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Azman MZB, Huang KS, Koh WJ, Leong SS, Ong B, Soon JL, Tan SW, Chan MY, Yang M, Yeung MT. Normative reference values, determinants and regression equations for the incremental shuttle walk test (ISWT) in healthy Asian population aged 21 to 80 years. PLoS One 2023; 18:e0291132. [PMID: 37669286 PMCID: PMC10479918 DOI: 10.1371/journal.pone.0291132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The validated Incremental Shuttle Walk Test (ISWT) is widely used for evaluating maximal exercise capacity, with the distance-walked (IWSD) as the primary outcome. However, there are no normative reference values (NRV) and reference equations to predict ISWD for the Singaporean population. OBJECTIVES This study aims to establish the NRV and reference equations for ISWD in healthy Singaporeans aged 21 to 80 and investigate the determining variables during ISWT. METHODS This cross-sectional study recruited community-dwelling healthy subjects aged 21-80 from the community via convenience sampling. Each subject completed two trials of the ISWT according to the standard protocol. Variables measured during the trials included ISWD, pre-and post-test heart rate (HR), oxygen saturation, blood pressure (BP), modified Borg's dyspnoea score and Borg's rate of perceived exertion (RPE). RESULTS 199 healthy Singaporean (females = 114, males = 85) participated in the study. The overall median ISWD was 660.0 metres (m) [interquartile range (IQR):440.0-850.0]. The age-stratified mean ISWD ranged from 430.0 m (IQR:350.0-450.0) (aged 60-80) to 480.0 m (IQR:438.0-650.0) (aged 40-59) to 780.0 m (IQR:670.0-960.0) (aged 21-39). Gender, age, weight, height and HR change (highest post-test HR minus pre-test HR) were the most significant variables (p < 0.001). IWSD (m) = 651.4(Height, m) +89.7(Gender, male = 1; female = 0) -6.31(Age, years) -3.61(Weight, kilograms) +2.54(HR change, beats per minute); R2 = 0.741. Previously published ISWT reference equations cannot accurately predict the ISWD in the Singaporean population. CONCLUSIONS This study investigated the ISWD NRV and established reference equations for healthy Singaporeans aged 21-80. The information would be beneficial in setting performance benchmarks to guide physical assessment, intervention and rehabilitation.
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Affiliation(s)
- Muhammad Zulhaziq Bin Azman
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Katherin S. Huang
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Wei Jun Koh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Sarah S. Leong
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Benjamin Ong
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Sengkang General Hospital, Singapore, Singapore
| | - Johanna L. Soon
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sherman W. Tan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Melissa Y. Chan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Mingxing Yang
- Department of Physiotherapy, Singhealth Polyclinics, Singapore, Singapore
| | - Meredith T. Yeung
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
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Bradley P, Merchant Z, Rowlinson-Groves K, Taylor M, Moore J, Evison M. Feasibility and outcomes of a real-world regional lung cancer prehabilitation programme in the UK. Br J Anaesth 2023; 130:e47-e55. [PMID: 35840361 PMCID: PMC9875904 DOI: 10.1016/j.bja.2022.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Prehabilitation, or multimodality patient optimisation before major treatment, has demonstrated meaningful improvements in patients' outcomes. In the setting of lung cancer surgery, postoperative complications and length of hospital stay are reduced, but there is currently limited access to prehabilitation. Prehab4Cancer (P4C) is an innovative regional programme serving all areas of Greater Manchester (GM). METHODS The lung cancer P4C service commenced in 2019 as a collaboration between the GM Cancer alliance and 12 leisure and community organisations. Patients planning surgical resection could be referred to receive exercise, nutrition, and well-being assessment and interventions before surgery. We evaluated the programme's feasibility, uptake, and outcomes during the 11 months before COVID-19 restrictions. RESULTS In total, 377 patients were referred to the lung cancer P4C service from all 11 hospitals in GM. Of the patients reached by telephone, 80.0% (n=280/348) attended initial P4C assessment, which occurred a median of 8 days (inter-quartile range [IQR]: 4-14) after referral. In addition, 74.3% (n=280/377) attended for baseline assessment and 47.7% (n=180/377) completed prehabilitation, attending a median of six sessions (IQR: 4-9). Statistically significant improvements in all objective physiological and subjective functional assessments were observed preoperatively, including a mean increase in the incremental shuttle walk test of 50 m (95% confidence interval: 25-74; P<0.001). CONCLUSIONS The P4C programme demonstrated feasibility at scale, high uptake, and promising impact on the status of patients with lung cancer before surgery. P4C is the first regional prehabilitation service internationally, and this evaluation provides a framework for implementing similar services in other regions.
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Affiliation(s)
- Patrick Bradley
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
| | - Zoe Merchant
- Greater Manchester Cancer Prehab4Cancer and Recovery Programme, Manchester, UK
| | | | - Marcus Taylor
- Department of Thoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - John Moore
- Greater Manchester Cancer Prehab4Cancer and Recovery Programme, Manchester, UK; Division for Anaesthesia, Peri-Operative Medicine and Critical Care Services, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Greater Manchester Cancer Prehab4Cancer and Recovery Programme, Manchester, UK
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Ang WQ, Tan HT, Goh SM, Seng SW, Huang KS, Chan MY, Yeung MT. Chinese (Mandarin) translation of the incremental shuttle walk test and its validity and reliability: A cross-sectional study. Hong Kong Physiother J 2022; 42:137-149. [PMID: 37560170 PMCID: PMC10406637 DOI: 10.1142/s1013702522500135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/19/2022] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND/PURPOSE To date, there are no published validated Chinese versions of the incremental shuttle walk test (ISWT) instructions despite its wide clinical applications. Translation of the Chinese ISWT instruction is done in an ad-hoc manner within the Chinese-speaking populations, affecting the test's reliability and validity since translation can differ significantly between individuals. This warrants the need for psychometric testing of such translation. OBJECTIVES To develop a Chinese (Mandarin) version of the ISWT instructions (ISWT-CHN) that is conceptually equivalent to the original English version (ISWT-ENG) and establish its reliability and validity. METHODS Forward and backward translations from the ISWT-ENG were done to generate the ISWT-CHN. Face and content validity was determined during the translation process. Intra-rater and inter-rater reliability of the ISWT-CHN, construct and criterion validity were established by analysing the ISWT and the gold standard cardiopulmonary exercise test results. RESULTS The Item-Content validity index (I-CVI), Scale-level-Content validity index (S-CVI), and content validity ratio (CVR) of the ISWT-CHN were 1.0. Intra-class Correlation Coefficient (ICC) for inter-rater reliability between two raters were excellent (ICC = 0 . 99 , 95% CI 0.97-1.0, p < 0 . 001 ; SEM = 0 . 85 m, MDC = 2 . 35 m). The intra-rater reliability of both Raters A (ICC = 0 . 92 , 95% CI 0.53-0.98, p = 0 . 003 ; SEM = 35 m, MDC = 97 m) and B (ICC = 0 . 90 , 95% CI 0.76-0.96, p < 0 . 001 ; SEM = 32 m, MDC = 88 m) were good. In a sample of 32 healthy participants, both ISWT-CHN and ISWT-ENG instruction results showed low-positive correlations with the VO2 max determined from the cardiopulmonary exercise test (r = 0.439, p < 0 . 001 ; r = 0 . 448 , p < 0 . 001 ). There is a very high correlation between ISWT-ENG and ISWT-CHN results with no statistically significant differences (r = 0 . 967 , p < 0 . 001 ). The construct and criterion validity of the ISWT-CHN were established. CONCLUSION This study developed the ISWT-CHN and showed that it is a valid and reliable measure conceptually comparable to the ISWT-ENG. It will benefit the determination of functional exercise capacity in Chinese-speaking populations. KEY MESSAGES •This study is aimed to develop a Chinese (Mandarin) version of the ISWT instructions.•The ISWT Chinese translation is valid and reliable that is conceptually comparable to the original English instruction.•The translated ISWT-Chinese instruction will enable the use of ISWT among the Chinese-speaking populations.
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Affiliation(s)
- Wei Qin Ang
- Health and Social Sciences Cluster Singapore Institute of Technology, Singapore
| | - Hong Ting Tan
- Health and Social Sciences Cluster Singapore Institute of Technology, Singapore
| | - Si Min Goh
- Health and Social Sciences Cluster Singapore Institute of Technology, Singapore
| | - Samantha W Seng
- Health and Social Sciences Cluster Singapore Institute of Technology, Singapore
| | - Katherin S Huang
- Health and Social Sciences Cluster Singapore Institute of Technology, Singapore
- Department of Physiotherapy Khoo Teck Puat Hospital, Singapore
| | - Melissa Y Chan
- Health and Social Sciences Cluster Singapore Institute of Technology, Singapore
| | - Meredith T Yeung
- Health and Social Sciences Cluster Singapore Institute of Technology, Singapore
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Avancini A, Sperduti I, Borsati A, Ferri T, Belluomini L, Insolda J, Trestini I, Tregnago D, Schena F, Bria E, Milella M, Pilotto S. Effect of exercise on functional capacity in patients with advanced cancer: A meta-analysis of randomized controlled trials. Crit Rev Oncol Hematol 2022; 175:103726. [PMID: 35659975 DOI: 10.1016/j.critrevonc.2022.103726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To determine the impact of exercise on functional capacity, measured through the "Six minutes walking test" (6MWT) in patients with advanced cancer stage. METHODS Systematic research on PubMed, Cochrane Library, and SportDiscus was conducted. Randomized controlled trials were eligible if they examined the effect of exercise on 6MWT. RESULTS Overall, a total of ten trials were included in the primary analysis. Compared to the controls, the exercise intervention was associated with an increase in functional capacity (+20.86 m; CI: -5.90 to 47.72, p = 0.12) although not reaching the statistical significance. Sensitivity analysis revealed an improvement for studies proposing a supervised exercise intervention towards the statistical significance. Few adverse events were associated with exercise training, and the median withdrawals rate was 17%. CONCLUSIONS Exercise may have a beneficial role on functional capacity in patients with advanced cancer, especially if supervised.
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Affiliation(s)
- Alice Avancini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Isabella Sperduti
- Biostatistical Unit - Clinical Trials Center IRCCS Istituto Nazionale Tumori Regina Elena, U.O. di Biostatistica e Bioinformatica, Rome, Italy.
| | - Anita Borsati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Thomas Ferri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Jessica Insolda
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Emilio Bria
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
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Objective methods for preoperative assessment of functional capacity. BJA Educ 2022; 22:312-320. [PMID: 36097575 PMCID: PMC9463693 DOI: 10.1016/j.bjae.2022.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
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Nakashima Y, Iwaki D, Kawae T, Fudeyasu K, Uemura K, Kimura H. Case-control study of the correlation between the five times sit to stand and 6-min walk distance in patients with pancreatic cancer. Support Care Cancer 2022; 30:9743-9749. [PMID: 36305956 PMCID: PMC9715511 DOI: 10.1007/s00520-022-07402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/07/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Cases of pancreatic cancer are increasing, and the risk of developing this disease reportedly increases with age. In recent years, there has been an increasing number of reports on physical function in patients with pancreatic cancer. Methods such as the 6-min walk distance (6 MWD) should be established to evaluate physical function, as a decline in exercise capacity is an important index in these patients. Recently, the 6 MWD has also been used to evaluate physical function in patients with pancreatic cancer. In healthy older adults, a decrease in 6 MWD is reportedly associated with intrinsic capacity and health status. Such factors make assessing 6 MWD important. However, the measurement of 6 MWD requires a sizable measurement environment. The five times sit to stand (FTSTS) test is a simple method that can be performed using a chair. FTSTS is hypothesized to be a useful assessment scale in patients with pancreatic cancer because it is easy to estimate the decline in physical function in clinical practice if the decline in 6 MWD can be estimated by evaluating FTSTS. The study's purpose was to clarify this hypothesis and ascertain the cutoff required to determine the decrease in 6 MWD in clinical practice. METHODS Sixty consecutive patients with preoperative pancreatic cancer who were assessed for physical function were studied. 6 MWD (< 400 m) was the objective variable, and binary logistic regression analysis was performed, with age, BMI, sex, FTSTS, and HGS as explanatory variables. Receiver-operating characteristic (ROC) curve analysis was performed for the explanatory variables, which were found to be significant based on logistic regression analysis. The area under the curve (AUC) was also calculated. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were evaluated. This study was approved by Hiroshima University Hospital's ethics committee (approval number: E808-1). RESULTS Fifty-seven of the 60 patients were included in the analysis. Logistic regression analysis showed that FTSTS was a significant explanatory variable; ROC curve analysis showed an AUC of 0.872 and a cutoff value of 8.98 s. The sensitivity, specificity, PPV, and NPV were 82.4%, 80.0%, 63.6%, and 91.4%, respectively. CONCLUSIONS A decrease in 6 MWD in preoperative pancreatic cancer patients can be identified by performing FTSTS.
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Affiliation(s)
- Yuki Nakashima
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan.
| | - Daisuke Iwaki
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshihiro Kawae
- Department of Physical Therapy, Makuhari Human Care Faculty, Tohto University, Chiba, Japan
| | - Kenichi Fudeyasu
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenichiro Uemura
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Kimura
- Department of Rehabilitation, Hiroshima University Hospital, Hiroshima, Japan
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Tous-Espelosin M, Ruiz de Azua S, Iriarte-Yoller N, Sanchez PM, Elizagarate E, Sampedro A, Maldonado-Martín S. Cross-Validation of Predictive Equation for Cardiorespiratory Fitness by Modified Shuttle Walk Test in Adults with Schizophrenia: A Secondary Analysis of the CORTEX-SP Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111390. [PMID: 34769904 PMCID: PMC8582746 DOI: 10.3390/ijerph182111390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
Cardiorespiratory fitness (CRF) can be direct or estimated from different field tests. The Modified Shuttle Walk Test (MSWT) is suitable for all levels of function, allowing a peak response to be elicited. Therefore, we aimed (1) to validate the equation presented in the original study by Singh et al. for evaluating the relationship between MSWT with peak oxygen uptake (VO2peak) in adults with schizophrenia (SZ), (2) to develop a new equation for the MSWT to predict VO2peak, and (3) to validate the new equation. Participants (N = 144, 41.3 ± 10.2 years old) with SZ performed a direct measurement of VO2peak through a cardiopulmonary exercise test and the MSWT. A new equation incorporating resting heart rate, body mass index, and distance from MSWT (R2 = 0.617; adjusted R2 = 0.60; p < 0.001) performs better than the Singh et al. equation (R2 = 0.57; adjusted R2 = 0.57; p < 0.001) to estimate VO2peak for the studied population. The posteriori cross-validation method confirmed the model’s stability (R2 = 0.617 vs. 0.626). The findings of the current study support the validity of the new regression equation incorporating resting heart rate, body mass index, and distance from MSWT to predict VO2peak for assessment of CRF in people with SZ.
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Affiliation(s)
- Mikel Tous-Espelosin
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports and Physical Exercise Research Group, Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain;
- Physical Activity, Exercise and Health Group, Bioaraba Health Research Institute, 01009 Vitoria-Gasteiz, Spain
| | - Sonia Ruiz de Azua
- Cibersam, Department of Neuroscience, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain;
| | - Nagore Iriarte-Yoller
- Refractory Psychosis Unit, Psychiatric Hospital of Alava, 01007 Vitoria-Gasteiz, Spain; (N.I.-Y.); (P.M.S.); (E.E.)
| | - Pedro M. Sanchez
- Refractory Psychosis Unit, Psychiatric Hospital of Alava, 01007 Vitoria-Gasteiz, Spain; (N.I.-Y.); (P.M.S.); (E.E.)
- Faculty of Medicine, University of Deusto, 48007 Bilbao, Spain
| | - Edorta Elizagarate
- Refractory Psychosis Unit, Psychiatric Hospital of Alava, 01007 Vitoria-Gasteiz, Spain; (N.I.-Y.); (P.M.S.); (E.E.)
| | - Agurne Sampedro
- Department of Psychology, Faculty of Health Sciences, University of Deusto, 48007 Bilbao, Spain;
| | - Sara Maldonado-Martín
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports and Physical Exercise Research Group, Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain;
- Physical Activity, Exercise and Health Group, Bioaraba Health Research Institute, 01009 Vitoria-Gasteiz, Spain
- Correspondence: ; Tel.: +34-945013534; Fax: +34-945013501
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500 Meters Is a Result of 6-Minute Walk Test Which Differentiates Patients with High and Low Risk of Postoperative Complications after Lobectomy-A Validation Study. J Clin Med 2021; 10:jcm10081686. [PMID: 33919996 PMCID: PMC8070994 DOI: 10.3390/jcm10081686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022] Open
Abstract
The 6-min walk test (6MWT) is a simple method of identifying patients with a high risk of postoperative complications. In this study, we internally validated the previously obtained threshold value of 500 m in the 6MWT as differentiating populations with a high and a low risk of postoperative complications after a lobectomy. Between November 2011 and November 2016, 624 patients who underwent a lobectomy and performed the 6MWT preoperatively entered this study. We compared the complication rates of two groups of patients—those who walked more than and those who walked less than 500 m. The patients who did not reach the distance of 500 m in the 6MWT were older (70 vs. 63 years p < 0.001), had worse pulmonary function tests (FEV1% 84 vs. 88 p = 0.041) and had a higher Charlson Comorbidity Index (p < 0.001). The patients who had a worse result in the 6MWT had a higher complication rate (52% vs. 42% p = 0.019; OR: 1.501 95% CI: 1.066–2.114) and a longer median postoperative hospital stay (7 vs. 6 days p = 0.010). In a multivariate analysis, the result of the 6MWT and pack-years proved to independently influence the risk of postoperative complications. This internal validation study confirms that 500 m is a result of the 6MWT which differentiates patients with a higher risk of postoperative complications and a prolonged hospital stay after a lobectomy.
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Wesolowski S, Orlowski TM, Kram M. The 6-min walk test in the functional evaluation of patients with lung cancer qualified for lobectomy. Interact Cardiovasc Thorac Surg 2020; 30:559-564. [PMID: 32068846 DOI: 10.1093/icvts/ivz313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/26/2019] [Accepted: 12/01/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The American College of Chest Physicians guidelines recommend low-technology exercise tests in the functional evaluation of patients with lung cancer considered for resectional surgery. However, the 6-min walk test (6MWT) is not included, because the data on its clinical value are inconsistent. Our goal was to evaluate the 6MWT in assessing the risk of cardiopulmonary complications in candidates for lung resection. METHODS We performed a retrospective assessment of clinical data and pulmonary function test results in 947 patients, mean age 65.3 (standard deviation 9.5) years, who underwent a single lobectomy for lung cancer. In 555 patients with predicted postoperative values ≤60%, the 6MWT was performed. The 6-min walking distance (6MWD) and the distance-saturation product (DSP), which is the product of the 6MWD in metres, and the lowest oxygen saturation registered during the test were assessed. RESULTS A total of 363 patients with predicted postoperative values <60% and a 6MWT distance (6MWD) ≥400 m or DSP ≥ 350 m% had a lower rate of cardiopulmonary complications than patients with shorter 6MWD or lower DSP values [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.35-0.81] and 0.47 (95% CI 0.30-0.73), respectively. This result was also true for patients with predicted postoperative values <40%, ORs 0.33 (95% CI 0.14-0.79) and 0.25 (95% CI 0.10-0.61), respectively. CONCLUSIONS The 6MWT is useful in the assessment of operative risk in patients undergoing a single lobectomy for lung cancer. It helps to stratify the operative risk, which is lower in patients with 6MWD ≥400 m or DSP ≥350 m% than in patients with a shorter 6MWD or lower DSP values.
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Affiliation(s)
- Stefan Wesolowski
- Lung Pathophysiology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Tadeusz M Orlowski
- Department of Thoracic Surgery, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Marek Kram
- Rehabilitation Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Preoperative Peak Oxygen Consumption: A Predictor of Survival in Resected Lung Cancer. Cancers (Basel) 2020; 12:cancers12040836. [PMID: 32244329 PMCID: PMC7226454 DOI: 10.3390/cancers12040836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/23/2020] [Accepted: 03/29/2020] [Indexed: 01/08/2023] Open
Abstract
The peak oxygen consumption (VO2 peak) serves as a prognostic factor in cardio-respiratory diseases and plays an important role in cancer patients. The long-term prognostic relevance of VO2 peak in lung cancer patients has not been investigated extensively. The aim of this study was to evaluate the impact of the preoperative VO2 peak on the postoperative long-term survival in patients with operated lung cancer. Retrospective analysis of 342 patients with curatively resected non-small-cell lung cancer using a multivariate Cox proportional hazard model. Results: Preoperative VO2 peak ranged from 10.2 to 51.8 mL/kg/min (mean: 18.3 ± 4.6), VO2 peak % of predicted ranged from 32 to 172% (mean: 65.2 ± 18.0%). Overall 10-year survival was 23%. A Log-rank test comparing predicted VO2 peak ≥ 60% with predicted VO2 peak < 60% showed overall survival of 30% and 17%, respectively (p < 0.001) and non-tumour-related survival of 71% and 51% (p = 0.001) at 10 years. In multivariable Cox analysis, overall 10-year survival correlated with a high predicted VO2 peak% (p = 0.001) and low N-stage corresponding to N0 and N1 (p < 0.001). Non-tumour-related death correlated with low VO2 peak% of predicted (p = 0.001), and age (p < 0.001). Low preoperative VO2 peak was associated with both decreased postoperative overall survival and decreased non-tumour-related survival during the 10-year follow-up.
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Abstract
The gut microbiota has been implicated in the pathogenesis and progression of kidney disease. However, little is known about the gut microbiota in hemodialysis (HD) patients. We assessed the gut microbiota and its relationship with clinical variables in ten HD patients. We found that the Firmicutes-to-Bacteroidetes ratio was positively associated with traditional risk factors for cardiovascular disease. Furthermore, Faecalibacterium was positively associated with carbohydrate intake and negatively associated with arterial stiffness. Finally, endotoxemia was inversely associated with butyrate producers. Future studies should assess if targeting the gut microbiota result in a lower burden for cardiovascular disease in HD patients.
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Hackett S, Jones R, Kapila R. Anaesthesia for pneumonectomy. BJA Educ 2019; 19:297-304. [PMID: 33456906 DOI: 10.1016/j.bjae.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- S Hackett
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Jones
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Kapila
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Ntima N, Lumb A. Physiology and conduct of pulmonary function tests. BJA Educ 2019; 19:198-204. [PMID: 33456891 PMCID: PMC7808018 DOI: 10.1016/j.bjae.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- N.O. Ntima
- St James's University Hospital, Leeds, UK
| | - A.B. Lumb
- St James's University Hospital, Leeds, UK
- University of Leeds, Leeds, UK
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Dunn A, Marsden DL, Barker D, van Vliet P, Spratt NJ, Callister R. Evaluation of three measures of cardiorespiratory fitness in independently ambulant stroke survivors. Physiother Theory Pract 2018; 35:622-632. [DOI: 10.1080/09593985.2018.1457746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ashlee Dunn
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
| | - Dianne L. Marsden
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Daniel Barker
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Medical Research Institute,New Lambton, NSW, Australia
| | - Paulette van Vliet
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Medical Research Institute,New Lambton, NSW, Australia
| | - Neil J. Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Medical Research Institute,New Lambton, NSW, Australia
- Department of Neurology, John Hunter Hospital, New Lambton, NSW, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Medical Research Institute,New Lambton, NSW, Australia
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15
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Jurio-Iriarte B, Gorostegi-Anduaga I, Aispuru GR, Pérez-Asenjo J, Brubaker PH, Maldonado-Martín S. Association between Modified Shuttle Walk Test and cardiorespiratory fitness in overweight/obese adults with primary hypertension: EXERDIET-HTA study. ACTA ACUST UNITED AC 2017; 11:186-195. [DOI: 10.1016/j.jash.2017.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/16/2017] [Accepted: 01/27/2017] [Indexed: 12/20/2022]
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16
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Fennelly J, Potter L, Pompili C, Brunelli A. Performance in the shuttle walk test is associated with cardiopulmonary complications after lung resections. J Thorac Dis 2017; 9:789-795. [PMID: 28449487 DOI: 10.21037/jtd.2017.03.22] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The current functional guidelines recommend the shuttle walk test (SWT) as an initial screening tool to identify candidates for lung resection without requiring cardiopulmonary exercise testing. This study aims to: (I) assess the use of the SWT in predicting postoperative cardiopulmonary complications; and (II) determine whether the recommended 400 m cut-off is an appropriate distance. METHODS We retrospectively analysed 101 patients that had performed a SWT prior to surgery. Univariate and multivariate regression analyses were used to test associations between patient variables [demographics, pre-existing conditions, pulmonary function, oxygen desaturation during the SWT, shuttle walk distance (SWD)] and post-operative cardiopulmonary complications. RESULTS Patients without cardiopulmonary complications walked longer distance compared to those with complication (417.3 vs. 348.6 m, P=0.01. Fifty two patients walked less than 400 m and 16 less than 250 m. Only 10% of patients who walked at least 400 m had cardiopulmonary complications compared to 33% of those who did not reach this distance (P=0.008). Half of the patients who walked less than 400 m and desaturated during the exercise developed cardiopulmonary complications. A SWD shorter than 400 m remained the only factor significantly associated with cardiopulmonary complications (P=0.009, OR: 4.3) after logistic regression analysis. CONCLUSIONS Our results support the use of the SWT as an initial screening tool in all patients prior to lung resection. Patients walking longer than 400 m experienced very low incidence of complications and would not need further testing prior to proceed to lung resection.
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Affiliation(s)
- Joseph Fennelly
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Lauren Potter
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Cecilia Pompili
- Section of Patient Centered Outcomes Research, Leeds Institute of Cancer and Pathology, Leeds, UK
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17
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Moran J, Wilson F, Guinan E, McCormick P, Hussey J, Moriarty J. The preoperative use of field tests of exercise tolerance to predict postoperative outcome in intra-abdominal surgery: a systematic review. J Clin Anesth 2016; 35:446-455. [DOI: 10.1016/j.jclinane.2016.09.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022]
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18
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Cavalheri V, Jenkins S, Cecins N, Gain K, Hill K. Comparison of the six-minute walk test with a cycle-based cardiopulmonary exercise test in people following curative intent treatment for non-small cell lung cancer. Chron Respir Dis 2016; 13:118-27. [PMID: 26869579 PMCID: PMC5734602 DOI: 10.1177/1479972316631137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study is aimed to (i) compare both the magnitude of impairment in exercise capacity and exercise responses measured during the six-minute walk test (6MWT) and the cardiopulmonary exercise test (CPET) and (ii) investigate the effect of test repetition on six-minute walk distance (6MWD) in people following curative intent treatment for non-small cell lung cancer (NSCLC). Twenty participants (67 ± 10 years; 14 females), 6-10 weeks following lobectomy, underwent a CPET and two 6MWTs. Peak exercise responses, dyspnoea and leg fatigue, as well as heart rate (HR) and oxygen saturation (SpO2) during the 6MWT, were compared to those during the CPET. Compared with exercise capacity when expressed as peak rate of oxygen consumption (%pred) measured during the CPET, exercise capacity when expressed as 6MWD (%pred) was less impaired (81 ± 10 vs. 63 ± 15 %pred; p < 0.001). Compared with the CPET, the 6MWT elicited lower peak HR (119 ± 15 vs. 128 ± 18 beats minute(-1); p = 0.02), lower SpO2 (93 ± 2 vs. 95 ± 3%; p < 0.05), less dyspnoea (3.1 ± 1.6 vs. 6.9 ± 2.6; p < 0.01) and less leg fatigue (2.0 ± 1.9 vs. 6.8 ± 2.4; p < 0.01). The 6MWD increased 19 ± 19 metre (4 ± 4%) with test repetition (p < 0.001). In people following curative intent treatment for NSCLC, the 6MWT appears to elicit sub-maximal exercise responses when compared with the CPET. There is a significant effect of test repetition on 6MWD.
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Affiliation(s)
- Vinicius Cavalheri
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sue Jenkins
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia Physiotherapy Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
| | - Nola Cecins
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia Physiotherapy Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia Community Physiotherapy Services, Perth, Western Australia, Australia
| | - Kevin Gain
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Kylie Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia, Australia
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19
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Agarwal B, Shah M, Andhare N, Mullerpatan R. Incremental shuttle walk test: Reference values and predictive equation for healthy Indian adults. Lung India 2016; 33:36-41. [PMID: 26933305 PMCID: PMC4748663 DOI: 10.4103/0970-2113.173056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Physical inactivity in Indians is leading to an increase in noncommunicable disorders at an early age in life. Early identification and quantification of the lack of physical activity using simple and reliable exercise testing is the need of the hour. The incremental shuttle walk test (ISWT) is an externally paced walk test widely used for the evaluation of exercise capacity. Currently the normative values available for clinical reference are generated from Western populations. Hence, the study was conducted to find normative values for the ISWT in healthy Indian adults (17-75 years). MATERIALS AND METHODS A convenience sample of 862 subjects was recruited after ethical approval was obtained. All subjects were divided into groups as per age and gender. For age, the grouping was as follows: Group 1: Young adulthood (17-40 years), group 2: Middle adulthood (40-65 years), and group 3: Old adulthood (>65 years). The ISWT was performed as per standard protocol by Sally Singh. RESULTS The average distance walked were 709.2m,556.4m and 441.3m in females and 807.9 m, 639.6 m and 478.2 m in males in the three respective age groups. Stepwise regression analysis revealed age and gender as key variables correlating with incremental shuttle walk distance (ISWD). The derived predictive equations for males and females may be given as follows: 740.351 - (5.676 × age) + (99.007 × gender). CONCLUSION Reference values were generated for healthy Indian adults. Physiological response to the ISWT was shown to be affected by gender and increasing age. Easily measurable variables explained 68% of the variance seen in the test, making the reference equation a relevant part of the evaluation of the ISWT.
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Affiliation(s)
- Bela Agarwal
- Department of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Monal Shah
- Department of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Nilesh Andhare
- Department of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Rajani Mullerpatan
- Department of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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20
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Scott JM, Hornsby WE, Lane A, Kenjale AA, Eves ND, Jones LW. Reliability of maximal cardiopulmonary exercise testing in men with prostate cancer. Med Sci Sports Exerc 2016; 47:27-32. [PMID: 24781891 DOI: 10.1249/mss.0000000000000370] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To accurately assess exercise interventions and to evaluate acute and chronic cardiovascular effects in patients with early-stage cancer, consistently reliable functional outcome measures must be obtained. An incremental cardiopulmonary exercise test (CPET) with gas exchange measurement to assess peak oxygen consumption (V˙O2peak) provides the gold standard outcome of cardiorespiratory fitness. METHODS In the context of a randomized controlled trial, 40 patients with prostate cancer (mean age, 59 ± 7 yr) after radical prostatectomy performed two maximal CPET within 5.6 ± 5.5 d of each other. Incremental treadmill tests were performed in the morning under identical laboratory conditions. Reliability and within-subject variability from test 1 to test 2 for peak and submaximal variables were assessed by correlation coefficients, intraclass correlations (ICC), Bland-Altman plots, coefficient of variation, and paired t-tests. RESULTS There was high reliability between CPET for V˙O2peak (r = 0.92; P < 0.001; ICC, 0.900), ventilatory threshold (r = 0.88; P < 0.001; ICC, 0.927), minute ventilation-carbon dioxide production relation (V˙E/V˙CO2) (r = 0.86; P < 0.001; ICC, 0.850), and peak heart rate (r = 0.95; P < 0.001; ICC, 0.944). However, high within-subject variability was observed for all CPET parameters (mean coefficient of variation, 4.7%). Compared with those for test 1, significantly higher mean values were observed for V˙O2peak (27.0 ± 5.6 vs 28.1 ± 5.3 mL·kg·min, P < 0.05), ventilatory threshold (1.91 ± 0.5 vs 1.97 ± 0.4 L·min, P < 0.05), and V˙E/V˙CO2 (31.3 ± 5.8 vs 32.8 ± 3.4, P < 0.05) in test 2. CONCLUSIONS These findings indicate the presence of significant, and potentially clinically important, variability in CPET procedures in men with clinically localized prostate cancer and have important implications for the application and use of CPET to evaluate the efficacy of interventions to improve aerobic capacity in the oncology setting.
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Affiliation(s)
- Jessica M Scott
- 1Universities Space Research Association, Houston, TX; 2Duke University Medical Center, Durham, NC; 3Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, CANADA; and 4Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Ha D, Fuster M, Ries AL, Wagner PD, Mazzone PJ. Heart Rate Recovery as a Preoperative Test of Perioperative Complication Risk. Ann Thorac Surg 2015; 100:1954-62. [PMID: 26410158 DOI: 10.1016/j.athoracsur.2015.06.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/09/2015] [Accepted: 06/22/2015] [Indexed: 12/25/2022]
Abstract
The autonomic nervous system plays important physiologic roles in a variety of organ systems. Autonomic dysfunction has been shown to be predictive of increased mortality in patients with cardiovascular disease. Its importance in patients with chronic respiratory disorders has been described in recent years. Here, we summarize the prognostic value of autonomic dysfunction, as reflected by impaired heart rate recovery (HRR), in patients with chronic respiratory disorders, including chronic obstructive pulmonary disease, interstitial lung disease, and lung cancer. We suggest that HRR may be clinically useful in the preoperative physiologic evaluation, specifically in lung cancer patients being considered for surgery.
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Affiliation(s)
- Duc Ha
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California.
| | - Mark Fuster
- VA San Diego Healthcare System, San Diego, California; Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
| | - Andrew L Ries
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
| | - Peter D Wagner
- Pulmonary and Critical Care Medicine Division, University of California, San Diego, La Jolla, California
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22
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Pulmonary function tests in the preoperative evaluation of lung cancer surgery candidates. A review of guidelines. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 11:278-82. [PMID: 26336435 PMCID: PMC4283874 DOI: 10.5114/kitp.2014.45677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 01/17/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022]
Abstract
Before planned surgical treatment of lung cancer, the patient's respiratory system function should be evaluated. According to the current guidelines, the assessment should start with measurements of FEV1 (forced expiratory volume in 1 second) and DLco (carbon monoxide lung diffusion capacity). Pneumonectomy is possible when FEV1 and DLco are > 80% of the predicted value (p.v.). If either of these parameters is < 80%, an exercise test with VO2 max (oxygen consumption during maximal exercise) measurement should be performed. When VO2 max is < 35 % p.v. or < 10 ml/kg/min, resection is associated with high risk. If VO2 max is in the range of 35-75% p.v. or 10-20 ml/kg/min, the postoperative values of FEV1 and DLco (ppoFEV1, ppoDLco) should be determined. The exercise test with VO2 max measurement may be replaced with other tests such as the shuttle walk test and the stair climbing test. The distance covered during the shuttle walk test should be > 400 m. Patients considered for lobectomy should be able to climb 3 flights of stairs (12 m) and for pneumonectomy 5 flights of stairs (22 m).
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23
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Granger CL, Denehy L, Parry SM, Martin J, Dimitriadis T, Sorohan M, Irving L. Which field walking test should be used to assess functional exercise capacity in lung cancer? An observational study. BMC Pulm Med 2015; 15:89. [PMID: 26264470 PMCID: PMC4534028 DOI: 10.1186/s12890-015-0075-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer (NSCLC). Cardiopulmonary exercise testing (CPET) is the gold standard measure of exercise capacity; however this laboratory test has limitations for use in research and clinical practice. Alternative field walking tests are the six-minute walk test (6MWT), incremental-shuttle walk test (ISWT) and endurance-shuttle walk test (ESWT); however there is limited information about their clinimetric properties in NSCLC. AIMS In NSCLC to determine the 1) criterion validity of the 6MWT, ISWT and ESWT against CPET; 2) construct validity of the 6MWT, ISWT and ESWT against measures of function, strength, respiratory function and health-related quality of life (HRQoL); and 3) clinical applicability of the tests. METHODS Twenty participants (40 % male, mean ± SD age 66.1 ± 6.5 years) with stage I-IIIb NSCLC completed the 6MWT, ISWT, ESWT and CPET within six months of treatment. Testing order was randomised. Additional measures included Eastern Cooperative Oncology Group Performance-Status (ECOG-PS, function), respiratory function, hand-grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships. RESULTS The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption (r = 0.61, p = 0.007). Relationships between CPET and six minute walk distance (6MWD) (r = 0.24, p = 0.329) or ESWT time (r = 0.02, p = 0.942) were poor. Moderate construct validity existed for the 6MWD and respiratory function (forced vital capacity % predicted r = 0.53, p = 0.019; forced expiratory volume in the first second % predicted r = 0.55, p = 0.015). There were no relationships between the walking tests and measures of function, strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time. No floor effects were seen in the tests. The mean ± SD time required to perform the individual 6MWT, ISWT and ESWT was 12.8 ± 2.5, 14.7 ± 3.7 and 16.3 ± 5.0 min respectively; in comparison to CPET which was 51.2 ± 12.7 min. Only one assessor was required to perform all field walking tests and no adverse events occurred. CONCLUSIONS The ISWT is a promising measure of functional exercise capacity in lung cancer. Findings need to be confirmed in a larger sample prior to translation into practice.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
- Institute for Breathing and Sleep, Heidelberg Road, Heidelberg, VIC, Australia.
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
- Institute for Breathing and Sleep, Heidelberg Road, Heidelberg, VIC, Australia.
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
| | - Joel Martin
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Tim Dimitriadis
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Maeve Sorohan
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
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Wu PT, Fitschen PJ, Kistler BM, Jeong JH, Chung HR, Aviram M, Phillips SA, Fernhall B, Wilund KR. Effects of Pomegranate Extract Supplementation on Cardiovascular Risk Factors and Physical Function in Hemodialysis Patients. J Med Food 2015; 18:941-9. [PMID: 25826143 DOI: 10.1089/jmf.2014.0103] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The purpose of this study was to evaluate the effects of oral supplementation with pomegranate extract on cardiovascular risk, physical function, oxidative stress, and inflammation in hemodialysis (HD) patients. Thirty-three HD subjects were randomized to the pomegranate (POM) or placebo (CON) group. Patients in POM ingested a 1000 mg capsule of a purified pomegranate polyphenol extract 7 days/week for 6 months. Individuals in CON ingested a noncaloric placebo capsule using the same protocol. Measurements were conducted at baseline and repeated 6 months following the start of the intervention. Brachial blood pressure (BP) was obtained using an automatic digital BP monitor. Cardiovascular risk was assessed using ultrasound and arterial tonometry. Blood samples were collected for the measurements of circulating markers of inflammation, oxidative stress, and antioxidant capacity. Muscle strength and physical function were assessed by isokinetic dynamometry, a validated shuttle walk test, and a battery of tests to assess functional fitness. Systolic blood pressure and diastolic blood pressure were reduced by 24 ± 13.7 and 10 ± 5.3 mmHg, respectively, in POM (P < .05). However, the BP differences in POM were no longer significant after controlling for baseline BP. The paraoxonase-1 activity increased by 26.6% (P < .05) in POM, compared to no significant change in CON. However, pomegranate supplementation had no effect on other markers of cardiovascular disease risk, inflammation and oxidative stress, or measures of physical function and muscle strength. While pomegranate extract supplementation may reduce BP and increase the antioxidant activity in HD patients, it does not improve other markers of cardiovascular risk, physical function, or muscle strength.
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Affiliation(s)
- Pei-Tzu Wu
- 1 School of Nursing, University of California-Los Angeles , Los Angeles, California, USA .,3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Peter J Fitschen
- 2 Division of Nutritional Sciences, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Brandon M Kistler
- 3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Jin Hee Jeong
- 3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Hae Ryong Chung
- 3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Michael Aviram
- 4 Technion Rappaport Faculty of Medicine, Rambam Medical Center , Haifa, Israel
| | - Shane A Phillips
- 5 Department of Physical Therapy, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Bo Fernhall
- 6 Department of Kinesiology and Nutrition, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Kenneth R Wilund
- 2 Division of Nutritional Sciences, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA .,3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
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25
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Marjanski T, Wnuk D, Bosakowski D, Szmuda T, Sawicka W, Rzyman W. Patients who do not reach a distance of 500 m during the 6-min walk test have an increased risk of postoperative complications and prolonged hospital stay after lobectomy. Eur J Cardiothorac Surg 2015; 47:e213-9. [PMID: 25721817 DOI: 10.1093/ejcts/ezv049] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/30/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Exercise testing is an additional tool to standard pulmonary assessment before radical pulmonary resection in lung cancer patients. Evidence is lacking, supporting the significance of routine implementation of these simple physiological tests in preoperative evaluation. METHODS Between April 2009 and October 2011, 253 lung cancer patients, who underwent lobectomy in a single institution, were entered into this study. All of the patients were accepted for resection based on a standard evaluation protocol. Additionally on the day before the surgery, patients performed a 6-min walk test (6MWT). Patients were categorized, depending on the result of 6MWT, in order to stratify their risk of postoperative complications. Threshold values of 6MWT were assessed on the basis of maximum area under ROC curves. RESULTS There were 148 men and 105 women with a mean age of 63 years. All patients underwent lobectomies due to primary lung cancer. A distance of 500 m and 100% of the predicted 6MWT were taken as threshold values differentiating risk of postoperative complications. The cut-off value of 500 m separates individuals with an increased risk of postoperative complications [60.6 vs 36.9%, odds ratio (OR): 2631; 95% confidence interval (CI): 1.423-4.880] and prolonged hospitalization (7 vs 6 days). By applying a cut-off value of 500 m, the higher incidence of atrial fibrillation (21.2 vs 11.7%; OR: 2019; 95% CI: 0.904-4.484) and higher requirement for blood transfusion (18.1 vs 9.0%; OR: 2222; 95% CI: 0.928-5.289) fairly reached the level of significance. There were no early postoperative deaths in the analysed groups. CONCLUSIONS Patients who walk <500 m during the 6MWT before lobectomy have an increased risk of postoperative complications and prolonged hospital stay.
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Affiliation(s)
- Tomasz Marjanski
- Thoracic Surgery Department, Medical University of Gdansk, Gdansk, Poland
| | - Damian Wnuk
- Department of Physiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Damian Bosakowski
- Thoracic Surgery Department, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Szmuda
- Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland
| | - Wioletta Sawicka
- Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdansk, Poland
| | - Witold Rzyman
- Thoracic Surgery Department, Medical University of Gdansk, Gdansk, Poland
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Preoperative evaluation of the patient with lung cancer being considered for lung resection. Curr Opin Anaesthesiol 2015; 28:18-25. [DOI: 10.1097/aco.0000000000000149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ramos E, de Oliveira LVF, Silva AB, Costa IP, Corrêa JCF, Costa D, Alves VL, Donner CF, Stirbulov R, Arena R, Sampaio LM. Peripheral muscle strength and functional capacity in patients with moderate to severe asthma. Multidiscip Respir Med 2015; 10:3. [PMID: 25973197 PMCID: PMC4429482 DOI: 10.1186/2049-6958-10-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/16/2014] [Indexed: 11/12/2022] Open
Abstract
Background The adequate control of asthma includes the absence of nocturnal symptoms, minimal use of medication, normal or nearly normal lung function and no limitations to physical activity. The choice of a more sedentary lifestyle can lead to physical de-conditioning, thereby aggravating asthma symptoms and increasing the risk of obesity. Methods This study aimed at performing a battery of function-related assessments in patients with asthma and comparing them to a healthy control group. A prospective, transversal and case–control study was designed. It was set up at Santa Casa de Misericórdia Hospital –Sao Paulo and Nove de Julho University on a population of outpatients. Subjects of the study were patients affected by moderate to severe asthma. A case–control study was carried out involving 20 patients with moderate to severe asthma and 15 healthy individuals (control group). All participants underwent body composition analysis (BMI and BIA) and a controlled walk test (Shuttle test), resistance muscle test (1RM) and answered a physical activity questionnaire (IPAQ). The group with asthma also answered a questionnaire addressing the clinical control of the illness (ACQ). Results In comparison to the control group (unpaired Student’s t-test), the patients with asthma had a significantly higher BMI (31.09 ± 5.98 vs. 26.68 ± 7.56 kg/m2) and percentage of body fat (38.40 ± 6.75 vs. 33.28 ± 8.23%) as well as significantly lower values regarding distance traveled on the walk test (369 ± 110 vs. 494 ± 85 meters) and metabolic equivalents (3.74 ± 0.87 vs. 4.72 ± 0.60). A strong correlation was found between the distance completed and peripheral muscle strength (r: 0.57, p < 0.05) and METs (Metabolic equivalents – minutes/week) and peripheral muscle strength of 1RM (r: 0.61, p = 0.009). Conclusions The individuals with asthma had lower functional capacity and levels of physical activity as well as a higher percentage of body fat compared to healthy individuals. This suggests that such patients have a reduced physical performance stemming from a sedentary lifestyle. Despite the existence of few studies reporting moderate to severe asthmatic patients and functional capacity assessment, it is clear that the assessment presented in the current study is a valid and accessible tool in clinical practice.
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Affiliation(s)
- Elisangela Ramos
- Rehabilitation Sciences Master's Program, Nove de Julho University, São Paulo, Brazil
| | | | | | - Ivan Peres Costa
- Rehabilitation Sciences Master's Program, Nove de Julho University, São Paulo, Brazil
| | | | - Dirceu Costa
- Rehabilitation Sciences Master's Program, Nove de Julho University, São Paulo, Brazil
| | - Vera Lucia Alves
- Santa Casa de Misericórdia São Paulo Hospital, São Paulo, Brazil
| | - Claudio F Donner
- Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero, NO Italy
| | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL USA
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Tomayko EJ, Kistler BM, Fitschen PJ, Wilund KR. Intradialytic protein supplementation reduces inflammation and improves physical function in maintenance hemodialysis patients. J Ren Nutr 2014; 25:276-83. [PMID: 25455421 DOI: 10.1053/j.jrn.2014.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/05/2014] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Protein malnutrition is both a cause and consequence of inflammation and related comorbidities for maintenance hemodialysis (MHD) patients. This study sought to determine if oral supplementation with soy or whey protein during dialysis treatment reduces inflammation and improves physical function and body composition in MHD patients. DESIGN The design used in the study was randomized controlled trial, and the setting used was hemodialysis clinics in Champaign and Chicago, Illinois. SUBJECTS Patients who received treatment ≥3 days/week, were ages ≥30 years did not have congestive heart failure or chronic obstructive pulmonary disease, and were receiving dialysis treatment for ≥3 months were eligible for inclusion. INTERVENTION Patients were randomized to oral supplementation with a whey protein, soy protein, or placebo beverage. Patients (WHEY, n = 11; SOY, n = 12; CON, n = 15) consumed their assigned beverage before every dialysis session for 6 months. MAIN OUTCOME MEASURES Body composition was measured by dual-energy x-ray absorptiometry, physical function by gait speed and shuttle walk test, and markers of inflammation (C-reactive protein and interleukin 6) using commercially available enzyme-linked immunosorbent assay kits before and after the 6-month intervention. Dietary intake was assessed by 24-hour dietary recalls. RESULTS Six months of whey or soy supplementation significantly reduced predialysis interleukin 6 levels (P < .05 for both), whereas there was a trend for a reduction in C-reactive protein when both protein groups were combined (P = .062). Gait speed and shuttle walk test performance also significantly improved in the protein groups (P < .05 for both). No changes in body composition were observed. However, alkaline phosphatase, a marker of bone turnover, was significantly reduced in the protein groups. CONCLUSIONS Intradialytic protein supplementation during a 6-month intervention reduced inflammation and improved physical function and represents an affordable intervention to improve the health of MHD patients.
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Affiliation(s)
- Emily J Tomayko
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois
| | - Brandon M Kistler
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois
| | - Peter J Fitschen
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois
| | - Kenneth R Wilund
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois; Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois.
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Parreira VF, Janaudis-Ferreira T, Evans RA, Mathur S, Goldstein RS, Brooks D. Measurement properties of the incremental shuttle walk test. a systematic review. Chest 2014; 145:1357-1369. [PMID: 24384555 DOI: 10.1378/chest.13-2071] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The incremental shuttle walk test (ISWT) was developed > 20 years ago and has been used to assess peak exercise capacity in a variety of chronic diseases. The aim of this systematic review is to describe the measurement properties of the ISWT in a clinical population.Methods: Of 800 articles identified by electronic and hand searches, 35 were included. Twenty-one articles included data on the validity of the ISWT, 18 on the reliability, four on the responsiveness,and four on the interpretability.Results: Most of the studies were conducted in patients with COPD (n = 13) or cardiac disease(n = 8). For criterion validity, comparisons between distance covered during the ISWT and peak oxygen consumption reported correlations ranging from 0.67 to 0.95 ( P <.01). Intraclass correlation coefficients for test-retest reliability ranged from 0.76 to 0.99. The ISWT was shown to be responsive to pulmonary rehabilitation and bronchodilator administration. The minimal clinically important difference (MCID) in patients with COPD was 48 m. Predictive equations for the distance in the ISWT are available for healthy individuals.Conclusions: The ISWT can be considered a valid and reliable test to assess maximal exercise capacity in individuals with chronic respiratory diseases. The ISWT has been shown to be responsive to pulmonary rehabilitation and bronchodilator use in individuals with COPD, cystic fibrosis,and asthma. Further studies examining responsiveness and the MCID of the ISWT in patients with conditions other than lung diseases are required for the interpretation of interventions in other populations.
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Affiliation(s)
- Verônica F Parreira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; CAPES Brazil, West Park Healthcare Centre (Respiratory Medicine), Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tania Janaudis-Ferreira
- Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, School of Medicine, University of Leicester, Leicester, England
| | - Rachel A Evans
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sunita Mathur
- Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, School of Medicine, University of Leicester, Leicester, England
| | - Roger S Goldstein
- Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, School of Medicine, University of Leicester, Leicester, England; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, School of Medicine, University of Leicester, Leicester, England.
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Stanzani F, Paisani DDM, Oliveira AD, Souza RCD, Perfeito JAJ, Faresin SM. Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients. ACTA ACUST UNITED AC 2014; 40:21-9. [PMID: 24626266 PMCID: PMC4075917 DOI: 10.1590/s1806-37132014000100004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/28/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs). METHODS This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010. RESULTS Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs. CONCLUSIONS Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies.
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Affiliation(s)
- Fabiana Stanzani
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Physician. Pulmonology Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Denise de Moraes Paisani
- Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil, Thoracic Surgeon. Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil
| | - Anderson de Oliveira
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Thoracic Surgeon. Thoracic Surgeon Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo Caetano de Souza
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Thoracic Surgeon. Thoracic Surgeon Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - João Aléssio Juliano Perfeito
- Federal University of São Paulo, Department of Medicine, São Paulo, Brazil, Affiliate Professor. Pulmonology Section, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Tanigawa T, Hirashima M, Fukutani N, Nishiguchi S, Kayama H, Yukutake T, Yamada M, Aoyama T. Shoe-fit is correlated with exercise tolerance in community-dwelling elderly people. FOOTWEAR SCIENCE 2014. [DOI: 10.1080/19424280.2014.941416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cardiopulmonary exercise testing prior to myeloablative allo-SCT: a feasibility study. Bone Marrow Transplant 2014; 49:1330-6. [PMID: 25068429 DOI: 10.1038/bmt.2014.159] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/03/2014] [Accepted: 06/06/2014] [Indexed: 11/08/2022]
Abstract
The feasibility of symptom-limited cardiopulmonary exercise testing (CPET) prior to allo-SCT was assessed in addition to the prognostic value of CPET-derived measures. CPET was performed prospectively on 21 patients with hematologic malignancies, with assessments of peak (for example, peak oxygen consumption, VO2peak) and submaximal (for example, ventilatory threshold (VT)) measures of cardiopulmonary function. No serious adverse events were observed during CPET procedures, with 95% of patients achieving criteria for a peak test. Mean VO2peak was 24.7±6.4 mL kg(-1 )min(-1) (range: 10.9-35.5), equivalent to 29%±17% below that of age-matched healthy controls. All patients proceeded with the conditioning regimen followed by allo-SCT. Median follow-up was 25 months. During this period, 11 (52.4%) patients died (n=6, relapsed disease; n=5, non-relapse mortality (NRM)); 9 patients (43%) developed pulmonary toxicity. In univariate analyses, both peak and submaximal markers of cardiopulmonary function were predictors of OS, pulmonary toxicity and NRM. For OS, the HR for VO2peak and VT were 0.89 (95% CI, 0.8-0.99, P=0.04) and 0.84 (95% CI, 0.71-0.98, P=0.03), respectively. In conclusion, CPET is safe and feasible prior to allo-SCT. Patients have marked impairments in cardiopulmonary function prior to allo-SCT. CPET-derived metrics may complement conventional measures to improve risk stratification.
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Spyratos D, Zarogoulidis P, Porpodis K, Angelis N, Papaiwannou A, Kioumis I, Pitsiou G, Pataka A, Tsakiridis K, Mpakas A, Arikas S, Katsikogiannis N, Kougioumtzi I, Tsiouda T, Machairiotis N, Siminelakis S, Argyriou M, Kotsakou M, Kessis G, Kolettas A, Beleveslis T, Zarogoulidis K. Preoperative evaluation for lung cancer resection. J Thorac Dis 2014; 6 Suppl 1:S162-6. [PMID: 24672690 DOI: 10.3978/j.issn.2072-1439.2014.03.06] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 03/07/2014] [Indexed: 12/25/2022]
Abstract
During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients.
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Affiliation(s)
- Dionysios Spyratos
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Paul Zarogoulidis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Konstantinos Porpodis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Angelis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Antonios Papaiwannou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Ioannis Kioumis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Georgia Pitsiou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Athanasia Pataka
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Andreas Mpakas
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Stamatis Arikas
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Katsikogiannis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Ioanna Kougioumtzi
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Theodora Tsiouda
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Stavros Siminelakis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Michael Argyriou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Maria Kotsakou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - George Kessis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Alexander Kolettas
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Thomas Beleveslis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Konstantinos Zarogoulidis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 6 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 7 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 8 Oncology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 9 Anesthisiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
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de Boer S, Kolbe J, Wilsher ML. Comparison of the modified shuttle walk test and cardiopulmonary exercise test in sarcoidosis. Respirology 2014; 19:604-7. [DOI: 10.1111/resp.12276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/23/2014] [Accepted: 01/25/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Sally de Boer
- Green Lane Respiratory Services; Auckland City Hospital; Auckland New Zealand
| | - John Kolbe
- Green Lane Respiratory Services; Auckland City Hospital; Auckland New Zealand
| | - Margaret L. Wilsher
- Green Lane Respiratory Services; Auckland City Hospital; Auckland New Zealand
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Dourado VZ, Guerra RLF, Tanni SE, Antunes LCDO, Godoy I. Reference values for the incremental shuttle walk test in healthy subjects: from the walk distance to physiological responses. J Bras Pneumol 2013; 39:190-7. [PMID: 23670504 PMCID: PMC4075833 DOI: 10.1590/s1806-37132013000200010] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/15/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To determine reference values for incremental shuttle walk distance (ISWD) and peak physiological responses during the incremental shuttle walk test (ISWT), as well as to develop a series of predictive equations for those variables in healthy adults. METHODS: We evaluated 103 healthy participants ≥ 40 years of age (54 women and 49 men). We fitted each participant with a gas analysis system for use during the ISWT. Oxygen consumption (VO2), carbon dioxide production, minute ventilation, heart rate (HR), ISWD, and maximal walking velocity (MWV) were obtained as primary outcomes. We also assessed hand grip strength (HGS) and lean body mass (LBM). RESULTS: The regression analysis models, including physiological variables, ISWD, and MWV (adjusted for age, body mass, height, and sex), produced R2 values ranging from 0.40 to 0.65 (for HR and peak VO2, respectively). Using the models including LBM or HGS, we obtained no significant increase in the R2 values for predicting peak VO2, although the use of those models did result in slight increases in the R2 values for ISWD and MWV (of 8% and 12%, respectively). The variables ISWD, MWV, and ISWD × body mass, respectively, explained 76.7%, 73.3%, and 81.2% of peak VO2 variability. CONCLUSIONS: Our results provide reference values for ISWD and physiological responses to the ISWT, which can be properly estimated by determining simple demographic and anthropometric characteristics in healthy adults ≥ 40 years of age. The ISWT could be used in assessing physical fitness in the general adult population and in designing individualized walking programs.
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Affiliation(s)
- Victor Zuniga Dourado
- Universidade Federal de São Paulo - UNIFESP, Federal University of São Paulo - Baixada Santista Campus, Santos, Brazil.
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Understanding clinical strategies that may impact tumour growth and metastatic spread at the time of cancer surgery. Best Pract Res Clin Anaesthesiol 2013; 27:427-39. [DOI: 10.1016/j.bpa.2013.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 10/07/2013] [Indexed: 12/19/2022]
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Stefanelli F, Meoli I, Cobuccio R, Curcio C, Amore D, Casazza D, Tracey M, Rocco G. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Eur J Cardiothorac Surg 2013; 44:e260-5. [PMID: 23892298 DOI: 10.1093/ejcts/ezt375] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Peak VO2, as measure of physical performance is central to a correct preoperative evaluation in patients with both non-small-cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) because it is closely related both to operability criteria and the rate of postoperative complications. Strategies to improve peak VO2, as a preoperative pulmonary rehabilitation programme (PRP), should be considered favourably in these patients. In order to clarify the role of pulmonary rehabilitation, we have evaluated the effects of 3-week preoperative high-intensity training on physical performance and respiratory function in a group of patients with both NSCLC and COPD who underwent lobectomy. METHODS We studied 40 patients with both NSCLC and COPD, age < 75 years, TNM stages I-II, who underwent lobectomy. Patients were randomly divided into two groups (R and S): Group R underwent an intensive preoperative PRP, while Group S underwent only lobectomy. We evaluated peak VO2 in all patients at Time 0 (T0), after PRP/before surgery in Group R/S (T1) and 60 days after surgery, respectively, in both groups (T2). RESULTS There was no difference between groups in peak VO2 at T0, while a significant difference was observed both at T1 and T2. In Group R, peak VO2 improves significantly from T0 to T1: 14.9 ± 2.3-17.8 ± 2.1 ml/kg/min ± standard deviation (SD), P < 0.001 (64.5 ± 16.5-76.1 ± 14.9% predicted ± SD, P < 0.05) and deteriorates from T1 to T2: 17.8 ± 2.1-15.1 ± 2.4, P < 0.001 (76.1 ± 14.9-64.6 ± 15.5, P < 0.05), reverting to a similar value to that at T0, while in Group S peak VO2 did not change from T0 to T1 and significantly deteriorates from T1 to T2: 14.5 ± 1.2-11.4 ± 1.2 ml/kg/min ± SD, P < 0.00001 (60.6 ± 8.4-47.4 ± 6.9% predicted ± SD, P < 0.00001). CONCLUSIONS PRP was a valid preoperative strategy to improve physical performance in patients with both NSCLC and COPD and this advantage was also maintained after surgery.
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Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery. Chest 2013; 143:e166S-e190S. [DOI: 10.1378/chest.12-2395] [Citation(s) in RCA: 542] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Andersen AH, Vinther A, Poulsen LL, Mellemgaard A. A modified exercise protocol may promote continuance of exercise after the intervention in lung cancer patients--a pragmatic uncontrolled trial. Support Care Cancer 2013; 21:2247-53. [PMID: 23508894 DOI: 10.1007/s00520-013-1781-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 03/04/2013] [Indexed: 01/22/2023]
Abstract
PURPOSE A previous study investigated the effects of a well-documented COPD exercise protocol in lung cancer patients. The study showed improvements in physical fitness, but poor adherence to continued exercise after intervention. The aim of the present study was to investigate the effect of a modified exercise intervention on post-intervention adherence, and physical fitness in a broad group of lung cancer patients. METHODS Fifty-nine patients enrolled in a 9-week exercise program. Eligibility criteria were limited to presence of motivation, and absence of comorbidities that could jeopardize safety. The intervention included three times 3 weeks of exercise (3 weeks supervised, 3 weeks home-based and 3 weeks supervised). The patient's activities were structured by logbooks during the 3 weeks at home. VO2 max was estimated at baseline and at the end of intervention. Self-reported quality of life was recorded before and after the exercise program. Post-intervention exercise activity was assessed by telephone interviews 4 weeks after intervention. RESULTS Fifty-one patients initiated the exercise intervention and 29 patients successfully completed the exercise program. Full data were available for 25 patients regarding estimated VO2 max. Twenty-six of the 29 were available for follow-up with respect to continuance of physical activity. Among the 26 who completed the 9-week training program, 18 (69 %) continued to be physically active on a daily basis. No change in estimated VO2 max was observed. A trend towards increased quality of life and better symptom control was noted. CONCLUSIONS The present study showed an increased level of continuance of physical activity compared to the previous study. The present study could, however, not repeat the significant improvements in estimated VO2 max from the previous study.
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Affiliation(s)
- Andreas H Andersen
- Department of Physical Therapy, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
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Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties. BMC Cancer 2013; 13:135. [PMID: 23514337 PMCID: PMC3623892 DOI: 10.1186/1471-2407-13-135] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/07/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The measurement properties of instruments used to assess functional capacity, physical activity and muscle strength in participants with non-small cell lung cancer (NSCLC) have not been systematically reviewed. METHOD OBJECTIVES To identify outcome measures used to assess these outcomes in participants with NSCLC; and to evaluate, synthesise and compare the measurement properties of the outcome measures identified. DATA SOURCES A systematic review of articles using electronic databases MEDLINE (1950-2012), CINAHL (1982-2012), EMBASE (1980-2012), Cochrane Library (2012), Expanded Academic ASAP (1994-2012), Health Collection Informit (1995-2012) and PEDRO (1999-2012). Additional studies were identified by searching personal files and cross referencing. Eligibility Criteria for Study Selection: Search one: studies which assessed functional capacity, physical activity or muscle strength in participants with NSCLC using non-laboratory objective tests were included. Search two: studies which evaluated a measurement property (inter- or intra-rater reliability; measurement error; criterion or construct validity; or responsiveness) in NSCLC for one of the outcome measures identified in search one. Studies published in English from 1980 were eligible. Data Extraction and Methodological Quality Assessment: data collection form was developed and data extracted. Methodological quality of studies was assessed by two independent reviewers using the 4-point COSMIN checklist. RESULTS Thirteen outcome measures were identified. Thirty-one studies evaluating measurement properties of the outcome measures in participants with NSCLC were included. Functional capacity was assessed using the six- and twelve-minute walk tests; incremental- and endurance-shuttle walk tests; and the stair-climbing test. Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness. Physical activity was measured using accelerometers and pedometers. Only the construct validity for accelerometers and pedometers was reported. Muscle strength was measured using hand-held dynamometry, hand-grip dynamometry, manual muscle test, one-repetition maximum and the chair-stand test, however only two studies reported reliability and measurement error and one study reported construct validity. CONCLUSION Currently there is a gap in the literature regarding the measurement properties of commonly used outcome measures in NSCLC participants, particularly reliability, measurement error and responsiveness. Further research needs to be conducted to determine the most suitable outcome measures for use in trials involving NSCLC participants.
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Nutt CL, Russell JC. Use of the pre-operative shuttle walk test to predict morbidity and mortality after elective major colorectal surgery. Anaesthesia 2012; 67:839-49. [DOI: 10.1111/j.1365-2044.2012.07194.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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von Groote-Bidlingmaier F, Koegelenberg CFN, Bolliger CT. Functional evaluation before lung resection. Clin Chest Med 2011; 32:773-82. [PMID: 22054885 DOI: 10.1016/j.ccm.2011.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lung cancer is the leading cause of cancer-related death worldwide, and lung resection remains the only curative approach. In the Western world, lung cancer is one of the main indications for lung resection, despite only 15% to 25% of all lung cancers being operable at the time of presentation. In most cases of operable lung cancer, a substantial part of functional lung tissue has to be resected, leading to a permanent loss of pulmonary function. Resection in patients with insufficient pulmonary reserves can result in permanent respiratory disability. This article reviews the current standards of preoperative assessment.
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Affiliation(s)
- Florian von Groote-Bidlingmaier
- Division of Pulmonology, Department of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa
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West M, Jack S, Grocott MPW. Perioperative cardiopulmonary exercise testing in the elderly. Best Pract Res Clin Anaesthesiol 2011; 25:427-37. [PMID: 21925407 DOI: 10.1016/j.bpa.2011.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/12/2011] [Indexed: 10/17/2022]
Abstract
The elderly constitute an increasingly large segment of the population and of the patients requiring medical attention. Major surgery is associated with a substantial burden of postoperative morbidity and mortality. Advancing age is a particular risk factor for these outcomes. This article reviews the current literature on the value and practical applications of cardiopulmonary exercise testing (CPET) as a tool to evaluate risk and thereby improve the management of the elderly patient undergoing major surgery. There is a consistent association between CPET-derived variables and outcome following major surgery. Furthermore, CPET-derived variables have utility in perioperative risk prediction and identification of patients at high risk of adverse outcome following major surgery. This optimal predictor appears to differ between various surgery types and the incremental benefit of combining CPET with alternative methods of perioperative risk prediction remains poorly defined.
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Affiliation(s)
- M West
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
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Priebe HJ. Preoperative cardiac management of the patient for non-cardiac surgery: an individualized and evidence-based approach. Br J Anaesth 2011; 107:83-96. [DOI: 10.1093/bja/aer121] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Granger CL, McDonald CF, Berney S, Chao C, Denehy L. Exercise intervention to improve exercise capacity and health related quality of life for patients with Non-small cell lung cancer: a systematic review. Lung Cancer 2011; 72:139-53. [PMID: 21316790 DOI: 10.1016/j.lungcan.2011.01.006] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 12/21/2010] [Accepted: 01/09/2011] [Indexed: 01/17/2023]
Abstract
CONTEXT The role of exercise intervention for patients with Non-small cell lung cancer (NSCLC) has not been systematically reviewed to date. OBJECTIVE To identify, evaluate and synthesize the evidence examining (1) the effect of exercise intervention on exercise capacity, health related quality of life (HRQoL), physical activity levels, cancer symptoms and mortality for patients with NSCLC; and (2) the safety and feasibility of exercise intervention for a population with NSCLC. DATA SOURCES A systematic review of articles using the electronic databases MEDLINE (1950-2010), CINAHL (1982-2010), EMBASE (1980-2010), TRIP (1997-2010), Science Direct (1994-2010), PubMed (1949-2010), Cochrane Library (2010), Expanded Academic ASAP (1994-2010), Meditext Informit (1995-2010), PEDRO (1999-2010) and DARE (2010). Additional studies were identified by manually cross referencing all full text reports and personal files were searched. No publication date restrictions were imposed. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised controlled trials (RCTs), case-control studies and case series assessing exercise intervention to improve exercise capacity, HRQoL, level of daily physical activity, cancer symptoms or mortality of patients with NSCLC were included. Only articles available in English and published in a peer reviewed journal were included. DATA EXTRACTION A data collection form was developed by one reviewer and data extracted. Data extraction was cross checked by a second reviewer. RESULTS AND DATA SYNTHESIS: 16 studies on 13 unique patient groups totalling 675 patients with NSCLC met the inclusion criteria. The majority of studies were case series (n=9) and two RCTs were included. Studies exercising participants pre-operatively reported improvements in exercise capacity but no change in HRQoL immediately post exercise intervention. Studies exercising participants post-treatment (surgery, chemotherapy or radiotherapy) demonstrated improvements in exercise capacity but conflicting results with respect to the impact on HRQoL immediately post exercise intervention. Heterogeneity among studies was observed and a meta-analysis was deemed inappropriate. PRISMA guidelines were followed in reporting this systematic review. CONCLUSION Exercise intervention for patients with NSCLC is safe before and after cancer treatment. Interventions pre-operatively or post-cancer treatment are associated with positive benefits on exercise capacity, symptoms and some domains of HRQoL. The majority of studies are small case series therefore results should be viewed with caution until larger RCTs are completed. Further research is required to establish the effect of exercise during and after cancer treatment and in the advanced stage of disease, the optimum type of exercise training and the optimum setting for delivery.
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Affiliation(s)
- C L Granger
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 1, 200 Berkeley Street, Parkville 3052, Victoria, Australia.
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Andersen AH, Vinther A, Poulsen LL, Mellemgaard A. Do patients with lung cancer benefit from physical exercise? Acta Oncol 2011; 50:307-13. [PMID: 21231792 DOI: 10.3109/0284186x.2010.529461] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with lung cancer are often burdened by dyspnoea, fatigue, decreased physical ability and loss of weight. Earlier studies of physical exercise of patients with COPD have shown promising results. The aim of this study was to investigate, if a well-documented COPD rehabilitation protocol can improve physical fitness and quality of life (QoL) in patients with lung cancer. MATERIAL AND METHODS Forty-five patients, with a minimum walking distance of 50 meters, absence of cognitive deficits or severe heart disease and motivated for physical training were invited to an exercise intervention. The intervention consisted of seven weeks of twice weekly training, focusing on walking training, circuit training, handling of dyspnoea and instructions in daily diary-based training at home. Prior to, and after the intervention, Incremental- and Endurance Shuttle Walk Test (ISWT and ESWT) were performed, and pulmonary function as well as self-reported QoL (EORTC-QLQ-C30 and LC13) were measured. RESULTS Fourteen subjects dropped out before commencement of the intervention. Seven were excluded after physiotherapeutic evaluation. Of the remaining 24, three were excluded because of insufficient attendance (<65% of scheduled exercise sessions) thus 21 patients completed the intervention. For 17 patients with complete pre- and post intervention data, ISWT increased 9% (-77 to 39%) (median and range) (p = 0.021), while ESWT increased 109% (-70 to 432%) (p = 0.002). Twelve of 17 improved in ISWT, while 15 improved in ESWT. No changes in pulmonary function and improvements in QoL were observed. CONCLUSION Patients with pulmonary cancer can achieve significant improvements in physical fitness measured with ISWT and ESWT after completion of the intervention program. No changes in pulmonary function and QoL were observed. In addition, we found that a large number of patients dropped out before intervention and that the patients, who succeeded, often discontinued training at home.
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Abstract
A lung cancer diagnosis and associated therapeutic management is associated with unique and varying degrees of adverse physical/functional impairments that dramatically reduce a patient's ability to tolerate exercise. Poor exercise tolerance predisposes to increased susceptibility to other common age-related diseases, poor quality of life (QOL), and likely premature death. Here we review the putative literature investigating the role of exercise as an adjunct therapy across the lung cancer continuum (i.e., diagnosis to palliation). The current evidence suggests that exercise training is a safe and feasible adjunct therapy for operable lung cancer patients both before and after pulmonary resection. Among patients with inoperable disease, feasibility and safety studies of carefully prescribed exercise training are warranted. Preliminary evidence in this area supports that exercise therapy may be an important consideration in multidisciplinary management of patients diagnosed with lung cancer.
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Affiliation(s)
- Lee W Jones
- Department of Surgery, Duke University Medical Center, 3085, Durham, NC 27710, USA.
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Cardiopulmonary exercise testing: a review of methods and applications in surgical patients. Eur J Anaesthesiol 2010; 27:858-65. [PMID: 20689441 DOI: 10.1097/eja.0b013e32833c5b05] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiopulmonary exercise (CPX) testing has a number of medical applications, including the assessment of heart failure and the investigation of unexplained breathlessness. Over the past decade, it has become an important preoperative assessment tool to evaluate functional capacity and predict outcomes in patients undergoing both cardiac and noncardiac surgery. A CPX test is an incremental exercise test during which respiratory variables, including oxygen uptake and carbon dioxide excretion are measured and the ECG is monitored. Among the variables reported from a CPX test are oxygen uptake at anaerobic threshold and peak oxygen uptake. A limited functional capacity as indicated by a low anaerobic threshold or VO(2peak) has been shown to be associated with an increased incidence of perioperative complications in a number of surgical settings. Other reported variables, including the ventilatory equivalents for oxygen (VE/VO(2)) and carbon dioxide (VE/VCO(2)) and the millilitre of oxygen delivered per heartbeat or oxygen pulse [VO(2)/heart rate (HR)] may give indications as to the reasons for exercise limitation. ECG evidence of myocardial ischaemia with increasing workload is also an important indicator of increased perioperative risk. As a noninvasive, low-risk, test of the integrated responses to increasing cardiovascular stress, anaesthesiologists involved in preoperative assessment should have an understanding of its current uses and test outcomes. This review presents the physiological basis for CPX testing, methodology, advantages over other preoperative tests of cardiovascular function and guidance on the interpretation of CPX results in the perioperative setting.
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