This study aimed to compare the prevalence of insomnia, lung function, inspiratory muscle function, functional capacity, and quality of life in individuals with and without post-COVID-19 fatigue.

Thirty-four post-COVID-19 individuals participated in the study, 20 with fatigue (32 ± 12 years old, 15% male) and 14 without fatigue (31 ± 12 years old, 42.9% male). The Chalder Fatigue Scale (CFS) was employed to categorize the volunteers into two groups: those with fatigue (score ≥4) and those without fatigue (score <4). The Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) were used to assess insomnia and excessive daytime sleepiness, respectively. Pulmonary function was evaluated by spirometry, inspiratory muscle strength was assessed by the maximum inspiratory pressure (MIP), and inspiratory endurance was evaluated by maintaining an inspiratory load of 60% of MIP until fatigue. The 6-min walk test (6MWT) was used to evaluated functional capacity, while the WHOQOL-BREF questionnaire assessed quality of life.

Individuals with post-COVID-19 fatigue demonstrated a higher prevalence of insomnia (80% vs. 49%) and excessive daytime sleepiness (45% vs. 7%), as well as lower MIP, shorter distance covered in the 6MWT, and lower FEV1/FVC (forced expired volume in the first second divided by forced vital capacity), and FEV1/FVC% of predicted. Additionally, they exhibited poorer quality of life in the physical and environmental domains. CFS demonstrated a direct correlation with ISI (r=0.436, p=0.01) and ESS (r=0.593, p=0.001), as well as an inverse correlation with the distance covered in the 6MWT (r=-0.398, p=0.022) and FEV1 (r=-0.412, p=0.01). ISI was an independent predictor of CFS, with 62% of CFS variance explained by ISI variance.

Individuals with symptoms of post-COVID-19 fatigue may have a higher prevalence of insomnia, reduced inspiratory muscle strength, functional capacity, and Tiffeneau index, along with impaired quality of life. ISI is an independent predictor of post-COVID-19 fatigue.

Evidence has linked blood pressure (BP) phenotypes with certain clinical, psychosocial, and occupational features, and characteristic BP variability.

We aimed to evaluate the value of a diagnostic score developed from these characteristics in predicting BP phenotypes, when used in a manner comparable to the application of out-of-office techniques.

Adult patients with no prior diagnosis of hypertension attending their office appointments, were prospectively enrolled. Their clinical, psychosocial, and occupational data were collected. 3-consecutive pre-appointment BP measurements, and BP variability with standing and the 6-minute walk test (6MWT) were obtained. All participants underwent 24-hour BP monitoring which was paired with office BP as the reference standard for BP phenotyping. Two scores were developed from the variables selected using linear regression analysis to differentiate between masked hypertension (MH) and normotension, and sustained hypertension (SH) and white coat hypertension (WCH).

In total 212 participants completed the study. Among office-normotensives, a score of 7 (calculated from, variables (points): dyslipidemia (3), irritable bowel syndrome (IBS) (3), orthostatic increase in SBP >5 mmHg (1), SBP increase >10 after 6MWT (1), and BP ≥130/80 after 6MWT (3)) identified MH with 90% sensitivity, 86% specificity, 70% positive predictive value (PPV), and 96% negative predictive value (NPV). Conversely, among office-hypertensives, a score of 6 (male sex (2), no IBS (2), ≥3 metabolic syndrome criteria (3), obesity (3), standing BP ≥140/90 (3), BP ≥140/90 after 6MWT (1)) identified SH with 82% sensitivity, 78% specificity, 90% PPV, and 64% NPV.

BP phenotypes correspond to distinct clinical phenotypes and can be predicted with acceptable sensitivity and specificity using BP phenotype scores. This novel approach to BP phenotyping provides an accessible addition, not a replacement, to available out-of-office techniques, particularly useful for screening for MH, and to support office diagnosis of SH when out-of-office measures are unavailable or not tolerated.

Persistent respiratory symptoms and impaired gas exchange are common in patients recovering from COVID-19 pneumonia. The Lung Diffusing Capacity for Carbon Monoxide (DLCO) and Carbon Monoxide Transfer Coefficient (KCO) do not adequately distinguish alveolar membrane dysfunction from vascular abnormalities. This study aimed to characterize persistent diffusion impairment in post-ICU patients with prior SARS-CoV-2 pneumonia and reduced DLCO.

After hospital discharge, patients underwent spirometry, DLCO measurement, and a 6-minute walking test every six months. If DLCO remained impaired at 18-24 months, a combined Lung Diffusing Capacity for Nitric Oxide (DLNO) and DLCO assessment was performed to differentiate alveolar-capillary membrane (DmCO) and pulmonary capillary blood volume (Vc) alterations.

Among 20 patients with persistent DLCO reduction, 3 had an obstructive ventilatory pattern, 6 had restriction, and 12 had low KCO. In restrictive cases, KCO was reduced but remained within normal limits without compensation. The DLNO/DLCO ratio exceeded 113.5% predicted in all patients. DmCO was impaired in 7 patients, while Vc was reduced in 16.

Both DLCO determinants were affected, with vascular impairment predominating. Vc reduction was present in most patients, with mean values below the lower limit of normality, whereas DmCO was less affected and often normal. The elevated DLNO/DLCO ratio suggests that persistent DLCO reduction is primarily driven by prolonged pulmonary capillary circulation dysfunction rather than alveolar membrane alterations, highlighting the vascular component as the primary site of long-term impairment.

A set of physical tests representing typical activities relevant to persons with knee osteoarthritis (KOA) is recommended by the Osteoarthritis Research Society International (OARSI). The objective of this study was to designate the cut-off values for OARSI-recommended performance-based tests to better discriminate disease severity in patients with KOA.

As recommended by the OARSI, we conducted the 30-s chair stand test (30-s CST), 40-m fast-paced walk test (40-m FPWT), stair climb test (SCT), 6-min walk test (6MWT), and timed up and go test (TUG). To investigate the discriminative power of the performance test scores using the Kellgren-Lawrence (K-L) grading system, receiver operating characteristic (ROC) curve analysis was performed. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess self-administered health status.

Forty-eight patients with bilateral KOA were included this study. The area under the curves for four of the five performance tests (30-s CST, six-step SCT, 40-m FPWT, and TUG) had acceptable discrimination (0.753-0.793), while the 6MWT had excellent discrimination (0.860). The stepwise multiple regression analysis demonstrated that 6MWT and 30-s CST were significant and independent determinants of WOMAC score, explaining 48% of the variance (P < 0.001).

The OARSI performance tests can discriminate disease severity in individuals with KOA. The 6MWT has the highest level of discriminative validity among all. In addition, despite the correlation between all five tests and the WOMAC score, 6MWT and 30-s CST are independent and significant determinants of the WOMAC.

A decrease in general muscle strength is associated with a poor prognosis and lower physical function in patients with heart failure (HF). We examined whether improved appendicular muscle weakness (dynapenia) conditions would predict a better prognosis and improved physical functions in patients with HF.

Handgrip and leg strength were assessed before discharge (baseline) and after outpatient cardiac rehabilitation (CR) (follow-up), based on which patients were divided into four dynapenia conditions: non-dynapenia at baseline/follow-up, dynapenia at baseline/non-dynapenia at follow-up, non-dynapenia at baseline/dynapenia at follow-up, and dynapenia at baseline/follow-up. Cox regression and mixed-effects analyses were performed to examine associations between changes in the dynapenia condition and all-cause mortality and physical functions (6-minute walking distance and gait speed).

Of 607 patients included in the analyses (median age 70 years, 64% male), 92 patients died during the follow-up period (median 2.81 years). The dynapenia at baseline/follow-up group (adjusted hazard ratio [aHR]: 1.936, 95% confidence interval [CI]: 1.086-3.451) and non-dynapenia at baseline/dynapenia at follow-up group (aHR: 2.442, 95% CI: 1.032-5.766) had higher mortality rates compared to the non-dynapenia at baseline/follow-up group. The mortality risk was not different between the group with dynapenia at baseline/non-dynapenia at follow-up (aHR: 1.270, 95% CI: 0.670-2.409) and the group with non-dynapenia at baseline/follow-up. Improved dynapenia conditions were associated with increased 6-minute walking distance (p = 0.004) but not significantly associated with gait speed (p = 0.173).

Dynapenia following CR is associated with a higher risk of mortality and lower exercise capacity in patients with HF.

People with HIV (PWH) have increased risk for worse pulmonary function and increased emphysema. HIV has been proposed as a risk factor for respiratory patient-reported outcomes (PROs). We assessed the association of HIV with respiratory symptoms, respiratory health status, and functional exercise capacity.

Systematic review and meta-analysis.

We searched PubMed, EMBASE, CENTRAL, CDSR, WoS, Scopus, CINAHL, and GIM through November 2023 for studies of PWH and people without HIV (PWOH) reporting respiratory PROs. Primary outcomes were activity-limiting dyspnea (defined as Modified Medical Research Council Dyspnea Scale score ≥2), respiratory health status by St. George's Respiratory Questionnaire (SGRQ), and exertional capacity by 6-min walking distance (6MWD). We performed random-effects meta-analyses estimating odds ratios (ORs) and mean differences with 95% confidence intervals (CIs).

We included 89 publications corresponding to 56 studies. HIV was associated with activity-limiting dyspnea (OR 1.67; 95% CI 1.05-2.65), worse respiratory health status (SGRQ mean difference 2.9 units; 95% CI 0.6-5.2), worse exertional capacity (6MWD mean difference -58.9 m; 95% CI -115.3 to -2.4), and chronic cough, dyspnea, phlegm, and wheeze (OR 1.38-1.78). Respiratory symptom and adverse respiratory health status risk was greatest in European PWH. Certainty of evidence was very low, primarily due to studies' observational design and inconsistency.

PWH have increased risk for worse respiratory PROs. Systematic respiratory PRO assessment should be incorporated into routine clinical care to facilitate active case-finding of chronic lung disease in PWH. Future studies should longitudinally co-assess objective physiologic measures and respiratory PROs.

Young patients with congenital heart disease (CHD) often display impaired peripheral vascular function, yet evidence of the effects of exercise is limited. This study tested the hypothesis that 1) brachial artery reactivity and forearm microvascular function would be impaired in young patients with CHD and 2) acute isometric handgrip (IHG) exercise would improve brachial artery reactivity and forearm microvascular function in young patients with CHD. Brachial artery flow-mediated dilation (FMD) and the reactive hyperemic response [mean brachial artery blood flow area under the curve (AUC)] were tested in young patients with CHD (n = 19; 13 (4) yr; 12 male, 7 female) and healthy age-matched controls (n = 21; 13 (4) yr, 12 male, 9 female) pre- and postacute IHG exercise. Pre-IHG exercise brachial artery FMD [4.0 (3.1) vs. 5.8 (3.9)%, P = 0.348] and reactive hyperemia [139 (69) vs. 167 (82) AUC, P = 0.449] were not different between controls and young patients with CHD, respectively. In controls, acute IHG exercise increased FMD [4.0 (3.1) to 5.9 (2.5)%, P = 0.016] and reactive hyperemia [139 (69) to 175 (75) AUC, P = 0.017]. However, in young patients with CHD, acute IHG exercise only increased reactive hyperemia [167 (82) to 187 (65) AUC, P = 0.017], but not FMD [5.8 (3.9) vs. 4.9 (2.9)%, P = 0.426]. Endothelial-dependent vasodilation is intact in young patients with CHD, but acute exercise may alter local regulatory mechanisms such that endothelial-dependent vasodilation fails to augment. Microvascular function is unaltered with CHD.NEW & NOTEWORTHY Although young healthy control participants realize augmented brachial artery flow-mediated dilation following acute isometric handgrip exercise, young patients with congenital heart disease (CHD) fail to do so. Forearm microvascular function remains intact in congenital heart disease and is enhanced similarly to control participants following acute isometric handgrip exercise. Acute exercise may alter local regulatory mechanisms such that conduit artery endothelial-dependent vasodilation is not augmented, providing evidence of stress-induced vascular impairment in young patients with CHD.

Hypophosphatasia (HPP) is a rare, inherited metabolic bone disease with a high degree of morbidity and mortality in children. Asfotase alfa is an enzyme replacement therapy for HPP reimbursed in the UK since 2017 under a Managed Access Agreement (MAA). This analysis assessed the effectiveness and safety of asfotase alfa in children < 18 years of age.

The MAA was a prospective, longitudinal data collection in children with paediatric-onset HPP. Effectiveness outcomes were evaluated in children who were treated with asfotase alfa for ≥ 6 months. Data were collected on respiratory support, growth, mobility, motor development, analgesic use, quality of life, and safety at enrolment and throughout the 5-year MAA.

Twenty-four children enrolled in the MAA and 20 were included in the analysis. Twelve children had received asfotase alfa before enrolment through a clinical trial or compassionate use program. From baseline to month 60, the median (minimum, maximum) change in height and weight Z-scores were 0.20 (- 0.9, 1.2; n = 6) and - 0.5 (- 1.9, 1.5; n = 6), respectively. The median (minimum, maximum) percent of predicted distance walked in the 6-Minute Walk Test increased by 3.8% (- 8.6, 4.3; n = 5) at month 3 and was sustained through follow-up. Median (minimum, maximum) child- and parent-reported Pediatric Quality of Life Inventory scores were 59.2 (15.2, 91.3; n = 11) and 53.4 (16.3, 100.0; n = 18) at baseline and increased by 21.7 (5.4, 37.0; n = 3) and 16.3 (9.8, 45.7; n = 4) at month 60, respectively. Treatment-naïve children had a greater clinical response than treatment-experienced participants, who maintained their status. No deaths occurred in the study. The most common adverse events were injection site reactions, reported in 8/24 participants (33.3%).

This analysis confirmed the clinical benefit of asfotase alfa in children with HPP. Asfotase alfa was well tolerated, with no new safety signals identified.

Diastolic stress echocardiography is useful in patients with heart failure with preserved ejection fraction (EF); however, its utility in asymptomatic patients with aortic stenosis (AS) remains unexplored. We investigated the value of diastolic stress echocardiography using a 6-minute walk test (6-MWT) in elderly AS patients. This retrospective observational study included 96 consecutive asymptomatic patients (82 years, 39.6% male) with at least moderate AS (mean pressure gradient (MPG) ≥ 20 mm Hg or aortic valve area < 1.5 cm2) and preserved left ventricular EF. All underwent diastolic stress echocardiography using the 6-MWT. Patients were classified into a post-exercise impaired relaxation pattern (pIR) and a post-exercise pseudo-normalised/restrictive pattern (pPN) groups, based on transmitral flow velocity post-6-MWT. The primary endpoint was the time to first occurrence of the composite endpoint (all-cause mortality, aortic valve replacement due to AS-related symptoms, and hospitalization for heart failure).22 patients (23%) changed from baseline IR pattern at rest to the pPN pattern after the 6-MWT.The pPN group demonstrated lower %predicted walking distance than the pIR group. Additionally, the pPN group exhibited greater dyspnea after the 6-MWT. During a median follow-up of 536 days (interquartile range, 106-720 days), 46 patients experienced AS-related events. Multivariable Cox regression analysis indicated that the pPN group was independently associated with increased event risk (hazard ratio: 5.37, p < 0.001). In conclusion, this study suggests that the diastolic stress echocardiography using the 6-MWT is useful for risk stratification in asymptomatic elderly AS patients.

Locomotor high-intensity interval training (HIIT) has been shown to improve walking capacity (speed and endurance) more than moderate-intensity aerobic training (MAT) after stroke, but it is unclear which training parameter(s) should be prioritized (e.g., speed, heart rate, blood lactate, step count) and to what extent walking capacity gains are the result of gait changes versus cardiorespiratory adaptations. This study aimed to assess which training parameters and longitudinal adaptations most strongly mediate 6-minute walk distance (6MWD) gains from poststroke HIIT.

The HIT-Stroke Trial randomized 55 persons with chronic stroke and walking limitations to HIIT or MAT, each involving overground and treadmill walking, 45 min, 3 times per week for 12 wk. HIIT used short maximum speed intervals, targeting >60% heart rate reserve (HRR). MAT targeted 40%-60% HRR. Blinded outcomes included 6MWD, short-distance gait function (e.g., fastest 10-m gait speed), and aerobic capacity (e.g., ventilatory threshold). This ancillary analysis used structural equation models to compare mediating effects of different training parameters and longitudinal adaptations on 6MWD changes.

Net gains in 6MWD from HIIT versus MAT were primarily mediated by faster training speeds (+57 m, P < 0.0001) and longitudinal gait adaptations (+37 m, P = 0.0005). Training step count was also positively associated with 6MWD gains but was lower with HIIT versus MAT, which decreased the net 6MWD gain from HIIT (-14 m, P = 0.02). HIIT generated higher training heart rate and lactate than MAT, but aerobic capacity gains were similar between groups, and 6MWD changes were not associated with training heart rate, training lactate, or aerobic adaptations.

To increase walking capacity with poststroke HIIT, training speed and step count appear to be the most important parameters to prioritize.

To test the equivalence of the 6-minute walk test and the 2-minute walk test in stroke survivors in a multicultural setting, focusing on reliability, performance, and associations with clinical and anthropometric factors.

Cross-sectional observational study.

238 participants (119 stroke survivors and 119 healthy individuals matched for age and sex).

Participants were assessed using the 6-minute walk test and the 2-minute walk test in Belgium and Vietnam. Stroke survivors were assessed in the acute and subacute phases (17 days post-stroke) and reassessed after 1-3 days.

The 6-minute walk test and the 2-minute walk test showed high test-retest reliability (ICC > 0.96). The difference between the two tests was not significant in terms of walking distance reduction in stroke survivors relative to healthy participants (1.4%), not clinically meaningful for walking speed (0.026 m/s), and not significant in chronotropic response (1.6 bpm). The correlation between the 2 tests in stroke survivors was high (r = 0.93) and walking distance was moderately related to height, weight, and phase, and type of stroke (p < 0.05).

The 6-minute walk test and the 2-minute walk test exhibited similar results in measuring the impact of stroke on walking performance. The similarity between Belgium and Vietnam further supports the clinical equivalence of both tests among acute and subacute stroke survivors.

Progressive lung fibrosis is frequently observed in patients with idiopathic interstitial pneumonias (IIPs), especially in those with idiopathic pulmonary fibrosis (IPF) being a representative form of IIPs characterized by a poor prognosis, even in the era of antifibrotic therapy. Predicting prognosis is essential for informing patients and determining future treatment strategies. Multiple prognostic factors have been reported for these diseases. The international clinical practice guidelines for IPF were repeatedly revised in 2010, 2018, and 2022, and the multidisciplinary classification of IIPs was updated in 2013. These updates have led to changes in how patients are classified under various IIP subtypes. Recent advances in the areas of genetic polymorphisms, radiological image analysis, and deep learning technology have helped identify multiple prognosis predictive factors for IPF and other forms of IIPs. This review provides an updated summary of the prognosis and prognostic predictors of IPF and other chronic fibrotic IIPs, incorporating recent reports published since antifibrotic therapy became the standard treatment for IPF and other forms of progressive pulmonary fibrosis, and covers other latest advancements and technologies as well.

Inspiratory muscle weakness is a known consequence of Parkinson's disease and could be a potential contributor to the dyspnoea experienced by many people living with the condition. Inspiratory muscle training is effective in improving inspiratory muscle strength and reducing dyspnoea in other chronic diseases. However, inspiratory muscle training has received little attention in people with Parkinson's disease, and it is unclear how this training affects inspiratory muscle strength, dyspnoea and quality of life.

This mixed methods, randomised controlled trial will recruit 50 participants with idiopathic Parkinson's disease who will be randomly allocated to either the experimental group, for 8 weeks, or the control group. Inspiratory muscle strength (maximum inspiratory pressure) will be the primary outcome. The secondary outcomes include motor experience of daily living (Movement Disorder Society-Unified Parkinson's Disease Rating Scale part II), rate of perceived exertion (modified Borg Scale), exercise capacity (6-minute walk test) and quality of life (39-item Parkinson's Disease Questionnaire). Quantitative data will be analysed using descriptive statistics. Semi-structured interviews will be conducted with participants who underwent inspiratory muscle training. Inductive reflexive thematic analysis will be used to explore the participants' experiences of inspiratory muscle training and its impact on dyspnoea, activities of daily living and overall quality of life.

ACTRN12622000097741.

Both prehabilitation and rehabilitation programs have been shown to improve functional capabilities, surgical outcomes, and quality of life in patients with peripheral arterial disease (PAD). However, referral rates remain low, and the benefits of combined prehabilitation and rehabilitation for PAD have not been explored.

Three hundred patients with symptomatic claudication referred for femoral-popliteal endovascular stenting will be studied. In this randomized trial, the effectiveness of a 6-week pre-operative program of exercise therapy and risk management (prehabilitation) will be compared to: 1) a 6-week program of rehabilitation (post-operative); and 2) both prehabilitation and rehabilitation. Comparisons will be made of time to claudication symptoms, 6-min walk performance, peak VO2, strength, endothelial function, biomarkers, and quality of life at baseline, 6-weeks (1 week prior to intervention), 14 weeks, and 22 weeks.

The concept of prehabilitation is based on the principle that patients with higher functional capabilities will better tolerate a surgical intervention and therefore exhibit better outcomes following the intervention. Recent studies have consistently demonstrated better functional, psychosocial, and surgery-related morbidity outcomes among subjects participating in pre-surgical prehabilitation programs, but few such data are available in patients with PAD. The prehabilitation period also provides an ideal opportunity for cardiometabolic risk intervention. The primary aim of this trial is to explore the functional and psychosocial impact of prehabilitation, rehabilitation, and their combination in patients with PAD scheduled for a non-emergent endovascular intervention. We anticipate that the combination of prehabilitation and rehabilitation will result in better outcomes than either intervention alone.

Invasive right heart catheterization plays a central role in identifying pulmonary hypertension (PH) disorders. However, non-invasive biomarkers of portopulmonary hypertension (PoPH) are required. Liver stiffness evaluated by FibroScan® is useful for the assessment of liver fibrosis in patients with chronic liver diseases. This study sought to investigate the utility of liver stiffness for the classification of PoPH among precapillary PH patients.

A total of 46 patients [38 females, median (interquartile range) age 63.0 (50.8-72.0) years old] with precapillary PH were divided into a PoPH group (N = 6) and a non-PoPH group (N = 40) based on the presence of portosystemic shunts and/or portal hypertension with hepatic venous pressure gradient >5 mmHg.

The PoPH group showed higher cardiac index and lower pulmonary vascular resistance than the non-PoPH group. Other hemodynamic variables and liver fibrosis biomarkers such as fibrosis-4 index and albumin-bilirubin score were comparable between the 2 groups. Liver stiffness measurements in the PoPH group were significantly higher than those in the non-PoPH group [12.8 kPa (9.4-17.3 kPa) vs 4.15 kPa (3.30-5.50 kPa), p < 0.001]. The cut-off value for the classification of PoPH was 8.50 kPa from the receiver operating characteristic curve (area under curve 0.979, 95 % Confidence interval 8.50 kPa - 11.00 kPa).

Liver stiffness evaluated by transient elastography may be a non-invasive biomarker to detect the liver status that caused PoPH among precapillary PH patients.

Postmenopausal women often experience fatigue and mood disturbance both of which interfere with quality-of-life. Since greater physical function aids psychosocial well-being, we hypothesized the acute cardiopulmonary responses during walking may reveal important factors linked to fatigue and mood disturbance. In this cross-sectional study, women of similar body mass index (BMI) aged 55-75 y were dichotomized to mid-life (55-65 y; 83.4 ± 8.4 kg/m2; n = 14) or older (≥65 y; 81.8 ± 10.4 kg/m2; n = 11) groups. A 6-minute walk test was used to estimate peak aerobic capacity (V̇O2peak). A treadmill task coupled with indirect calorimetry measured mean response time (MRT) - representing the duration to reach 63 % of steady-state net oxygen uptake (V̇O2). Average daily fatigue and fatigue interference were measured with the Fatigue Symptom Inventory. General mood disturbance was measured with the Profile of Mood States (POMS) questionnaire. Age-group differences were not detected in fatigue ratings, MRT, or walking net V̇O2. However, older women had lower aerobic capacity (p = 0.002, ES = 1.39) and greater disturbance in the POMS Depression-Dejection subscale (p = 0.042, ES = 0.41). Among all participants, and independent of V̇O2peak, MRT correlated with average daily fatigue (r = 0.500, p = 0.015), fatigue interference (r = 0.421, p = 0.046), and POMS total mood disturbance (rs = 0.437, p = 0.037). Regression modeling revealed MRT and walking net V̇O2 jointly explained 55 % (R = 0.744, p < 0.001) of the variance in average daily fatigue. In conclusion, MRT and walking net V̇O2 may serve as important points of intervention to alleviate fatigue and mood disturbance in postmenopausal women.

Background/Objectives: Supervised pulmonary rehabilitation (PR) is effective in improving cardiorespiratory fitness in non-hospitalised individuals with long COVID. However, there is limited evidence regarding PR-induced improvements in cardiorespiratory parameters in previously hospitalised COVID-19 survivors. This study aimed to investigate the effect of a hybrid PR programme (outpatient followed by a digital intervention) on exercise tolerance, cardiorespiratory adaptations, functional capacity and quality of life outcomes in previously hospitalised COVID-19 survivors. Methods: Forty-two patients (age (mean ± SD): 57 ± 12 yrs) with excessive fatigue due to long COVID (FACIT score (26 ± 10) were allocated to PR (n = 27) or usual care (UC) (n = 15) 140 ± 75 days from hospital discharge. PR consisted of 8 outpatient sessions (twice weekly for 4 weeks) followed by 24 home-based sessions (3 times/week for 8 weeks). Patients in the UC group were instructed to be physically active. Exercise tolerance was assessed by cardiopulmonary cycling testing to the limit of tolerance. Results: Following the completion of the hybrid PR programme, peak work rate (WRpeak) and peak oxygen uptake (VO2peak) were, respectively, improved in the PR group by 19 ± 10 Watt (p = 0.001) and by 2.4 ± 3.0 mL/kg/min (p = 0.001). Furthermore, in the PR group, the 6 min walk distance was increased by 72 ± 69 metres (p = 0.001). FACIT and mMRC scores were also improved in the PR group by 15 ± 10 (p = 0.001) and by 1.4 ± 1.0 (p = 0.001), respectively. In the UC group, only the mMRC score was improved by 0.7 ± 1.0 (p = 0.008). Conclusions: The application of a hybrid PR programme was beneficial in improving cardiorespiratory exercise fitness, functional capacity and quality of life in previously hospitalised COVID-19 survivors.

Cancer-related fatigue (CRF) is a multifactorial symptom commonly experienced by breast cancer patients treated with chemotherapy (CT) that impairs quality of life and may influence cancer recurrence by reducing treatment compliance. This cohort study examined the kinetics of CRF throughout CT in breast cancer patients and determined its relationship with exercise-related variables. One hundred breast cancer patients were included. Three time points were investigated: pre-CT, 8 weeks, and post-CT. Patients were categorized as fatigued or non-fatigued according to their FACIT-F score. Exercise capacity (assessed using the 6-minute walking test), muscle mass and force, neuromuscular fatigue, and physical activity level were measured. Among the seven patterns of CRF trajectories identified, three represented 78% of the fatigued patients. Fatigued patients exhibited reduced exercise capacity compared to non-fatigued patients during CT (p = 0.001). This was associated with greater knee extensor (p < 0.001) and handgrip (p = 0.009) neuromuscular fatigue and lower physical activity level (p < 0.001) in fatigued patients. The model combining knee extensors neuromuscular fatigue (p = 0.007) and force (p = 0.081), 6-minute walking test distance (p < 0.001) and physical activity level (p = 0.029) explained 39% of the variance in the FACIT-F score evolution from pre- to post-CT. The dissociation between fatigued versus non-fatigued patients highlighted that CRF was associated with altered exercise capacity and neuromuscular fatigue. Exercise-related variables seem to play an important role in CRF evolution during CT, suggesting that exercise training should be initiated at the start of CT.

Total protein (TP), comprising albumin and globulin, is a common and readily available indicator. This study aimed to assess the correlation between total protein and disease severity as well as exercise tolerance in patients with stable chronic obstructive pulmonary disease (COPD).

A total of 84 patients with COPD were recruited in this study. Plasma total protein levels, body mass index, air-flow obstruction, dyspnea, exercise capacity (BODE) index, the six-minute walking distance (6MWD), lung function and other relevant data were recorded. Patients were divided into three groups according to TP tertiles. Receiver operating characteristic (ROC) curves were used to evaluate the performance of TP in predicting severe COPD (BODE ≥ 5). Besides, logistic regression analyses were conducted to assess whether TP was an independent factor associated with BODE grades.

COPD subjects with TP levels below 61.2 exhibited a significantly higher proportion of severe COPD. Logistic regression analyses substantiated that TP was associated with COPD severity. Compared with albumin and globulin levels, TP levels showed the highest accuracy in predicting a high BODE index in COPD (BODE ≥ 5) (the area under the ROC curve (AUC) = 0.789). Moreover, TP was positively related to 6WMD during the first 30 days of admission.

A lower level of TP was associated with a higher BODE index, indicating more severe COPD.

Increasing physical function for individuals in chronic pain is challenging. Despite the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials guidelines, no pain trial has comprehensively assessed multimodal physical function (ie, self-reported, performance-based, and objective or step count-based measures), and most of these trials have limited racial and ethnic diversity.

To test the feasibility of a mind-body walking program and a health education program among geographically, racially, and ethnically diverse sedentary adults with chronic pain.

This single-blind, 2-arm, feasibility randomized clinical trial was conducted at Massachusetts General Hospital in the Northeast, Duke University in the Southeast, and Rush University in the Midwest, capturing a racially, ethnically, and geographically diverse US population. Recruitment occurred between April 2023 and January 2024. Participants were sedentary adults with chronic musculoskeletal pain. After baseline assessment, participants were randomized to either the mind-body walking program or the health education program. Given the pilot nature of this trial, all analyses were conducted on the observed data rather than following intent-to-treat principles.

Both interventions consisted of 10 weekly hour-long, in-person group sessions.

Primary outcomes were feasibility benchmarks, including feasibility of recruitment, treatment arms, assessments, participant retention, racial and ethnic diversity attainment, treatment expectancy, treatment credibility, participant satisfaction, and treatment fidelity.

Ninety-two participants were randomized to the mind-body walking program (n = 47) or the health education program (n = 45). Participants had a mean (SD) age of 57 (14.3) years; were predominantly females (69 [75.0%]); and included Asian (2.2%), Black or African American (44.6%), Hispanic (5.4%), non-Hispanic (83.7%), and White (40.2%) individuals. Both mind-body walking and health education interventions met the benchmarks for feasibility of treatment arms (95.7% [44 of 46 patients] and 82.2% [37 of 45 patients]), treatment credibility (100% (41 of 41 patients] and 87.2% [34 of 39 patients]), treatment fidelity (9.93 and 9.95 scores), assessment (93.0% accuracy), and participant retention (93.6% [44 of 47 patients] and 86.7% [39 of 45 patients]). Benchmarks for treatment expectancy (85.7% [36 of 42 patients] vs 66.7% [26 of 39 patients]) and participant satisfaction (97.6% [41 of 42 patients] vs 75.0% [30 of 40 patients]) were met in the mind-body walking program but not in the health education program. The racial and ethnic diversity benchmark was met (54.3% [50 of 92] vs ≥38.0% planned). The recruitment benchmark was not met (69.7% [92 of 132] of eligible participants recruited vs ≥80.0% planned).

In this trial, both a mind-body walking program and a health education program were feasible at 3 geographically, racially, and ethnically diverse academic medical centers. The findings support and inform a fully powered, multisite, future efficacy trial of these interventions.

ClinicalTrials.gov Identifier: NCT05700383.

Recent research has explored frailty in systemic lupus erythematosus using multiple measures. We examined the agreement among frailty measures and the association of each with cross-sectional and longitudinal health outcomes.

We used data from the California Lupus Epidemiology Study to examine the following measures of frailty: Systemic Lupus International Collaborating Clinics (SLICC) Frailty Index (SLICC-FI), Short Physical Performance Battery (SPPB), and Fatigue, Resistance, Ambulation, Illness, and Loss of Weight (FRAIL) scale questionnaire. Patient-Reported Outcomes Measurement Information System Physical Function 10a (PF) was tested as a proxy measure of frailty. Agreement between frailty classifications by each measure was assessed. Cross-sectional associations of frailty classifications with hospitalization, valued life activities disability, cognitive impairment, six-minute walk test distance, self-reported disease damage, fatigue, and depressive symptoms were assessed with logistic and linear regression analyses. Associations with hospitalization, disease damage increase, and disability increase over the subsequent three years were assessed by Cox proportional hazards analyses.

Percentages of participants identified as frail varied among the measures, from 10.8% to 45.9%. Agreement among classifications ranged from slight to substantial (k from 0.17 to 0.63). Most of the frailty measures were associated with both cross-sectional and longitudinal health outcomes, with the notable exception of the SPPB. SLICC-FI had the most consistent association with outcomes, followed by FRAIL and PF.

Multiple measures of frailty appear to identify the risk of poor health outcomes. The intended use, as well as the simplicity and practicality of implementing the measure, may be the most important considerations in choosing a frailty measure.

Cardiovascular disease (CVD) is associated with several risk and protective factors, including psychological variables, such as anxiety and depressive symptoms, stress and coping strategies. These factors may be either a cause or a consequence of CVD and are thought to influence the cardiac rehabilitation (CR) process after acute cardiac event, a multifaceted intervention that is crucial for reducing rehospitalisation and mortality. The main aim of this study was to correlate such psychological components with cardiac outcomes in a sample of 315 CVD referred to an in-hospital CR program.

Participants completed self-report questionnaires on perceived stress, anxiety and depressive symptoms, and coping styles.

Females (36.51 %) reported higher levels of depressive symptoms and turning to religion as a coping strategy compared to male. Perceived stress did not differ between male and female, but it was found to be significantly higher in heart failure patients, regardless of gender. Functional outcomes after a CR program were not predicted by any psychological variable, whereas clinical outcomes were predicted by depressive symptoms and coping strategies (social support and positive attitude). Finally, perceived health status was predicted by anxiety, depressive symptoms and avoidance.

These findings confirm the importance of conducting psychological screening in patients with CVD, as recommended by international guidelines, and highlight the need to provide them with adequate psychological support to reduce the adverse consequences of cardiac disease, and to promote protective attitudes and behaviours through tailored psychological interventions to improve outcomes after a CR program.

The study investigated the influence of mental fatigue on older people's enjoyment during a series of physical exercises. Using a randomized cross-over design, participants (n = 35) completed a 6-minute walking test - 6MWT, a Timed Up and Go-TUG test and three sets of knee extension exercise (first set: KE1, second set: KE2, third set: KE3) under two experimental conditions (control or mental fatigue). The Nonparametric Analysis of Longitudinal Data in Factorial Experiments was used to compare the number of repetitions performed during three sets of resistance exercise between conditions. The same analysis method was applied to compare the perception of effort and enjoyment across five moments (Post-6MWT, Post-TUG, Post-KE1, Post-KE2, Post-KE3) and two conditions and the Visual Analogue Scales (VAS) across four moments (baseline, Pre-6MWT, Pre-TUG, Pre-KE) and two conditions. Mental fatigue did not affect the physical function, perception of effort and enjoyment of exercise in older people. Participants, however, reported higher enjoyment for walking and dynamic balance compared to strength exercise. Mental fatigue had no effect on the physical function, perception of effort and enjoyment of exercise of older people. Participants presented a higher enjoyment for walking and dynamic balance compared to strength exercise. Given the importance of resistance exercises for health, clinicians should prioritize resources to education programs emphasizing the benefits of resistance exercise in both short- and long-term health. Including social interaction opportunities in physical exercise programs and prescribing activities appropriate to participants' ability levels could enhance engagement and adherence.

Exploring the relationship between perioperative physical function and unplanned readmission (UR) in patients with colorectal cancer (CRC) can aid in rehabilitation interventions. In this study, we aimed to determine whether perioperative physical function is associated with UR within 1 year in patients with CRC.

This retrospective cohort study included 155 consecutive patients with CRC who underwent surgery. The outcome was UR within 1 year. Physical function was evaluated through isometric knee extension force (IKEF) and 6-min walk distance. Additionally, the decline ratio of physical function was calculated using the following formula: the decline ratio (%) = ([before discharge - before surgery]/before surgery) × 100. The propensity score-matching strategy was used to adjust for confounders in the relationship between perioperative physical function and UR. Subsequently, the association between perioperative physical function and UR was assessed using the log-lank test and Cox proportional hazards model analysis.

Of 155 patients, 120 were included in the analysis. A significant difference in the decline ratio of IKEF was observed between patients with and without UR (p = 0.007). After propensity score-matching, 52 patients were matched. In matched patients, the decline in IKEF (decline ratio of IKEF ≤ -18.8 %) was significantly correlated with UR in the log-rank test (p = 0.003) and Cox proportional hazards model analysis (hazard ratio, 9.26; 95 % confidence interval, 1.15, 74.12; p = 0.035).

A decline in IKEF was associated with UR within 1 year in patients with CRC.

Exercise is an important treatment for people with asthma and should be considered alongside pharmacological therapy when developing personalised asthma management plans. Despite this, there remains limited guidance concerning the practicalities of asthma-specific exercise prescription. This European Academy of Allergy and Clinical Immunology task force was therefore established to achieve three fundamental aims: first, to provide an up-to-date perspective concerning the role of exercise for asthma management (i.e., describe the disease modifying potential of exercise and associated impact on asthma-related extrapulmonary comorbidities); second, to develop pragmatic recommendations to facilitate safe and effective exercise prescription; and third, to identify key unmet needs and provide focused direction for future research. The position paper is structured as a practically focused document, with recommendations formulated according to best available scientific evidence and expert opinion, with an emphasis on providing healthcare providers with pragmatic advice that can be implemented during routine asthma review.

Integrating aerobic exercise (AE) into rehabilitation programs for post-stroke individuals could enhance motor recovery and cardiovascular health by increasing brain-derived neurotrophic factor (BDNF) and the myokine irisin. Chronic stroke survivors typically exhibit elevated matrix metalloproteinase-9 (MMP-9) activity, which is negatively correlated with steps and time in medium cadence, although the impact of AE on this biomarker remains unclear.

To evaluate the effect of high-intensity AE training prior to modified constraint-induced movement therapy (mCIMT) on BDNF and irisin concentration, and on MMP-2 and MMP-9 activity in chronic post-stroke individuals and to associate these results with functional improvements.

Nine participants received AE combined with mCIMT for two weeks, while the control group (n = 7) received mCIMT alone. Manual dexterity and functional capacity were assessed before and after the intervention. Serum samples were analyzed for BDNF, irisin, MMP-2 and MMP-9.

There were no significant main effects of assessment, group or interaction on molecular biomarkers. However, the AE group had a significant increase in MMP-9 activity post-intervention (p = .033; d = 0.67). For the Box and Block Test, there were significant main effects of assessment (F [1, 14] = 33.27, p = .000, ηp2 = 0.70) and group (F [1, 14] = 5.43, p = .035, ηp2 = .28). No correlations were found between biomarkers and clinical assessments.

AE prior to mCIMT did not influence circulating BDNF and irisin levels but did induce an acute rise in MMP-9 activity, suggesting potential effects on cardiovascular remodeling in this population.

BackgroundSkeletal muscle weakness and mild cognitive impairment (MCI) commonly occur with aging.ObjectiveWe examined whether presence of chronic morbidities in MCI is associated with specific alterations in muscle health, functional capacity, and whole body amino acid kinetics.MethodsA group of 247 older adults were stratified into MCI/non-MCI (Montreal Cognitive Assessment) and presence/absence of chronic diseases. We measured lean mass by dual-energy x-ray absorptiometry, strength by dynamometry, and functional capacity by 6-min walk test. Postabsorptive whole body production (WBP) of amino acids were assessed by pulse administration of a mixture of 18 amino acid stable isotopes.ResultsMCI was associated with lower lean mass, functional capacity (p < 0.003), and WBP of arginine, glycine, leucine, and phenylalanine to tyrosine conversion (reflecting net protein breakdown (net PB)) but higher WBP of taurine (all p < 0.05). Presence of chronic morbidities was associated with lower muscle strength, WBP of glycine, and net PB (p < 0.0001), but higher WBP of phenylalanine, glutamate, taurine, tryptophan, and leucine (all p < 0.05). MCI*chronic morbidity interactions were found for muscle strength and net PB (p < 0.0001), with the lowest values in MCI with chronic morbidities.ConclusionsPresence of MCI and chronic morbidities in the older population affect different markers of muscle health and functional decline. Individuals with both MCI and chronic morbidities are at increased risk for severe muscle weakness likely related to a severe downregulation of glycine production and net protein breakdown. Therefore, it is important to consider the presence of chronic morbidities when investigating muscle health and functional capacity in MCI.

Physical exercise is a non-pharmacological treatment that can bring positive changes to menopausal women experiencing physiological and hormonal changes leading to various physical and psychological symptoms. This study introduces the MenosPausa Mais Movimento Project protocol, aiming to compare the effects of Urban Dance and Functional Fitness with a control group on the physical and psychological well-being of postmenopausal women.

This study outlines a protocol for a three-arm randomized clinical trial involving two interventions (Urban Dance and Functional Fitness) lasting 12 weeks. The participants will be women in early postmenopause, aged between 40 and 59 years, assigned to three groups: (1) Urban Dance Intervention Group, (2) Functional Fitness Intervention Group, and (3) Control Group. Both interventions will consist of two weekly sessions lasting 60 min each. The outcomes to be assessed include physical aspects (body mass index, fat percentage, waist circumference, muscle strength, cardiorespiratory fitness, bone densitometry, sleep quality, urinary incontinence, sexual function, and follicle-stimulating hormone) as well as psychological aspects (stress, cognition, mood state, depressive symptoms, and anxiety). Data collection and analysis will be conducted during pre- and post-intervention periods.

The study is proposed with the aim of expanding the evidence related to the effects of different types of physical exercise in reducing and/or stopping symptoms resulting from menopause. The hypothesis is that women who perform the types of physical exercise will significantly improve the symptoms investigated when compared to those in the control group, thus expanding the possibilities of non-pharmacological therapies to assist the work of health professionals, favoring the physical and psychological aspects of this population.

Despite receiving guideline-directed medical heart failure (HF) therapy, patients with pulmonary hypertension associated with left heart disease (PH-LHD) experience higher mortality and hospitalization rates than the general HF population. AZD3427 is a functionally selective, long-acting mimetic of relaxin, a hormone that has the potential to induce vasodilation and prevent fibrosis. In a phase 1b study conducted in patients with HF, AZD3427 demonstrated a favourable safety and pharmacokinetic profile. To address the unmet medical need in patients with PH-LHD in the context of HF, AZD3427 is currently under development as a potential treatment option.

The Re-PHIRE study is a phase 2b, randomized, double-blind, placebo-controlled, multicentre, dose-ranging study to evaluate the effect of AZD3427 on a broad range of PH-LHD phenotypes. In total, 220 patients will be randomized to four treatment groups to receive a subcutaneous injection of AZD3427 or placebo every 2 weeks for 24 weeks. The primary endpoint of the study is the change in pulmonary vascular resistance in patients treated with AZD3427 versus placebo after 24 weeks of treatment. Key secondary endpoints include changes in mean pulmonary arterial pressure, pulmonary artery wedge pressure, systemic vascular resistance, 6-min walking distance, N-terminal pro B-type natriuretic peptide levels, echocardiographic parameters, and health-related quality of life (assessed by the Kansas City Cardiomyopathy Questionnaire).

Re-PHIRE is the first study of a relaxin mimetic in patients with PH-LHD. The insights gained from the Re-PHIRE study are expected to inform the further development of AZD3427 in the PH-LHD population, including identifying the most suitable pulmonary hypertension and HF phenotypes for treatment.

This study investigated the feasibility and effectiveness of a telehealth-delivered pelvic floor muscle training program for postmenopausal women with urinary incontinence, in comparison with face-to-face pelvic floor muscle training.

This was a pilot mixed-methods study that included a non-inferiority randomized controlled trial with a nested qualitative study. Community-dwelling postmenopausal women (>40 years) with urinary incontinence were recruited and randomly allocated to 12 weeks of telehealth or face-to-face pelvic floor muscle training. The face-to-face group received supervised training twice weekly, while the telehealth group had eight virtual sessions plus weekly telephone coaching.

Assessments at baseline, post-intervention, and three-month follow-up included feasibility, anthropometry, body composition, hand grip strength, functional exercise capacity, physical activity levels, the severity of urinary incontinence, and pelvic floor muscle function (assessed through vaginal manometry, transperineal ultrasound, and digital palpation).

Among 55 potential participants, 22 enrolled (40 % consent rate). Attendance was 100 %, with 63.3 % adherence to the home program. Satisfaction was high (very satisfied: 71 % face-to-face, 89 % telehealth). Both groups reported increased confidence in pelvic floor muscle training. Urinary symptoms and pelvic floor function improved in both groups, with benefits sustained at three months. Telehealth pelvic floor muscle training also enhanced grip strength. No significant differences were found between groups.

Telehealth pelvic floor muscle training appears to be a feasible and potentially effective alternative to face-to-face therapy for postmenopausal women with urinary incontinence. Larger studies are needed to confirm these preliminary findings and guide future interventions.

ClinicalTrials.gov (NCT05970796); date of registration: 29/07/2023.

Chronic obstructive pulmonary disease (COPD) is a critical disease, with lung function closely linked to disease severity. This study aimed to evaluate the clinical efficacy of treatments for stable COPD in patients with pulmonary function Grades I and II.

We conducted a multicenter, randomized, double-blind, placebo-controlled trial (registration number: NCT01486186). A total of 502 patients were randomly assigned to an experimental group (n = 251, treated with Bufei, Bufei Jianpi, and Bufei Yishen granules based on traditional Chinese medicine [TCM] syndromes) and a control group (n = 251, treated with a Chinese medicine-based placebo). Acute exacerbations (AEs), lung function, clinical symptoms, 6-min walking distance (6MWD), and dyspnea were assessed over 12 months of treatment and 12 months of follow-up.

A total of 432 patients, including 214 and 218 patients in the experimental and control groups, respectively, completed the trial. The early treatment group had fewer AEs (p < 0.05), better clinical symptom scores (p < 0.05), longer 6MWD (p < 0.05), and better Modified Medical Research Council (mMRC) scores than the control group (p < 0.05). No significant differences were found in forced vital capacity (FVC) and forced expiratory volume in first second (FEV1%) between the two groups, but there was a significant difference in FEV1 and the annual rate of FEV1 decline between the groups over 2 years (p < 0.05).

Treatment with TCM for stable COPD significantly reduced AEs, increased the 6MWD, and alleviated dyspnea in patients with pulmonary function Grades I and II. FEV1 was improved, and the slower FEV1 decline indicates a potential benefit in mitigating disease progression.

To determine whether a 12-week supervised dose-graded aerobic exercise (D-GAE) training, when implemented in conjunction with traditional rehabilitation, could help pediatric survivors of acute lymphoblastic leukemia (ALL) enhance their cardiopulmonary capacity and improve their physical performance.

Fifty-eight pediatric survivors of ALL (age 13.78 ± 2.47 years; boys 60.34%) were assigned at random to either undergo the D-GAE in addition to the traditional physical rehabilitation (D-GAE group; n = 29) or the traditional physical rehabilitation solely (control group; n = 29). The cardiopulmonary fitness (peak oxygen uptake (VO2peak), ventilatory equivalent (VEq/VO2), minute ventilation (VE, L/min), oxygen pulse (O2P), maximum heart rate (HRmax), 1-min heart rate recovery (HRR1), and respiratory exchange ratio (RER)) and physical performance (6-min walk test (6-MWT), timed up and down stairs (TUDS), and 4 × 10-m shuttle run test (4 × 10mSRT)) were assessed on the pre- and post-intervention occasions.

The mixed-model ANOVA revealed a meaningful increase of VO2peak (P = .002), VE (P = .026), O2P (P = .0009), HRmax (P = .004), and HRR1 (P = .011), and reduction of VEq/VO2 (P = .003) and RER (P = .003) in the D-GAE group compared with the control group. Besides, the analysis detected a favorable increase in the physical performance for the D-GAE group (6-MWT (P = .007), TUDS (P < .001), 4 × 10mSRT (P = .009)).

A 12-week D-GAE program in conjunction with traditional rehabilitation holds promise in enhancing cardiopulmonary fitness and improving the physical performance of pediatric survivors of ALL. Clinicians and physical rehabilitation professionals can, therefore, integrate the D-GAE into the traditional rehabilitation protocols for such a patient population to optimize their cardiopulmonary fitness and physical function, while also facilitating a gradual transition to practice and adaption.

The favorable outcomes of this study bolster the inclusion of D-GAE as a crucial element in the care and rehabilitation of pediatric survivors of ALL. By embracing these findings, healthcare professionals and oncologists can contribute to mitigating the long-term cardiopulmonary and physical complications associated with cancer treatments and fostering a state of enhanced well-being and increased physical activity among survivors.

We examined cardiorespiratory fitness and physical performance in long-term survivors of paediatric haematopoietic stem cell transplantation (HSCT) and explored how these are associated with the presence of metabolic syndrome (MetS).

We included 90 survivors of paediatric HSCT (median age, 30.3 years; range, 19.6-53.0; median follow-up time, 20.2 years) and 32 healthy controls. Cardiorespiratory fitness was evaluated by cardiopulmonary exercise tests, and physical performance was assessed through sit-to-stand, handgrip strength, timed-up-and-go, walking pace and six-minute walk tests. We assessed for components of MetS (blood pressure, waist circumference, plasma lipids, and glucose). For comparison of physical capacity between survivors and controls and survivors with or without the presence of MetS, a multiple linear regression analysis corrected for age and sex was applied.

Survivors demonstrated lower cardiorespiratory fitness compared with controls (mean ± SD VO2 peak 29.3 ± 7.0 mL/kg/min vs. 44.3 ± 6.8 mL/kg/min, p < 0.0001) and impairment in all physical performance outcomes, where the most prominent differences compared with controls were seen in the sit-to-stand test (33% reduction). Twenty-eight percent of survivors fulfilled the criteria for MetS. The presence of MetS associated with lower VO2 peak (p = 0.03), poorer outcomes in the six-minute walk test (p = 0.02), walking pace (p = 0.03) and the timed-up-and-go test (p = 0.003).

Young adult survivors of paediatric HSCT are at risk of markedly reduced physical capacity compared with age- and sex-matched controls, and the high incidence of MetS observed among survivors was associated with this impairment. Overall, these data underline the importance of monitoring physical capacity in survivors of paediatric HSCT.

Hypophosphatasia (HPP) is a rare disease characterized by skeletal and nonskeletal manifestations that can increase patient disability. The 6-Minute Walk Test (6MWT) is frequently used to assess mobility in patients with HPP, although the test is laborious to conduct in clinical practice. The purpose of the current study was to determine correlations between time to complete the 6MWT, time to complete the Chair-Rise Test (CRT), and scores on the Lower Extremity Functional Scale (LEFS) in adults with HPP.

Pearson correlations between time to complete outcomes on the 6MWT and CRT, time to complete the 6MWT and scores on the LEFS, and time to complete the CRT and scores on the LEFS were calculated using de-identified data from adults with HPP who had first onset of symptoms in childhood. All patients were enrolled in the previously conducted, observational EmPATHY study.

Pearson correlation analyses showed inverse correlations between 6MWT and CRT outcomes (r = -0.584) and between CRT and LEFS outcomes (r = -0.596) and a direct correlation between 6MWT and LEFS outcomes (r = 0.808).

Time to complete the 6MWT was correlated with time to complete the CRT and scores on the LEFS in adults with HPP. CRT and LEFS may be suitable, expeditious options to amend or substitute 6MWT when assessing functional status in patients with HPP.

Rehabilitation has been shown to enhance patient performance before and after lung transplantation, but limited data exist on its role during the immediate post-transplant phase in critical care units.

We conducted a single-center retrospective study. All adult patients who underwent bilateral transplantation for cystic fibrosis were included. Patients were followed from admission to discharge from critical care. All rehabilitation sessions were recorded. We aimed to evaluate the relationship between the amount of mobilization performed by the patient in critical care, and functional performance at discharge.

We included 36 patients (21 males) with a median age of 29 years (IQR: 24.5-35.0) and a median critical care length of stay of 15 days (12.5-20). Patients performed a total of 388 sessions of rehabilitation. Out-of-bed mobilization started at a median of post-operative day 2.5 (IQR: 1.0-4.5), with the first walking session at day 3 (IQR: 2.0-4.5). A strong correlation was found between daily walking distance and functional performance, as measured by the 6-minute walk test, with a Pearson correlation coefficient of 0.70 (95 % CI: 0.48-0.84).

After lung transplantation for cystic fibrosis, early initiated rehabilitation in critical care is feasible and can improve patients' functional performance. These findings are promising, but require validation in other lung transplant populations.