), and QoL was evaluated using the Short Form-36 Health Survey Questionnaire (SF-36).

RESULTS

When comparing the pre- and post-TOHR values of TGlittre, a significant reduction was found in total time (p= 0.002) and manual time (p= 0.010). There was a nonsignificant decrease in HAQ-DI scores between pre- and post-TOHR (p= 0.07). Regarding hand function, there was a significant reduction in the CHFS between pre- and post-TOHR (p= 0.036), although no significant difference was observed in HGS between pre- and post-TOHR (p= 0.08). Regarding QoL, there was an increase in all SF-36 categories, although physical function was the only category that was significantly increased (p= 0.008).

CONCLUSION

After TOHR, patients with SSc are able to more quickly perform TGlittre tasks when considering both total and manual times. TOHR also positively affects manual skills and QoL.

Can home rehabilitation impact impulse oscillometry and lung ultrasound findings in patients with scleroderma-associated interstitial lung disease? A pilot study

Objective

Exercise has been demonstrated to be beneficial for improving physical capacity and quality of life in people with scleroderma, although knowledge of its impact on the respiratory system is limited. This study evaluated the impact of therapist-oriented home rehabilitation (TOHR) on impulse oscillometry (IOS) and lung ultrasound (LUS) findings in patients with scleroderma-associated interstitial lung disease (ILD).

Results

Twelve women with scleroderma underwent spirometry, IOS, and LUS before and after performing TOHR. Regarding spirometry, a normal pattern and restrictive damage were observed in five (41.7%) and seven (58.3%) participants pre-TOHR and post-TOHR, respectively. For IOS, an abnormal result was detected in nine (75%) pre-TOHR participants and six (50%) post-TOHR participants. Heterogeneity of resistance between 4–20 Hz (R4-R20) > 20% of the predicted value was observed in eight (66.7%) pre-TOHR participants and three (25%) post-TOHR participants (P = 0.031). An abnormal LUS result was observed in nine (75%) participants both pre-TOHR and post-TOHR. The main change observed was B-lines > 2, which was noted in nine (75%) participants both pre-TOHR and post-TOHR. Our findings suggest that TOHR for women with scleroderma-associated ILD improves the resistance and reactance measured by IOS, including small airway disease.

Trial Registration ClinicalTrials.gov ID: NCT05041868 Registered on: 13th September 2021.

Therapist-oriented home rehabilitation for adults with sickle cell anemia: effects on muscle strength, functional capacity, and quality of life

OBJECTIVES

Considering the advances in functional rehabilitation in recent decades, therapist-oriented home rehabilitation (TOHR) has been increasingly used in the field of physical therapy because it increases patient compliance and reduces health system costs. The objective of this study was to investigate the effects of TOHR on functional capacity, muscle strength, and quality of life (QoL) in adults with sickle cell anemia (SCA).

METHODS

Forty adults with SCA underwent manually guided TOHR for 12 weeks. Before and at the end of training, the following variables were assessed in the participants: distance covered in the 6-min walk test (6MWD); maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP); handgrip strength (HGS); quadriceps strength (QS); and QoL using the Short Form-36 physical component summary (SF-36_PCS) and the Short Form-36 mental component summary (SF-36_MCS).

RESULTS

After TOHR, significant increases were observed in the mean values for the 6MWD, MIP, MEP, HGS, QS, and SF-36_PCS and SF-36_MCS scores. The relative delta between the pre- and post-TOHR 6MWDs correlated significantly with the relative deltas of MIP (r_s = 0.640, p < 0.0001), MEP (r_s = 0.587, p < 0.0001), HGS (r_s = 0.360, p = 0.022), and QS (r_s = 0.351, p = 0.026). When the participants were separated according to their use of hydroxyurea, significant increases were observed in the relative deltas of the 6MWD, MIP and MEP values.

CONCLUSIONS

This study shows that TOHR can potentially increase functional capacity, muscle strength, and QoL in adults with SCA. Furthermore, there appears to be a relationship between 6MWD gains and muscle strength gains with TOHR.Trial registration: ClinicalTrials.gov identifier: NCT04705792.

GH/IGF-1 Abnormalities and Muscle Impairment: From Basic Research to Clinical Practice

The impairment of skeletal muscle function is one of the most debilitating least understood co-morbidity that accompanies acromegaly (ACRO). Despite being one of the major determinants of these patients’ poor quality of life, there is limited evidence related to the underlying mechanisms and treatment options. Although growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels are associated, albeit not indisputable, with the presence and severity of ACRO myopathies the precise effects attributed to increased GH or IGF-1 levels are still unclear. Yet, cell lines and animal models can help us bridge these gaps. This review aims to describe the evidence regarding the role of GH and IGF-1 in muscle anabolism, from the basic to the clinical setting with special emphasis on ACRO. We also pinpoint future perspectives and research lines that should be considered for improving our knowledge in the field.

Updates in rare and not-so-rare complications of acromegaly: focus on respiratory function and quality of life in acromegaly

Acromegaly is a complex disease with excessive growth hormone and insulin-like growth factor 1 (IGF-1) causing multisystem effects, particularly cardiovascular, respiratory, and metabolic. Psychological concerns and poor quality of life (QoL) are also major disease consequences. This review is intended for clinicians and focuses on the latest developments related to respiratory and QoL effects of long-term growth hormone excess. Along with biochemical disease control, patient treatment satisfaction and outcomes have become major treatment objectives; current knowledge and tools to evaluate and manage this aspect of the disease are described. Sleep apnea syndrome and other derangements of lung function and apparatus, from pathophysiology to treatment, and evaluation tools and determinants of QoL in patients with acromegaly are discussed.