UNASSIGNED: Exercise training is commonly employed as a efficacious supplementary treatment for individuals suffering from heart failure, but the optimal exercise regimen is still controversial. The objective of the review was to compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on the exercise capacity, cardiac function, quality of life (QoL) and heart rate among patients with heart failure with reduced ejection fraction.
UNASSIGNED: A systematic search was performed using the following eight databases from their inception to July 5, 2023: PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials, China Knowledge Network, Wan fang Data, and the China Biology Medicine databases. The meta-analysis results were presented as mean difference (MD) and 95% confidence interval (CI). The Cochrane Risk of Bias tool was used for the included studies. The Grading of Recommendations Assessment, Development, and Evaluations was used to assess the certainty of evidence.
UNASSIGNED: Thirteen randomized controlled trials were included in the study. The results showed that HIIT had a significant positive effect on peak oxygen uptake (MD = 1.78, 95% CI for 0.80-2.76), left ventricular ejection fraction (MD = 3.13, 95% CI for 1.25-5.02), six-minute walk test (MD = 28.13, 95% CI for 14.56-41.70), and Minnesota Living with Heart Failure Questionnaire (MD = -4.45, 95% CI for -6.25 to -2.64) compared to MICT. However, there were no statistically significant differences observed in resting heart rate and peak heart rate.
UNASSIGNED: HIIT significantly improves peak oxygen uptake, left ventricular ejection fraction, six-minute walk test, and Minnesota Living with Heart Failure Questionnaire in patients with heart failure with reduced ejection fraction. Additionally, HIIT exhibits greater effectiveness in improving peak oxygen uptake among patients with lower body mass index.
UNASSIGNED: https://www.doi.org/10.37766/inplasy2023.7.0100, identifier (INPLASY2023.7.0100).

BACKGROUND: Respiratory muscle training is a continuous and standardized training of respiratory muscles, but the evidence of the effects on early stroke patients is not clear. This meta-analysis aimed to investigate the effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke.
METHODS: PubMed, Embase, PEDro, ScienceDirect, AMED, CINAHL, and China National Knowledge Infrastructure databases were searched from inception to December 8, 2023 for articles about studies that 1) stroke patients with age ≥ 18 years old. Early stroke < 3 months at the time of diagnosis, 2) respiratory muscle training, including inspiratory and expiratory muscle training, 3) the following measurements are the outcomes: respiratory muscle strength, respiratory muscle endurance, pulmonary function testing, dyspnea fatigue score, and functional capacity, 4) randomized controlled trials. Studies that met the inclusion criteria were extracted data and appraised the methodological quality and risk of bias using the Physiotherapy Evidence Database scale and the Cochrane Risk of Bias tool by two independent reviewers. RevMan 5.4 with a random effect model was used for data synthesis and analysis. Mean differences (MD) or standard mean differences (SMD), and 95% confidence interval were calculated (95%CI).
RESULTS: Nine studies met inclusion criteria, recruiting 526 participants (mean age 61.6 years). Respiratory muscle training produced a statistically significant effect on improving maximal inspiratory pressure (MD = 10.93, 95%CI: 8.51-13.36), maximal expiratory pressure (MD = 9.01, 95%CI: 5.34-12.69), forced vital capacity (MD = 0.82, 95%CI: 0.54-1.10), peak expiratory flow (MD = 1.28, 95%CI: 0.94-1.63), forced expiratory volume in 1 s (MD = 1.36, 95%CI: 1.13-1.59), functional capacity (SMD = 0.51, 95%CI: 0.05-0.98) in patients with early stroke. Subgroup analysis showed that inspiratory muscle training combined with expiratory muscle training was beneficial to the recovery of maximal inspiratory pressure (MD = 9.78, 95%CI: 5.96-13.60), maximal expiratory pressure (MD = 11.62, 95%CI: 3.80-19.43), forced vital capacity (MD = 0.87, 95%CI: 0.47-1.27), peak expiratory flow (MD = 1.51, 95%CI: 1.22-1.80), forced expiratory volume in 1 s (MD = 0.76, 95%CI: 0.41-1.11), functional capacity (SMD = 0.61, 95%CI: 0.08-1.13), while inspiratory muscle training could improve maximal inspiratory pressure (MD = 11.60, 95%CI: 8.15-15.05), maximal expiratory pressure (MD = 7.06, 95%CI: 3.50-10.62), forced vital capacity (MD = 0.71, 95%CI: 0.21-1.21), peak expiratory flow (MD = 0.84, 95%CI: 0.37-1.31), forced expiratory volume in 1 s (MD = 0.40, 95%CI: 0.08-0.72).
CONCLUSIONS: This study provides good-quality evidence that respiratory muscle training is effective in improving respiratory muscle strength, pulmonary function, and functional capacity for patients with early stroke. Inspiratory muscle training combined with expiratory muscle training seems to promote functional recovery in patients with early stroke more than inspiratory muscle training alone.
BACKGROUND: Prospero registration number: CRD42021291918.

Introduction: The six-minute walk test (6MWT) is a well-established tool for assessing submaximal functional capacity for cardiac patients, but space limitations challenge its implementation. Treadmill-based (TR) 6MWT is a promising alternative, but it requires patients to complete a familiarization test to adapt treadmill speed regulation. With the advancement of sensors, it is possible to automatically control speed for individual patients and thus overcome the space limitation or the speed control difficulty on the treadmill for each patient.Methods: This study investigated the validity and interchangeability of automated speed TR6MWT and standard hallway (HL) 6MWT. Eighteen patients were assessed at baseline of the 12-week cardiac rehabilitation program. Fourteen of them were assessed after rehabilitation. All patients performed three TR6MWTs and three HL6MWTs at baseline and one of each test after the program.Results: Patients well tolerated the TR6MWT. There was a strong correlation between both test methods (r = 0.79). However, patients performed significantly better in HL6MWT (514.8m ± 59.7m) than in TR6MWT (447.2 ± 79.1m) with 95% CI, 40.4-94.6m, p < 0.05. Both tests showed high test-retest reliability (intraclass correlation coefficient of 0.86). The TR6MWT showed a valuable comparison of the effect of the cardiac rehabilitation program (20% increase, effect size 1.1) even though it is not interchangeable with the HL6MWT.Conclusion: The automated speed TR6MWT appears to be an acceptable tool with adequate validity, reliability, and responsiveness for assessing functional capacity in patients utilizing cardiac rehabilitation programs.

BACKGROUND: Acapella plus active cycle of breathing technique (ACBT), external diaphragm pacemaker (EDP) plus ACBT have been shown to facilitate the recovery of functional capacity and lung function in patients suffering from airway obstruction but the efficacy in perioperative patients with lung cancer has not been proven.
METHODS: We conducted a three-arm, prospective, randomized, assessor-blinded, controlled trial in patients with lung cancer who underwent thoracoscopic lobectomy or segmentectomy in the department of thoracic surgery, China. Patients were randomly assigned (1:1:1) to receive Acapella plus ACBT, EDP plus ACBT, or ACBT group (control group) using SAS software. The primary outcome was functional capacity, measured by the 6-minute walk test (6MWT).
RESULTS: We recruited 363 participants over 17 months: 123 assigned to the Acapella plus ACBT group, 119 to the EDP plus ACBT group, and 121 to the ACBT group. Statistically significant differences were noted for functional capacity between the EDP plus ACBT and control groups at each follow-up time (1-week follow-up: difference = 47.25 m, 95% CI, 31.56-62.93; P < 0.001; and 1-month follow-up: difference = 49.72 m, 95% CI, 34.04-65.41; P < 0.001), between the Acapella plus ACBT and control groups at postoperative week 1 (difference = 35.23 m, 95% CI, 19.30-51.16; P < 0.001) and postoperative month 1 (difference = 34.96 m, 95% CI, 19.03-50.89; P < 0.001), and between the EDP plus ACBT and Acapella plus ACBT groups at 1-month follow-up (difference = 14.76 m, 95% CI, 1.34-28.19; P = 0.0316).
CONCLUSIONS: EDP plus ACBT and Acapella plus ACBT significantly improved functional capacity and lung function in perioperative patients with lung cancer, compared with single-model ACBT, and the effects of EDP plus ACBT were clearly superior to those of other programs.
BACKGROUND: The study was registered in the clinical trial database (clinicaltrials.gov) on June 4, 2021 (No. NCT04914624).

BACKGROUND: Prehabilitation has been shown to have a positive effect on the postoperative recovery of functional capacity in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. The optimal way to implement prehabilitation programs, such as the optimal forms of prehabilitation, duration, intensity, and methods to improve compliance, remained to be studied. This Prehabilitation for Thoracic Surgery Study will compare the effectiveness of multimodal and aerobic training-only programs in patients undergoing thoracoscopic lobectomy.
METHODS: This randomized pragmatic trial will be conducted in Peking Union Medical College Hospital (PUMCH) and include 100 patients who are eligible to undergo VATS lobectomy. Patients will be randomized to a multimodal or aerobic training group. Prehabilitation training guidance will be provided by a multidisciplinary care team. The patients in the multimodal group will perform aerobic exercises, resistance exercises, breathing exercises, psychological improvement strategies, and nutritional supplementation. Meanwhile, the patients in the aerobic group will conduct only aerobic exercises. The interventions will be home-based and supervised by medical providers. The patients will be followed up until 30 days after surgery to investigate whether the multimodal prehabilitation program differs from the aerobic training program in terms of the magnitude of improvement in functional capability pre- to postoperatively. The primary outcome will be the perioperative 6-min walk distance (6MWD). The secondary outcomes will include the postoperative pulmonary functional recovery status, health-related quality of life score, incidence of postoperative complications, and clinical outcomes.
CONCLUSIONS: Prehabilitation remains a relatively new approach that is not widely performed by thoracic surgery patients. The existing studies mainly focus on unimodal interventions. While multimodal prehabilitation strategies have been shown to be preferable to unimodal strategies in a few studies, the evidence remains scarce for thoracic surgery patients. The results of this study will contribute to the understanding of methods for thoracoscopic lobectomy patients.
BACKGROUND: ClinicalTrials.gov NCT04049942 . Registered on August 8, 2019.

UNASSIGNED: The aim of this study was to assess the impact of short-term, hospital-based, supervised multimodal prehabilitation on elderly patients with colorectal cancer.
UNASSIGNED: A single-center, retrospective study was conducted from October 2020 to December 2021, which included a total of 587 CRC patients who were scheduled to undergo radical resection. A propensity score-matching analysis was performed to reduce selection bias. All patients were treated within a standardized enhanced recovery pathway, and patients in the prehabilitation group received an additional supervised, short-term multimodal preoperative prehabilitation intervention. Short-term outcomes were compared between the two groups.
UNASSIGNED: Among the participants, 62 patients were excluded; 95 participants were included in the prehabilitation group and 430 in the non-prehabilitation group. After PSM analysis, 95 pairs of well-matched patients were included in the comparative study. Participants in the prehabilitation group had better preoperative functional capacity (402.78 m vs. 390.09 m, P<0.001), preoperative anxiety status (9% vs. 28%, P<0.001), time to first ambulation[25.0(8.0) hours vs. 28.0(12.4) hours, P=0.008], time to first flatus [39.0(22.0) hours vs. 47.7(34.0) hours, P=0.006], duration of the postoperative length of hospital stay [8.0(3.0) days vs. 10.0(5.0) days, P=0.007), and quality of life in terms of psychological dimensions at 1 month postoperatively [53.0(8.0) vs. 49.0(5.0), P<0.001].
UNASSIGNED: The short-term, hospital-based, supervised multimodal prehabilitation is feasible with a high degree of compliance in older CRC patients, which improves their short-term clinical outcomes.

UNASSIGNED: As a validated assessment tool for functional disability (activities of daily living), the Barthel index (BI) assessed initially at admission has the potential to stratify patients with high-risk acute coronary syndrome (ACS). Dynamic trajectory evaluation of functional capacity in hospitals may provide more prognostic information. We aimed to establish a novel dynamic BI-based risk stratification program (DBRP) during hospitalization to predict outcomes among ACS patients.
UNASSIGNED: A total of 2,837 ACS patients were included from the Retrospective Multicenter Study for Early Evaluation of Acute Chest Pain. The DBRP rating (low, medium, and high-risk categories) was calculated from dynamic BI at admission and discharge. The primary outcome was all-cause mortality, and the secondary outcome was cardiac mortality.
UNASSIGNED: Of all the included patients, 312 (11%) died during a median follow-up period of 18.0 months. Kaplan-Meier analysis revealed that the cumulative mortality was significantly higher in patients in the higher risk category according to the DBRP. Multivariable Cox regression analysis indicated that, compared to the low-risk category, the higher risk category in the DBRP was an independent strong predictor of all-cause mortality after adjusting for confounding factors (medium-risk category: hazard ratio [HR]: 1.756, 95% confidence interval [95% CI]: 1.214-2.540; P = 0.003; high-risk category: HR: 5.052, 95% CI: 3.744-6.817; P < 0.001), and the same result was found for cardiac mortality.
UNASSIGNED: The DBRP was a useful risk stratification tool for the early dynamic assessment of patients with ACS.
UNASSIGNED: [http://www.chictr.org.cn], identifier [ChiCTR1900024657].

Aging and increased vulnerability define the clinical condition of frailty. However, while the cervical function is recognized as a determinant of balance and walking performance, no study simultaneously physical ability, cervical function, balance, and plantar pressure distribution in walking in nursing house population. Thus, the present study aimed to compare these parameters between Frail and Pre-Frail aged people. Thirty-one (12 men and 19 women) institutionalized participants (age: 89.45 ± 5.27 years, weight: 61.54 ± 9.99 kg, height: 160.34 ± 7.93 cm) were recruited and divided into Pre-Frail and Frail groups according to SPPB (Short Physical Performance Battery) score (Frail <6, Pre-Frail ≥6). Participants performed the Timed Up and Go Test (TUGT) and a static balance evaluation. The cervical range of motion (COM), knee extensor strength, and walking plantar pressure distribution have been measured. The Pre-Frail group showed a higher gait speed (ES = 0.78, p ≤ 0.001) and a better TUGT, as well as higher knee extensor strength (ES = 0.4, p = 0.04). Furthermore, the Pre-Frail group presented a center of pressure (COP) displacement velocity on the sagittal axis (ES = 0.43, p = 0.02) and a more COP projection on this axis (ES = 0.43, p = 0.02). No significant difference has been observed between the two groups concerning the total contact time and most of the plantar pressure parameters except for the rear foot relative contact time which was lower in the Pre-Frail group. The Pre-Frail group also showed better cervical tilt mobility (ES = 0.35, p = 0.04). This study highlights the influence of some new parameters on frailty in older people, such as cervical mobility and plantar pressure distribution in walking.

UNASSIGNED: Prehabilitation is analogous to marathon training and includes preoperative preparation for exercise, as well as nutrition and psychology. However, evidence-based recommendations to guide prehabilitation before colorectal surgery are limited. We aimed to evaluate the effect of prehabilitation on the postoperative outcomes of patients undergoing colorectal surgery.
UNASSIGNED: This study is a systematic review and meta-analysis.
UNASSIGNED: The PubMed, Embase, and Cochrane databases were searched for studies reporting the effect of prehabilitation strategies versus standard care or rehabilitation in patients undergoing colorectal surgery. The primary outcomes were overall postoperative complications and length of hospital stay (LOS), and the secondary outcome was functional capacity (measured using the 6-min walk test [6MWT]) at 4 and 8 weeks after surgery.
UNASSIGNED: Fifteen studies with 1,306 participants were included in this meta-analysis. The results showed no significant reduction in the number of overall postoperative complications (risk ratio = 1.02; 95% confidence interval [CI] = 0.79-1.31; p = 0.878) or LOS (standardized mean difference = 0.04; 95% CI = -0.11 to 0.20; p = 0.589) in patients who underwent colorectal surgery with or without prehabilitation strategy. Additionally, there were no significant differences in the functional capacity estimated using the 6MWT at 4 and 8 weeks postoperatively.
UNASSIGNED: Prehabilitation did not significantly affect the number of postoperative complications, LOS, or functional capacity of patients undergoing colorectal surgery. Whether prehabilitation should be recommended deserves further consideration.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290108, identifier CRD42021290108.

To evaluate the efficacy of different physical therapy interventions that could validate decisions taken by health care providers in the field of rehabilitation of patients with hemophilia according to the International Classification of Functioning, Disability and Health (ICF), including body functions and structures, activity, and participation.
Seven databases-PubMed, Cochrane Library, Scopus, Web of Science, Physiotherapy Evidence Database, Google Scholar, and Clinicaltrials.gov-were systematically searched for randomized controlled trials evaluating any physical therapy modality to manage hemophilia.
After abstract and full-text filtration, a methodological quality assessment was performed using the Physiotherapy Evidence Database scale for the studies that met the eligibility criteria.
Relevant data were extracted from eligible studies and outcomes were categorized according to the ICF.
Using Review Manager and Microsoft Excel, a quantitative analysis using standardized mean differences with the 95% confidence interval was completed. Statistical heterogeneity between studies was explored using the I2 test. A fixed effect model was applied to all data analyses. If heterogeneity was statistically significant, the Der Simonian and Laird random effects models were used instead.
35 randomized controlled trials with 1216 participants were included in this systematic review; 13 of them dealt with pediatric patients. Most of the studies were of good quality; 12 studies were of low quality. Meta-analysis showed a significant difference in favor of manual therapy, laser, and therapeutic exercises on selected outcomes of body function and structure, activity, and participation categories of the ICF model.
This systematic review recommends using manual therapy and therapeutic exercise modalities to improve join health status in combination with educational sessions to improve the quality of life of patients with hemophilic arthropathy. For pediatric patients with hemophilic arthropathy, using laser therapy is promising for improving functional capacity.