Effects of Cardiac Rehabilitation Exercise Protocols on Physical Function in Patients with Chronic Heart Failure: An Experience from a Resource Constraint Nation

Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled trial recruited 70 patients who are in stage II CHF with ejection fraction (≤40%) from a Nigerian university teaching hospital. They were randomly assigned into Exercise Group (EG: n = 35) or Control Group (CG: n = 35). Physical function, activity of daily living (ADL), distance walked in six minutes and grip strength were assessed using a validated ADL questionnaire, six minute walk test and a hand dynamometer respectively. In addition to medication, EG underwent aerobic and upper extremity resistance exercises thrice weekly for eight weeks while CG used medications only. Data were analyzed using descriptive and inferential statistics. Alpha level was at p p > 0.05). Significant improvements were noticed at fourth week among participants’ ADL (30.0% ± 6.0%), 6MWD (321.7 ± 26.3 m) and VO2 max (8.9 ± 0.4 mL/kg/min) variables within the exercise EG but no significant changes were observed in the CG (p > 0.05). Participants in EG demonstrated more significant improvements in ADL (15.0% ± 5.0%), 6MWD (406.0 ± 29.7 m) and VO2 max (10.3 ± 0.5 mL/kg/min) (p p > 0.05). Conclusions: Cardiac rehabilitation exercise protocols involving self-paced walking, sit-to-stand and upper extremity dynamic strength training improved activity of daily living, walking and functional capacity in patients with stable chronic heart failure.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Concurrent validity of evaluating knee kinematics using Kinect system during rehabilitation exercise

Squats,ascending and descending stairs,and lunges are three functional movements popularly used in clinical rehabilitation.This study aimed to analyze the validity of the Kinect v2 for assessing the kinematics of three functional knee movements.An intelligent program was developed for real-time kinematic evaluation of the knee joint using the Kinect v2 system.Based on image recognition technology,images from the Kinect v2 depth camera were used to develop a kinematic evaluation program for knee joint movements.The kinematics of 30 healthy volunteers during stair ascent and descent,squatting,and lunging movements were collected synchronously with both VICON and Kinect systems.The peak knee angles in the sagittal and coronal planes were extracted and analyzed.A paired samples t-test and the relative coefficient within the groups were used for statistical analysis of the validity of the Kinect compared to the VICON.There was no significant difference(p>0.05)in bilateral knee flexion angle when lunging.No significant difference(p>0.05)was found in left knee flexion during squatting exercises.Although the Kinect generally underestimated knee flexion and valgus,it displayed excellent consistency and good to excellent agreement with the VICON motion analysis system.The results demonstrated that the Kinect based measurement tool for analyzing knee kinematics has the potential to be an effective clinical training device for maintaining knee alignment during exercise.

Cancer Rehabilitation,A New Discipline Based upon Multidisciplinary Collaboration

Cancer Rehabilitation is a new discipline,a combination of tumor medication,immunology,psychology,nutritional science and exercise physiology etc..The core of cancer rehabilitation is the therapy of natural immunology,which aims at activating T-cells,and restoring the bone marrow function impaired during chemo-radiation therapy.Cancer rehabilitation seeks to achieve the gradual recovery of the immune system,which in turn hinders recurrence and metastasis.In addition,with the help of psychological consultation,nutritional and physical exercise guidance,cancer patients may have a better chance at managing the risk of recurrence and metastasis,extending life expectancy with an improved quality of life.

Ventilation function changes in patients with Duchenne muscular dystrophy under and over 12 years of age Analysis of 65 cases

BACKGROUND：Previous studies indicate that vital capacity in patients with Duchenne muscular dystrophy increases with age when they are under 12 years old, and decreases from 13 or 14 years of age; however, recent studies indicate that the vital capacity in patients with Duchenne muscular dystrophy begins to decrease even before 12 years of age. OBJECTIVE： To verify if the vital capacity in patients with Duchenne muscular dystrophy decreases before the age of 12 years and to observe the effect of rehabilitation exercise on vital capacity. DESIGN, TIME AND SETTING： The case analysis was performed at the Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University （Guangzhou, Guangdong Province, China） from December 2004 to January 2006. PARTICIPANTS： Sixty-five male patients diagnosed as having Duchenne muscular dystrophy and who underwent pulmonary ventilation function examination at the Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University （Guangzhou, Guangdong Province, China） from December 2004 to January 2006; ages ranged from 6 to 22 years old. METHODS： The ventilation function of 65 patients was determined using a Sensor Medics 2100 pulmonary function test apparatus （USA）, and the data obtained were subjected to statistical analysis comparing patients under 12 years of age and those above 13 years of age, and comparing those who performed rehabilitation exercise with those who did not. MAIN OUTCOME MEASURES： Forced vital capacity （FVC）; forced expiratory volume in one second （FEV1）; maximal voluntary ventilation （MMV）; the ratio of forced expiratory volume in one second and forced vital capacity （FEV1/FVC）; each measured value as a percentage of the corresponding predicted value. RESULTS： There were no significant differences in FVC, FEV1 and MMV between patients under 12 years of age and those above 13 years of age （P 〉 0.05）. The FVC, FEV1 and MMV values, as percentages of the predicted values, were, in patients under 12 years old, significantly higher than those in patients older than 13 （P 〈 0.05）. All ventilation function parameters except FEV1/FVC in patients undergoing rehabilitation exercise were higher than those in patients without rehabilitation exercise. This difference was not significant in patients under 12 years of age, but was statistically significant in those older than 13 years （P 〈 0.05）. CONCLUSION： Although the values of ventilation function measured increase with age in Duchenne muscular dystrophy patients less than 12 years of age, real ventilation function is already damaged. Thirteen years of age is an important time point for pulmonary function change. Rehabilitation exercise can slow down the process of pulmonary function exacerbation in Duchenne muscular dystrophy patients, especially when therapy starts before 12 years of age.

The role of exercise in rehabilitation of discharged COVID-19 patients

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)mainly caused pneumonia and pulmonary fibrosis through upper respiratory tract infection,which resulted in acute respiratory distress syndrome(ARDS)and multiorgan damage of cardiovascular,nervous,digestive,and genitourinary systems.Although the virus test turned negative after the patient recovered,the damage to multiorgan caused by SARS-CoV-2 may irreversible.Therefore,the health status of the recovered patients has gradually become the focus of people's attention.Whether coronavirus disease 2019(COVID-19)patients can receive exercise rehabilitation training after discharge?and what's the basis?We try to analyze and answer these questions,will provide some ideas about the patients to develop a reasonable and effective exercise rehabilitation program.

Study on effect of exercise rehabilitation combined with self-management intervention therapy in patients with heart failure

Background Exercise rehabilitation and self-management intervention therapy models have been confirmed beneficial for patients with acute myocardial infarction,but the effect remains unclear for heart failure(HF)case.Methods This study included 72 patients with HF admitted to the Guangdong Provincial People.s Hospital from 2017 to 2020.According to whether the patients were admitted to the hospital before the establishment of the Heart Failure Center(in 2019)or not,patients were assigned to either the control group(n=31)or the combined treatment group(n=41).The patient.s treatment process data were mainly collected through the inpatient system.Endpoints and in-hospital events were recorded.Multivariate Poisson regression was used to evaluate the difference between two groups.Results Baseline data,including gender,age,height,weight,systolic blood pressure,diastolic blood pressure,cardiac function classification,and medication prescription,demonstrated no significant difference between two groups.During hospitalization,there were no deaths in both groups.Analysis showed that the median duration of edema symptoms in the combined treatment group was significantly shorter than that in the control group[3(2-5)days vs.5(4-8)days,respectively,RR:0.73,95%CI:0.62-0.87,P<0.001].At the same time,the median hospital stay of patients in the combined treatment group was also significantly shorter than that in the control group[7(5-8)days vs.9(7-13)days,respectively,RR:0.57,95%CI:0.45-0.72,P<0.001].Conclusions Exercise rehabilitation combined with self-management intervention in patients with HF may accelerate the regression of patients.edema and shorten the length of hospital stay.

Design of Rehabilitation Robot with Combined Movement of Arms and Legs

Rehabilitation instruments are effective tools for patients to recover from disability. However, we still do not have a rehabilitation instrument which could provide combined movement with arms and legs. Rehabilitation with combined movement of arms and legs is completely a new method. In order to check the effect of this new rehabilitation method and to provide patients with more efficient rehabilitation instrument, we design a new rehabilitation robot. This robot lets patients practice when they lie down and stand up. This article explains the design of this instrument clearly. Using Unigraphics NX software to build 3D model, we have a complete design of this rehabilitation robot.

Application Status of Chinese Medicine on Cancer Rehabilitation: A Preliminary Questionnaire Survey

Objective:To investigate the application status of Chinese medicine(CM)in cancer rehabilitation,so as to provide references for improving the level of CM cancer rehabilitation.Methods:A survey questionnaire regarding"application status of CM rehabilitation in cancer patients"for oncologists(doctor version)and cancer patients(patient version)were developed,respectively.From September 2014 to November 2016,a total of 1,000 doctors from oncology department in 48 hospitals and 2,000 cancer patients from CM oncology department from 8 hospitals in China were recruited in this survey.The psychological,nutrition and exercise rehabilitation guidance for cancer patients provided by doctors,their mastery conditions regarding cancer staging treatment and CM syndrome differentiation,and recommendation from doctors on CM rehabilitation were investigated.Cancer patients’awareness on the importance of psychological,nutrition and exercise rehabilitation,as well as their knowledge and needs for rehabilitation were also analyzed.The impact of gender,age,professional title,hospitals grades of physicians on their knowledge of cancer staging treatment and CM syndrome differentiation,and the relationship between gender,age,education level and economic conditions and patient’s knowledge along with the needs of CM rehabilitation were further analyzed.Results:Totally 1,000 questionnaires were issued to doctors and 963 questionnaires returned,among which 948 were valid representing a response rate of 94.80%.A total of 2,000 questionnaires were issued to patients and 1,705 valid data finally returned with a response rate of 85.25%.The survey showed that cancer patients generally paid much attention to psychological,nutritional and sports rehabilitation,and had a strong demand for CM rehabilitation.Knowledge of CM rehabilitation was not well provided by oncologists,and the rehabilitation guidance as well as CM rehabilitation measures were obviously insufficient in cancer patients.Educational and economic levels were positively correlated with cognition level of CM rehabilitation knowledge among cancer patients(Kendall-tau_b correlation coefficients=0.130,0.057,respectively;P<0.05).Gender and education level were positively correlated with the patients’willingness for taking CM measures(Kendall-tau_b correlation coefficient=0.057,0.105,respectively;P<0.05).Age was negatively correlated with intention of applying CM measures(kendall-taub correlation coefficient=–0.105,P<0.05).Conclusions:Health education and professional training for both cancer patients and oncologists should be strengthened and CM rehabilitation knowledge among cancer patients and oncologists should be improved,so as to give full play to CM in cancer rehabilitation.

Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure

Acute-on-chronic liver failure(ACLF)is a syndrome in which acute liver failure with extrahepatic organ failure occurs on chronic liver disease.Recently,liver transplantation is the only effective treatment for ACLF.There is still room for discussion on the optimal surgery timing for ACLF,perioperative infection prevention and control,and maintenance of nutrition and organ function.The Transplantation Immu-nology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association and Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Association invited relevant experts to discuss the perioperative management of ACLF liver transplantation in areas including surgery timing,organ protection,nutritional support,infection prevention and control,rehabilitation exercises,regulation of the internal environment,etc.An expert consensus was developed as reference for clinicians.