Purpose: To compare the effects of sustained abdominal exercises—pelvic tilt and twist curl-up—on the magnitude of abdominal muscle activation and maximal expiratory pressure (MEP) in healthy men and women. It was hypothesized that the activation would differ between men and women during these 3 exercise maneuvers. Methods: Using a cross-sectional design, 10 healthy men and 10 women sustained pelvic tilt and twist curl-up exercises until task failure. Baseline MEP was compared with MEP immediately after both exercises. The root mean square of the internal oblique, rectus abdominis, external oblique, and transverse abdominis were evaluated during pelvic tilt, twist curl-up, and MEP. Results: Pelvic tilt and twist curl-up were sustained for similar durations. Twist curl-up induced higher activations and more shifts to lower median frequency in all 4 abdominals compared with pelvic tilt. Although internal oblique activation was highest during MEP and lowest during pelvic tilt in women, these comparisons did not differ in men. Maximal expiratory pressure tended to decrease after sustained pelvic tilt in women but did not change in men. Conclusions: Twist curl-up activated abdominal muscles more so than pelvic tilt. Some sex differences were shown that should be considered in future research of abdominal muscle exercise prescription.
{"title":"Sustained Abdominal Exercises Affect Abdominal Muscle Activation and Maximal Expiratory Pressures Differently in Healthy Men and Women","authors":"BScPT MSc Karina Tamy Kasawara, MD Arnaud Delafontaine, PT Shirin Tajali, MD Ewan Goligher, MD Laurent Brochard, PT Romain Artico, Bmrpt W. Darlene Reid","doi":"10.1097/CPT.0000000000000158","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000158","url":null,"abstract":"Purpose: To compare the effects of sustained abdominal exercises—pelvic tilt and twist curl-up—on the magnitude of abdominal muscle activation and maximal expiratory pressure (MEP) in healthy men and women. It was hypothesized that the activation would differ between men and women during these 3 exercise maneuvers. Methods: Using a cross-sectional design, 10 healthy men and 10 women sustained pelvic tilt and twist curl-up exercises until task failure. Baseline MEP was compared with MEP immediately after both exercises. The root mean square of the internal oblique, rectus abdominis, external oblique, and transverse abdominis were evaluated during pelvic tilt, twist curl-up, and MEP. Results: Pelvic tilt and twist curl-up were sustained for similar durations. Twist curl-up induced higher activations and more shifts to lower median frequency in all 4 abdominals compared with pelvic tilt. Although internal oblique activation was highest during MEP and lowest during pelvic tilt in women, these comparisons did not differ in men. Maximal expiratory pressure tended to decrease after sustained pelvic tilt in women but did not change in men. Conclusions: Twist curl-up activated abdominal muscles more so than pelvic tilt. Some sex differences were shown that should be considered in future research of abdominal muscle exercise prescription.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":"147 - 155"},"PeriodicalIF":0.0,"publicationDate":"2020-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45176690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-13DOI: 10.1097/CPT.0000000000000149
T. Davenport, Sean D. Rundell
The role for physical therapists related to addressing the novel coronavirus (COVID-19) crisis is still crystallizing in acute and post-acute settings. It is not too early to begin learning from the recent unprecedented disruptions in physical therapists’ ability to provide care related to public health orders for infection control. Emerging evidence suggests that disruptions to health services, such as COVID infections and outcomes, are associated with various population characteristics. These observations suggest the importance of multilevel strategies for physical therapists to mitigate future service disruptions. The purpose of this perspective is to propose a set of practice, research, and advocacy imperatives using the social–ecological model of health. The viewpoint describes the model and then applies it to COVID-related health service disruptions. The perspective then culminates in a specific set of practice, research, and policy recommendations that can be applied to the current experiencewith COVID-19 and also potential future sources of service disruption, such as future epidemics and climate change. (Cardiopulm Phys Ther J. 2021;32:S4–S7)
{"title":"How Can Physical Therapists Engage the Social Ecology of Health to Mitigate Service Disruptions in a Post-COVID World?","authors":"T. Davenport, Sean D. Rundell","doi":"10.1097/CPT.0000000000000149","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000149","url":null,"abstract":"The role for physical therapists related to addressing the novel coronavirus (COVID-19) crisis is still crystallizing in acute and post-acute settings. It is not too early to begin learning from the recent unprecedented disruptions in physical therapists’ ability to provide care related to public health orders for infection control. Emerging evidence suggests that disruptions to health services, such as COVID infections and outcomes, are associated with various population characteristics. These observations suggest the importance of multilevel strategies for physical therapists to mitigate future service disruptions. The purpose of this perspective is to propose a set of practice, research, and advocacy imperatives using the social–ecological model of health. The viewpoint describes the model and then applies it to COVID-related health service disruptions. The perspective then culminates in a specific set of practice, research, and policy recommendations that can be applied to the current experiencewith COVID-19 and also potential future sources of service disruption, such as future epidemics and climate change. (Cardiopulm Phys Ther J. 2021;32:S4–S7)","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42375989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-23DOI: 10.1097/CPT.0000000000000159
Keriann Groen, P. Robison, Annie Xiong, Kent E. Irwin, Amy B Stein, C. C. Evans
Supplemental Digital Content is Available in the Text. Purpose: Studies suggest that additional exercise (Ex) training beyond “usual care” increases peak VO2 in people post-heart transplant (HTx); however, no recent studies have quantified improvements or compared moderate-intensity aerobic Ex (MOD) to high-intensity interval training (HIIT). The purpose of this study was to quantify improvements in VO2 for patients post-HTx undergoing additional Ex training and compare effectiveness of MOD to HIIT. Methods: Inclusion criteria were: randomized clinical trials, systematic reviews, or meta-analyses published between 2008 to 2018, subjects post-HTx, participated in an aerobic Ex program beyond usual care, and reported peak VO2. Results: A total of 242 records were obtained and 7 randomized clinical trials were reviewed. The average PEDro score was 4.86 (range 2–7). The within-group weighted mean difference (WMD) in peak VO2 comparing baseline to post-training for the Ex group = 3.3 (0.5) ml/kg/min and for the control group = −0.2 (0.2) ml/kg/min. The between-group WMD in peak VO2 = 3.5 (7.9) ml/kg/min, Hedge's g = 0.606 (95% confidence intervals = 0.337–0.874), P < .001, favoring Ex. Comparison between Ex protocols indicated that there was no difference between HIIT and MOD (Q = 1.83, P = .176). Conclusions: Physical therapists should challenge patients post-HTx with aerobic Ex that goes beyond usual post-HTx care and should consider incorporating HIIT into the treatment plan or home program to maximize the benefits of rehabilitation when possible.
{"title":"How Effective Is Aerobic Exercise Training in Improving Aerobic Capacity After Heart Transplant? A Systematic Review and Meta-analysis","authors":"Keriann Groen, P. Robison, Annie Xiong, Kent E. Irwin, Amy B Stein, C. C. Evans","doi":"10.1097/CPT.0000000000000159","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000159","url":null,"abstract":"Supplemental Digital Content is Available in the Text. Purpose: Studies suggest that additional exercise (Ex) training beyond “usual care” increases peak VO2 in people post-heart transplant (HTx); however, no recent studies have quantified improvements or compared moderate-intensity aerobic Ex (MOD) to high-intensity interval training (HIIT). The purpose of this study was to quantify improvements in VO2 for patients post-HTx undergoing additional Ex training and compare effectiveness of MOD to HIIT. Methods: Inclusion criteria were: randomized clinical trials, systematic reviews, or meta-analyses published between 2008 to 2018, subjects post-HTx, participated in an aerobic Ex program beyond usual care, and reported peak VO2. Results: A total of 242 records were obtained and 7 randomized clinical trials were reviewed. The average PEDro score was 4.86 (range 2–7). The within-group weighted mean difference (WMD) in peak VO2 comparing baseline to post-training for the Ex group = 3.3 (0.5) ml/kg/min and for the control group = −0.2 (0.2) ml/kg/min. The between-group WMD in peak VO2 = 3.5 (7.9) ml/kg/min, Hedge's g = 0.606 (95% confidence intervals = 0.337–0.874), P < .001, favoring Ex. Comparison between Ex protocols indicated that there was no difference between HIIT and MOD (Q = 1.83, P = .176). Conclusions: Physical therapists should challenge patients post-HTx with aerobic Ex that goes beyond usual post-HTx care and should consider incorporating HIIT into the treatment plan or home program to maximize the benefits of rehabilitation when possible.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":"114 - 128"},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49044853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-19DOI: 10.1097/CPT.0000000000000145
Ted L. Marks, Sarah Leah Berg, Batsheva Granek, Peter Rybakov, Irina Taranenko, Dana Yee, Ralph K. Garcia
Purpose: The purposes of this study were (1) to investigate discrepancies between what physical therapy students report learning in the classroom regarding blood pressure (BP) guidelines and what physical therapy students report observing and practicing in clinical settings and (2) to establish whether students felt discomfort when discrepancies were encountered. Methods: This was a prospective descriptive survey study generated using a sample of convenience employing a survey developed by the researchers. Face and content validity were established through expert review. An email was sent to 21 New York State Physical Therapy Programs asking each program to share the survey with students in their programs who had completed clinical experiences. The responses were analyzed descriptively using frequency counts, percentages, and cross tabulations. Results: Responses were received from 206 students attending 13 different programs, or 61.9% of the programs contacted. More than half the students (53.4%) reported there were differences between what they learned during classroom instruction regarding BP assessment and what they saw and practiced in the clinic; 24.8% of students expressed discomfort related to discrepancies between what they learned in school and what they saw and practiced in the clinic. Inpatient and outpatient experiences were compared. Statistical differences were found indicating patients had their BP assessed less often in outpatient settings. In addition, students were less likely to discuss BP assessment with their clinical instructors (CIs) in outpatient settings and students were more likely to express increased competence taking BP after inpatient clinical experiences. Across all settings, 20.4% of students reported that neither they nor their CI ever measured BP during their most recent clinical experience. Conclusions: Across all settings, the BP assessment practices that students encounter in clinic differ from what students report learning is best practice during their physical therapy education. Students are more likely to encounter discrepancies in outpatient settings. For many students, encountering discrepancies gives rise to feelings of discomfort.
{"title":"Physical Therapy Student Reports of Blood Pressure Guidelines Learned in the Classroom, and Observed and Practiced in Clinical Experiences","authors":"Ted L. Marks, Sarah Leah Berg, Batsheva Granek, Peter Rybakov, Irina Taranenko, Dana Yee, Ralph K. Garcia","doi":"10.1097/CPT.0000000000000145","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000145","url":null,"abstract":"Purpose: The purposes of this study were (1) to investigate discrepancies between what physical therapy students report learning in the classroom regarding blood pressure (BP) guidelines and what physical therapy students report observing and practicing in clinical settings and (2) to establish whether students felt discomfort when discrepancies were encountered. Methods: This was a prospective descriptive survey study generated using a sample of convenience employing a survey developed by the researchers. Face and content validity were established through expert review. An email was sent to 21 New York State Physical Therapy Programs asking each program to share the survey with students in their programs who had completed clinical experiences. The responses were analyzed descriptively using frequency counts, percentages, and cross tabulations. Results: Responses were received from 206 students attending 13 different programs, or 61.9% of the programs contacted. More than half the students (53.4%) reported there were differences between what they learned during classroom instruction regarding BP assessment and what they saw and practiced in the clinic; 24.8% of students expressed discomfort related to discrepancies between what they learned in school and what they saw and practiced in the clinic. Inpatient and outpatient experiences were compared. Statistical differences were found indicating patients had their BP assessed less often in outpatient settings. In addition, students were less likely to discuss BP assessment with their clinical instructors (CIs) in outpatient settings and students were more likely to express increased competence taking BP after inpatient clinical experiences. Across all settings, 20.4% of students reported that neither they nor their CI ever measured BP during their most recent clinical experience. Conclusions: Across all settings, the BP assessment practices that students encounter in clinic differ from what students report learning is best practice during their physical therapy education. Students are more likely to encounter discrepancies in outpatient settings. For many students, encountering discrepancies gives rise to feelings of discomfort.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":"86 - 96"},"PeriodicalIF":0.0,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48762931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-19DOI: 10.1097/CPT.0000000000000148
Becca Jordre, Brody W. Brisk, William E. Schweinle
Purpose: This observational cross-sectional study of aging athletes aims to (1) compare the prevalence of cardiovascular disease (CVD) and diabetes in aging athletes to the general population, (2) describe anthropometric values of aging athletes, (3) investigate the influence of cardiovascular sport competition on these measures, and (4) address any predictive value of evaluated measures. Methods: Health and sport history, blood pressure, waist circumference (WC), waist-to-hip ratio, and body mass index (BMI) were collected on 2351 aging athletes. Results: Aging athletes showed a significantly lower prevalence of CVD and diabetes than the general population. Athletes demonstrated BMI in the overweight range, WC in a healthy range, and waist-to-hip ratio in a healthy range for women but just over risk thresholds for men. Average blood pressure was near stage 1 hypertension. Waist circumference and waist-to-hip ratio were superior predictors of disease in the population. Cardiovascular athletes showed a lower disease risk and overall superior anthropometric values than other aging athletes. Conclusion: Aging athletes demonstrate a relatively low prevalence of CVD and diabetes despite demonstrating some anthropometric measurements over risk thresholds. Measures of central adiposity seem best for predicting disease in this population.
{"title":"Keep Them in the Game: Screening for Cardiovascular Disease and Diabetes in Aging Athletes","authors":"Becca Jordre, Brody W. Brisk, William E. Schweinle","doi":"10.1097/CPT.0000000000000148","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000148","url":null,"abstract":"Purpose: This observational cross-sectional study of aging athletes aims to (1) compare the prevalence of cardiovascular disease (CVD) and diabetes in aging athletes to the general population, (2) describe anthropometric values of aging athletes, (3) investigate the influence of cardiovascular sport competition on these measures, and (4) address any predictive value of evaluated measures. Methods: Health and sport history, blood pressure, waist circumference (WC), waist-to-hip ratio, and body mass index (BMI) were collected on 2351 aging athletes. Results: Aging athletes showed a significantly lower prevalence of CVD and diabetes than the general population. Athletes demonstrated BMI in the overweight range, WC in a healthy range, and waist-to-hip ratio in a healthy range for women but just over risk thresholds for men. Average blood pressure was near stage 1 hypertension. Waist circumference and waist-to-hip ratio were superior predictors of disease in the population. Cardiovascular athletes showed a lower disease risk and overall superior anthropometric values than other aging athletes. Conclusion: Aging athletes demonstrate a relatively low prevalence of CVD and diabetes despite demonstrating some anthropometric measurements over risk thresholds. Measures of central adiposity seem best for predicting disease in this population.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":"106 - 113"},"PeriodicalIF":0.0,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44721095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-19DOI: 10.1097/CPT.0000000000000153
K. Black, Carly Walters
There is little published information available to guide the acute care physical therapist in caring for acutely ill patients with COVID-19. Significant debility after prolonged stays in the intensive care unit can make rehabilitation more difficult. In this case, a 54-year-old man spent 1 month on mechanical ventilation before initiating therapies. Despite his poor medical prognosis, intensive therapies were initiated—including cardiopulmonary interventions, therapeutic exercise, and neuromuscular re-education. The patient displayed profound improvement andwas able to discharge to an inpatient rehabilitation facility. (CardiopulmPhys Ther J. 2021;32:S28–S31)
{"title":"Physical Therapy Interventions for a Patient Requiring Prolonged Intubation Due to Severe COVID-19: A Case Study","authors":"K. Black, Carly Walters","doi":"10.1097/CPT.0000000000000153","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000153","url":null,"abstract":"There is little published information available to guide the acute care physical therapist in caring for acutely ill patients with COVID-19. Significant debility after prolonged stays in the intensive care unit can make rehabilitation more difficult. In this case, a 54-year-old man spent 1 month on mechanical ventilation before initiating therapies. Despite his poor medical prognosis, intensive therapies were initiated—including cardiopulmonary interventions, therapeutic exercise, and neuromuscular re-education. The patient displayed profound improvement andwas able to discharge to an inpatient rehabilitation facility. (CardiopulmPhys Ther J. 2021;32:S28–S31)","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43035422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-15DOI: 10.1097/CPT.0000000000000154
J. Jordan, J. Rice, Shane Bassett, Jessica Lazore, D. Weeks
Introduction: The novel coronavirus disease-19 (COVID-19) has many unique features in its presentation. One increasingly noted symptom is the incidence of hypercoagulability which may lead to ischemic stroke. Physical therapists (PTs) are an integral component of the medical team and contribute to the early identification of stroke-like symptoms in patients with COVID-19. Case Presentation: This case series will describe the rehabilitation process of 3 patients who survived critical illness due to COVID-19 and had secondary complications including right hemiparesis while in critical care. Patients received rehabilitation by PTs and occupational therapists on average 6 times per week with interventions focused on recovery of strength, functionalmobility, neurological re-education, and cognition. Themobility status was assessedwith the Perme Intensive Care Unit Mobility Score. Conclusion: Patients who present with COVID-19 need careful screening for neurological impairment. Conventionalmeans to diagnose stroke, such as radiological imaging, canbe difficult to obtain in these unique circumstances because of infection control measures. Physical therapists can assist in early identification of neurological impairment in the absence of traditional diagnostic methods through identification of deficits in abilities such as mobility and balance. (Cardiopulm Phys Ther J. 2021;32:S22–S27)
{"title":"Rehabilitation of Patients Presenting With Coronavirus Disease-19 and Hemiparesis: A Case Series","authors":"J. Jordan, J. Rice, Shane Bassett, Jessica Lazore, D. Weeks","doi":"10.1097/CPT.0000000000000154","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000154","url":null,"abstract":"Introduction: The novel coronavirus disease-19 (COVID-19) has many unique features in its presentation. One increasingly noted symptom is the incidence of hypercoagulability which may lead to ischemic stroke. Physical therapists (PTs) are an integral component of the medical team and contribute to the early identification of stroke-like symptoms in patients with COVID-19. Case Presentation: This case series will describe the rehabilitation process of 3 patients who survived critical illness due to COVID-19 and had secondary complications including right hemiparesis while in critical care. Patients received rehabilitation by PTs and occupational therapists on average 6 times per week with interventions focused on recovery of strength, functionalmobility, neurological re-education, and cognition. Themobility status was assessedwith the Perme Intensive Care Unit Mobility Score. Conclusion: Patients who present with COVID-19 need careful screening for neurological impairment. Conventionalmeans to diagnose stroke, such as radiological imaging, canbe difficult to obtain in these unique circumstances because of infection control measures. Physical therapists can assist in early identification of neurological impairment in the absence of traditional diagnostic methods through identification of deficits in abilities such as mobility and balance. (Cardiopulm Phys Ther J. 2021;32:S22–S27)","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44972503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-15DOI: 10.1097/CPT.0000000000000147
Shane Bassett, J. Jordan, D. Weeks
Purpose: Patients in the intensive care unit (ICU) receiving heated humidified high-flow nasal cannula (HHFNC) therapy for acute respiratory failure have limited ambulation distance due to restrictions in supplying HHFNC away from bedside. This study investigated the safety and efficacy of transitioning patients requiring HHFNC to a portable high-flow oxygen (HFO2) device for ambulation. Methods: Twenty-three patients with acute respiratory failure participated in this prospective longitudinal observational study. Three diagnostic groups were formed (cardiac n = 8; pulmonary n = 11; and other n = 4). Initial aerobic tolerance was established through bedside marching on HHFNC, then participants transitioned to HFO2 for ambulation. During each phase, vital signs were monitored. Results: No differences were found among diagnostic groups or sexes during ambulation for blood pressure, heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), or the Borg dyspnea scale (BDS) (all P > .05). Outcomes during marching and ambulation differed from outcomes at rest and during recovery for HR, RR, SpO2, and BDS (all P < .001). Transitory adverse events during ambulation included anxiety (n = 2), hypotension (n = 1), and arrhythmia (n = 2). Conclusions: Results indicate it is safe and efficacious for patients in the ICU with acute respiratory failure requiring HHFNC to ambulate on HFO2 under the supervision of a physical therapist.
{"title":"Safety and Efficacy of Early Ambulation on an Alternative Oxygen Delivery Device for Patients Receiving Bedside Heated Humidified High-Flow Nasal Cannula Therapy","authors":"Shane Bassett, J. Jordan, D. Weeks","doi":"10.1097/CPT.0000000000000147","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000147","url":null,"abstract":"Purpose: Patients in the intensive care unit (ICU) receiving heated humidified high-flow nasal cannula (HHFNC) therapy for acute respiratory failure have limited ambulation distance due to restrictions in supplying HHFNC away from bedside. This study investigated the safety and efficacy of transitioning patients requiring HHFNC to a portable high-flow oxygen (HFO2) device for ambulation. Methods: Twenty-three patients with acute respiratory failure participated in this prospective longitudinal observational study. Three diagnostic groups were formed (cardiac n = 8; pulmonary n = 11; and other n = 4). Initial aerobic tolerance was established through bedside marching on HHFNC, then participants transitioned to HFO2 for ambulation. During each phase, vital signs were monitored. Results: No differences were found among diagnostic groups or sexes during ambulation for blood pressure, heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), or the Borg dyspnea scale (BDS) (all P > .05). Outcomes during marching and ambulation differed from outcomes at rest and during recovery for HR, RR, SpO2, and BDS (all P < .001). Transitory adverse events during ambulation included anxiety (n = 2), hypotension (n = 1), and arrhythmia (n = 2). Conclusions: Results indicate it is safe and efficacious for patients in the ICU with acute respiratory failure requiring HHFNC to ambulate on HFO2 under the supervision of a physical therapist.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":"97 - 105"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42757483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1097/cpt.0000000000000137
R. Zant, W. Colchagoff, M. Kunish, Tamara Kunz, Mark Marshall, S. McDermott, Trevor Myers, Byron Sunga
PURPOSE: The use of body weight support treadmill (BWST) training for rehabilitation of patients with brain injuries, as well as musculoskeletal and neuromuscular impairments, is an emerging clinical treatment method. Because of the limited evidence of physiological stress of BWST training, the purpose of this study was to describe the metabolic and cardiovascular response to varying levels of BWST walking in healthy adult subjects. METHODS: A total of 21 subjects (10 females; 34+6.7 yr; 74.6+14.3 kg; 170.8+6.9 cm; 26.1+5.3 kg/m) provided their informed consent to participate in three 5-minute walking trials at a self-selected treadmill speed, with body weight support (BWS) of 0, 15, and 30%. Test order was randomized for each subject. Subjects rested for a minimum of 5 minutes between each trial, and did not begin a subsequent trial until HR was verified to be < 5 bpm of HR rest. Mean HR (12-lead ECG), BP (auscultation), oxygen uptake (continuous indirect calorimetry), and RPE (Borg ratio scale) were determined from the last 3 minutes of each trial. Mean values for all variables were assessed for difference between trials using repeated measures analysis of variance (SPSS ver. 24, New York, NY). RESULTS: At rest, HR was 78.2+11.5 bp and BP was 121.2+7.9 / 76.9+8.0 mmHg. Mean walking speed of subjects was 64.2 m/min. HR and systolic BP significantly (p<0.05) increased from rest to exercise at all BWS levels, with no significant difference in diastolic BP seen from rest to exercise at all BWS levels. There was no statistical difference among levels of BWS for HR, BP, RPE, oxygen uptake, respiratory exchange ratio, respiratory rate, tidal volume, and METs. CONCLUSIONS: Metabolic and cardiovascular responses to treadmill walking at 3 levels of BWS (0, 15, 30%) were similar in apparently healthy adult subjects.
{"title":"Metabolic and Cardiovascular Effects of Body Weight Support Treadmill Walking in Healthy Adults","authors":"R. Zant, W. Colchagoff, M. Kunish, Tamara Kunz, Mark Marshall, S. McDermott, Trevor Myers, Byron Sunga","doi":"10.1097/cpt.0000000000000137","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000137","url":null,"abstract":"PURPOSE: The use of body weight support treadmill (BWST) training for rehabilitation of patients with brain injuries, as well as musculoskeletal and neuromuscular impairments, is an emerging clinical treatment method. Because of the limited evidence of physiological stress of BWST training, the purpose of this study was to describe the metabolic and cardiovascular response to varying levels of BWST walking in healthy adult subjects. METHODS: A total of 21 subjects (10 females; 34+6.7 yr; 74.6+14.3 kg; 170.8+6.9 cm; 26.1+5.3 kg/m) provided their informed consent to participate in three 5-minute walking trials at a self-selected treadmill speed, with body weight support (BWS) of 0, 15, and 30%. Test order was randomized for each subject. Subjects rested for a minimum of 5 minutes between each trial, and did not begin a subsequent trial until HR was verified to be < 5 bpm of HR rest. Mean HR (12-lead ECG), BP (auscultation), oxygen uptake (continuous indirect calorimetry), and RPE (Borg ratio scale) were determined from the last 3 minutes of each trial. Mean values for all variables were assessed for difference between trials using repeated measures analysis of variance (SPSS ver. 24, New York, NY). RESULTS: At rest, HR was 78.2+11.5 bp and BP was 121.2+7.9 / 76.9+8.0 mmHg. Mean walking speed of subjects was 64.2 m/min. HR and systolic BP significantly (p<0.05) increased from rest to exercise at all BWS levels, with no significant difference in diastolic BP seen from rest to exercise at all BWS levels. There was no statistical difference among levels of BWS for HR, BP, RPE, oxygen uptake, respiratory exchange ratio, respiratory rate, tidal volume, and METs. CONCLUSIONS: Metabolic and cardiovascular responses to treadmill walking at 3 levels of BWS (0, 15, 30%) were similar in apparently healthy adult subjects.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"31 1","pages":"167-171"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/cpt.0000000000000137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42389861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1097/cpt.0000000000000127
S. Gore, A. Goldberg, M. Huang, M. Shoemaker, J. Blackwood
the design, analysis, drafting, and revisions of this manuscript. Purpose: The Global Physical Activity Questionnaire (GPAQv2) is widely used and one of the only national surveillance measures recommended by the World Health Organization for physical activity (PA) assessment globally. No studies to date have examined the validity of GPAQv2 in older adults with chronic obstructive pulmonary disease (COPD). This observational study examined its construct validity using population-based data. Methods: Individuals aged 65 years and older with COPD, interviewed in the National Health and Nutrition Examination Survey (NHANES) between years 2007 and 2012 were included. GPAQv2-derived PA was compared with constructs of lung function, shortness of breath, and the diagnosis of COPD. Results: The GPAQv2 was not found to be a significant predictor of COPD status (odds ratio 5 1.00, 95% confidence interval: 0.99, 1.00) when controlling for relevant covariates. Age and smoking status emerged as the strongest predictors of COPD. Total PA was neither significantly associated with shortness of breath nor lung function. Conclusions: Older adults with chronic conditions such as COPD represent a unique subset of population discrete from the healthier counterparts. Given the importance of GPAQv2 as the only widely accepted population surveillance tool, future studies exploring its validity in this subset of individuals with COPD using different constructs and objective reference standards are needed. (Cardiopulm Phys Ther J. 2020;31:159 – 166)
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