Search Results (259)

Background/Objectives: The 2-minute walk test (2MWT) is a time-based gait assessment commonly employed for populations with limited walking ability for greater tolerability compared to the longer 6-minute test. The recommended distance to perform the tests is a 30 m straight path, a space requirement that is not always available in non-laboratory contexts. Shorter paths are therefore often adopted, but associated changes in gait patterns are not clear. The aim of the study is therefore to investigate how different walking path lengths affect gait patterns during the 2MWT. Methods: Twenty healthy young adults performed three walking trials on a straight hallway of 5 m, 15 m, and 30 m lengths. Spatiotemporal gait parameters were measured using three inertial measurement units on both distal tibiae and at pelvis level. Results: The 5 m path showed the greatest deviations, specifically in walking distance, walking speed, stride duration, stance time, swing time, single support time, and cadence, if compared to longer distances (p < 0.05). The 15 m path showed differences only in walking distance and walking speed (p < 0.05), if compared to the 30 m path. Conclusions: Shorter path lengths, particularly the 5 m, significantly impact gait patterns and should be considered when interpreting 2MWT results in clinical settings. The 30 m path is recommended as the gold standard, with 15 m as a viable alternative for assessing temporal parameters. Nevertheless, the extent to which each feature would be over/underestimated when walking in limited spaces is also addressed. Full article

The ability to walk is essential in daily life, making walking outcomes key measures in clinical practice. This study aims to develop and validate two novel stride length model-based approaches for total distance estimation using a smart insole. Eight participants wore a pair of smart insoles. For a period of six minutes, each participant walked back and forth on a predefined 20 m pathway, and the numbers of round trips and strides taken were counted. Two stride length estimation approaches based on the director coefficients of acceleration data (Approach 1) and dynamic time warping (Approach 2) using smart insoles were used. The median accuracies of the total distance using Approach 1 are 98.92% [1.24%] (ICC = 0.992) and 98.69% [2.44%] (ICC = 0.994) for the right and left sides, respectively. For Approach 2, the average accuracies are 98.95% [0.18%] (ICC = 0.996) for the right side and 99.03% [0.14%] (ICC = 0.991) for the left side. The Mann–Whitney U test shows no statistically significant difference between the actual distance and smart insole for the total distance covered. Furthermore, there is no statistically significant difference between Approach 1 and Approach 2 for stride length. Although the sample size was small, the estimated total distance using the novel model-based algorithms appears to be accurate in comparison to the actual total distance. Full article

Heart failure with reduced ejection fraction (HFrEF) continues to impose a high burden of morbidity and mortality despite significant advances in pharmacologic and device-based therapy. Cardiac resynchronization therapy (CRT) and angiotensin receptor–neprilysin inhibitors (ARNIs) have independently demonstrated substantial benefits in symptoms, health-related quality of life (HRQoL), and survival. Cardiac rehabilitation (CR), incorporating structured exercise, education, and lifestyle optimization, is well established as an effective intervention in HFrEF, yet its role in the era of combined CRT and ARNI therapy remains insufficiently characterized. This literature review synthesizes current evidence on CR in HFrEF populations receiving CRT, ARNI, or both, highlighting its impact on HRQoL, exercise capacity, and functional outcomes. Across diverse study designs—including randomized trials, observational cohorts, and meta-analyses—CR consistently yielded clinically meaningful improvements in patient-reported HRQoL and objective measures such as six-minute walk distance (6MWD) and peak oxygen uptake. Data directly evaluating CR in patients concurrently receiving both CRT and ARNI are lacking; indirect evidence suggests CR is compatible with, and may add to, contemporary device and drug therapy. However, referral rates remain low, indicating an implementation gap despite strong evidence of benefit. The review underscores the importance of integrating CR into contemporary HFrEF care and identifies a pressing need for targeted prospective studies to define its role in patients receiving dual device–pharmacologic therapy. Full article

Objective: To synthesize the available evidence on field tests used to assess functional capacity in children with CLDs other than asthma, such as cystic fibrosis (CF), and non-CF bronchiectasis (NCFB). Still, the application and reliability of the field tests in non-asthmatic pediatric CLDs populations is scarce. Methods: Three databases (PubMed, Medline via EBSCOhost, and Web of Science) were searched from inception to 20 May 2025. Two researchers independently screened the retrieved articles and rated the methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Information was extracted about study design, field test used, outcomes measured, and methodological quality. Results: Out of 784 records, 8 studies met the inclusion criteria. Most studies focused on CF. Five different field tests were identified: six-minute walk test (6MWT), modified shuttle walk test (mSWT), one-minute sit-to-stand test (1mSTS), three-minute step test (3mST), and TGlittre-P test. The 6MWT (n = 3) and mSWT (n = 2) were the most frequently used and demonstrated good reliability and clinical applicability. Reported outcomes included distance walked, total steps, task’ repetitions, and cardiopulmonary parameters, such as heart rate and perceived exertion of dyspnea/leg fatigue. Conclusions: Field exercise tests appear to be feasible in children with CLDs other than asthma, with most data available in CF. They can be used to monitor functional capacity over time, to assess the effectiveness of rehabilitation programs, and to complement symptom assessment with tools such as the Borg scale. Evidence in NCFB and PCD is still limited, and additional pediatric studies are needed. Full article

Background: This study aims to investigate and monitor cardiorespiratory fitness levels, measured by the 6-minute walk test (6MWT) and quality of life (QoL), assessed using the Short form-36 (SF-36), in patients with hypertension, both with and without coronavirus disease 2019 (COVID-19), at a 3-month follow-up. Methods: Sixty participants were recruited, comprising two groups: hypertensive patients with COVID-19 and hypertensive patients without COVID-19, with 30 individuals in each group. Cardiorespiratory response parameters were assessed before and after performing the 6MWT. QoL was evaluated using the SF-36 at baseline and again at 3 months. Results: Hypertensive patients who recovered from COVID-19 showed significant improvements, including reduced post-exercise HR, SBP, SpO₂, RPE, and leg fatigue, as well as increased 6MWT distance and enhanced QoL compared to baseline (p < 0.05). These parameters improved and returned to levels similar to those of hypertensive patients without COVID-19 by the 3-month follow-up. Conclusions: Hypertensive patients who have recovered from COVID-19 can achieve cardiorespiratory fitness and QoL levels comparable to those of hypertensive individuals who did not contract COVID-19 by the 3-month follow-up. Full article

Pulmonary hypertension (PH) with chronic obstructive pulmonary disease (COPD) is associated with poor survival with no approved therapies. We report on the response to inhaled treprostinil (iTRE) of a small retrospective cohort of PH-COPD patients with a baseline “PH-right ventricular (RV) phenotype”, defined by a RV-dependent circulatory limitation derived from a combination of echocardiographic and hemodynamic criteria. Patients were started on inhaled treprostinil with significant improvement in six-minute walk distance, NT-proBNP, and improved RV metrics by echocardiography. The preliminary findings of this cohort provide evidence for the importance of precision phenotyping of PH-COPD. Full article

As the core spatial carriers for teaching, research, and academic exchange, university campuses have long been central subjects in architectural design research. As a distinct phenotypic type of university campus, the grid-type campus has gradually gained academic attention due to its modular characteristics, horizontal expandability, and flexible organization—with advantages including improved spatial efficiency, enhanced interdisciplinary interaction, and stronger adaptability. In this study, a typological analysis was performed on 23 representative global grid-type campuses to explore their planning concepts and module selection criteria. Research data were collected from literature reviews, architectural drawings, and Google Maps (Web) satellite images and visualized and analyzed using Origin Pro 2021. Results show that campus module selection is primarily influenced by three factors: walking distance, functional requirements, and structural systems. At the master planning level, module selection aligns with the “five-minute walking radius” standard, and campus scale is generally controlled within 500 × 350 m. At the architectural level, functional needs determine that module sizes typically range from 50–90 m or 7.2–10 m. At the structural level, module ranges are usually 7–18 m, depending on usage requirements and structural systems. This study’s findings can provide theoretical support and practical references for the planning, design, and module selection of future grid-type university campuses. Full article

Introduction: Rheumatoid arthritis (RA) is known to affect the musculoskeletal system and, consequently, may lead to sarcopenia, but the role of respiratory muscle involvement in RA patients is unclear. Methods: This prospective, exploratory, single-center, matched-pair analysis study was designed to compare respiratory muscle strength and handgrip strength in RA patients and controls. Results: RA patients with low disease activity as estimated from the Disease Activity Score 28 (2.3 ± 1.2) and without signs of interstitial lung disease (n = 36, 72% female, 28% smoker, mean age 48 + 15 years, mean forced vital capacity 3.9 ± 1.0 L, 98% ± 11% predicted) and control subjects (n = 36, 72% female, 11% smoker, mean age 48 + 14 years, mean forced vital capacity 4.1 ± 1.1 L, 98% ± 16% predicted) were well balanced. Maximal inspiratory mouth pressure (PImax, primary endpoint) tended to be lower in RA patients, but this was statistically not significant (−0.9 kPa; 95%CI = −2.11/0.32). However, RA patients more frequently had PImax values below the lower limit of normal (OR 1.74 kPa; 95% CI 0.65/4.77). RA patients had lower handgrip strength (−5.97 kg; 95%CI = −9.43/−2.50). In addition, PImax was correlated to handgrip strength both in RA patients (R = 0.51, p = 0.0017) and controls (R = 0.48, p = 0.0029) and to the 6-minute walking distance (RA-patients: R = 0.30, p = 0.075; controls: R = 0.52, p = 0.0012). Conclusions: Even though the primary endpoint has not been reached, an impairment of respiratory muscle strength in RA cannot be excluded at least in a subset of patients. Further studies also involving RA patients with more disease activity are needed. Full article

Background: Immediately after discharge from hospital, COVID-19 patients have poor physical function and impaired performance in activities of daily living. Persisting symptoms and cognitive impairments have been reported, but the long-term impact on objectively measured physical activity (PA) in patients hospitalized for COVID-19 is not clear. Methods: A prospective cohort study was conducted to compare objectively measured PA and physical function 12 months post discharge in patients who were hospitalized for COVID-19 with age- and sex-matched healthy controls and to elucidate the impact of ICU admission on these outcomes. PA was objectively assessed using accelerometry in patients, healthy controls, and in a subset of partners of patients. Additionally, lung function, physical function (six-minute walk distance (6 MWD) and isometric quadriceps and handgrip force), symptom experience, and health-related quality of life (HRQoL) were evaluated in patients with and without ICU admission. Results: Included in the study were 101 patients (60 ± 10 years, 69% male), 36 healthy controls (60 ± 9 years, 58% male), and 14 partners (55 ± 8 years, 21% male). Daily step count and movement intensity (MI) during walking in patients were significantly lower compared with healthy controls (6726 ± 328 vs. 8155 ± 555 n.day⁻¹, p = 0.03 and 1.99 ± 0.04 vs. 2.21 ± 0.07 min/s².day⁻¹, p = 0.005). PA levels of patients and their partners were comparable. Physical function, symptom experience, HRQoL, and PA levels were comparable in patients with and without ICU admission (p > 0.05). Daily step count was weakly positively associated with 6 MWD (r = 0.30). Conclusions: One year post discharge, patients had lower PA levels than healthy controls. ICU admission did not affect physical function, symptoms, HRQoL or activity levels. Full article

Background: Patients with early-stage (I–IIIA) resectable non-small cell lung cancer (NSCLC) often experience reduced physical activity (PA) after surgery. PA telecoaching may support a more active lifestyle, but evidence in this population is limited. Objective: To evaluate acceptability, feasibility, safety, and actual usage of an automated and manual PA telecoaching program following surgery for NSCLC. Methods: In this multicenter, single-blind study, patients received either an eight-week automated coaching program (ACP) with a customized smartphone app or a manual coaching program (MCP) with weekly phone calls from a coach. Both groups used an activity tracker, linked to their smartphone, to monitor steps and receive feedback. Primary outcomes included acceptability, feasibility, safety and usage, assessed via questionnaires and interviews. Secondary outcomes included objectively measured PA (accelerometry), functional exercise capacity (six-minute walk distance) and symptoms (dyspnea, fatigue) and quality of life, evaluated via questionnaires. Results: Nineteen patients (12 males; 68 ± 6 years; baseline daily steps 7820 ± 2799) were included. The majority (18/19) found the intervention enjoyable, and a minority (6/19) reported minor smartphone issues. All patients wore the activity tracker consistently. No adverse events occurred. The ACP required significantly less coach contact time compared to the MCP (25 ± 14 vs. 54 ± 15 min, p = 0.0003). No other differences in primary outcomes were observed between groups. Changes in secondary outcomes were limited in both groups. Conclusion: PA telecoaching is feasible, well accepted, and safe in patients with NSCLC post-surgery, with excellent activity tracker adherence. The ACP required less coach involvement. However, increasing PA remains challenging, and no conclusions can be made about the effectiveness of telecoaching. Future research should explore longer interventions in larger populations to assess efficacy and long-term outcomes. Full article

Background: Obesity affects over one billion people globally. Bariatric surgery is the most effective long-term intervention for severe obesity. However, postoperative outcomes can vary considerably, with such factors as baseline fitness and cardiorespiratory reserve influencing surgical outcomes. This systematic review aimed to evaluate the effects of preoperative exercise or physical activity, compared to standard care or no intervention, on preoperative fitness parameters and perioperative surgical outcomes in adults with obesity undergoing metabolic and bariatric surgery. Methods: A systematic review was conducted in accordance with the recommendations of the Cochrane Handbook and the PRISMA guidelines. Randomized controlled trials, non-randomized controlled trials, and cohort studies with control groups evaluating preoperative exercise interventions were included. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment using Cochrane tools. Meta-analyses were performed using random effects models, with standardized mean differences calculated for continuous outcomes. Evidence certainty was assessed using the GRADE approach. Results: A total of 15 studies, including 1378 participants, were identified for qualitative synthesis, with 12 contributing data for quantitative meta-analysis. Preoperative exercise interventions significantly improved six-minute walk test distance (SMD 2.01; 95% CI: 0.51 to 3.50; p = 0.009) and VO₂ peak (SMD 1.02; 95% CI: 0.52 to 1.51; p < 0.0001). BMI reduction was significant (SMD −0.96; 95% CI: −1.75 to −0.16; p = 0.02), while weight change was not statistically significant (SMD −0.81; 95% CI: −1.72 to 0.09; p = 0.08). One study reported a reduction in hospital length of stay of 0.64 days (95% CI: −0.86 to −0.42; p < 0.00001). Evidence certainty was rated as very low to low across all outcomes. Conclusions: Preoperative exercise interventions have been shown to significantly improve cardiorespiratory fitness in bariatric surgery candidates, with large effect sizes for functional capacity measures. Despite the low certainty of the evidence, these findings suggest that supervised exercise programs should be incorporated into the preoperative care of bariatric surgery patients. Full article

Tuberculosis (TB) continues to be the world’s deadliest infectious disease, with an estimated 10.8 million new cases reported in 2023, of which India alone accounted for 28% of the global burden. This study aims to evaluate the impact of tuberculosis on pulmonary function and exercise tolerance, and to examine how these impairments affect health-related quality of life (HRQoL). In a cross-sectional design, 96 bacteriologically confirmed TB patients and 96 age- and sex-matched community controls underwent spirometry, six-minute-walk test (6 MWT), and HRQoL evaluation. DR-TB was detected in 27 patients (28.1%): Isoniazid monoresistance 59.3%, rifampicin monoresistance 11.1%, and XDR-TB 29.6%. Dyspnoea (70.8%) and cough (37.5%) were the most commonly reported symptoms among TB patients. Mean values of FEV₁, FVC, and FEV₁/FVC were significantly lower in TB patients compared to controls (62.8%, 65.97%, and 70.08% vs. 82.55%, 80.09%, and 78.08%, respectively; p < 0.001). Recurrent or DR-TB was associated with reduced spirometric indices and 6 MWT distances (241 m vs. 358 m in drug-sensitive TB). St. George’s respiratory questionnaire (SGRQ) scores indicated significantly poorer health-related quality of life (HRQoL) in patients compared to controls across all domains—symptoms (23.7 vs. 10.7), activity (33.3 vs. 14.2), and impact (20.6 vs. 9.4; p < 0.05). SGRQ scores were inversely correlated with lung function parameters (r = −0.42 to −0.56). These findings underscore the persistent health burden TB poses post-therapy, highlighting the need for routine post-TB functional screening and robust DR-TB control to achieve End-TB goals. Full article

Background: Minimally invasive direct coronary artery bypass (MIDCAB) surgery offers advantages over off-pump coronary artery bypass (OPCAB), including reduced trauma and faster recovery. However, differences in perioperative cardiac rehabilitation (CR) outcomes between MIDCAB and OPCAB remain unclear. This study compared perioperative clinical characteristics, surgical features, and CR outcomes in patients undergoing MIDCAB versus OPCAB. Methods: This retrospective cohort analysis included 304 patients (31.2% MIDCAB, 68.8% OPCAB) who participated in a CR program, including the 6-min walk test (6MWT), from November 2023 to December 2024. Results: MIDCAB patients had shorter surgery times, fewer grafted vessels, shorter ventilator-assisted time, less total intraoperative fluid, less bleeding, and shorter postoperative hospital stays (all p < 0.05). After cardiac rehabilitation, MIDCAB patients showed shorter time to 6MWT, longer six-minute walk distance (6MWD) (200 ± 125 vs. 178 ± 125 m), higher 6MWD relative to predicted values, and greater metabolic equivalents (all p < 0.05). The median LVEF of MIDCAB patients was the same as that of OPCAB patients (p < 0.05). Conclusions: Our study demonstrates that MIDCAB patients exhibit superior exercise capacity following cardiac rehabilitation. Full article

Background: Spinal muscular atrophy (SMA) is a neurodegenerative disorder caused by variants in the SMN1 gene. This study investigates the functional and biochemical effects of moderate-intensity aerobic exercise in SMA Type III patients. Methods: Twenty-three patients aged 18–57 years were included in this study. The training group underwent a 12-week aerobic exercise program using a bicycle ergometer at 60–70% of their maximum heart rate three times per week for 30 min per session. The training continued for an additional four months. The primary outcome measures were the six-minute walk distance and oxygen uptake, both reflecting exercise capacity. Secondary outcome measures included muscle strength with dynamometer, functional performance, and fatigue with different scales. Furthermore, serum survival motor neuron (SMN) protein and insulin-like growth factor-1 (IGF-1) hormone levels were measured at baseline, post-training first measurement (after 12 weeks), and post-training second measurement (after 28 weeks). Results: The exercise group showed a significant increase in exercise capacity (p < 0.001) and 6MWT walking distance (p = 0.003). Furthermore, reduction in walking time in the 10-m walk test (p = 0.019) and improvements in strength of the right and left quadriceps (p = 0.004, p = 0.031) and right gastrocnemius (p = 0.034) muscles were identified. Furthermore, an improvement in the Fatigue Severity Scale (FSS) (p = 0.037) was found. SMN protein and IGF-1 levels were increased in the second measurement in the training group (p = 0.022 and p = 0.016, respectively). Conclusions: An aerobic exercise program improved physical function and muscle strength and reduced fatigue in SMA Type III patients, with sustained biochemical improvements. Aerobic exercise may serve as a beneficial adjunct therapy for this population. Full article

Background: To evaluate and compare cardiorespiratory function, assessed by the 6-minute walk test (6MWT), and musculoskeletal function, assessed by the handgrip strength test and the sit-to-stand test (STS10) in post-coronavirus disease 2019 (COVID-19) patients. Participants were stratified based on the time since infection (≤6 months and >6 months) and compared with matched healthy controls. Methods: A total of 111 participants were recruited and divided into three groups (n = 37/group). Cardiorespiratory function was assessed using the 6MWT, while musculoskeletal function was evaluated through the handgrip strength test and the STS10. Results: All three groups had normal body mass index values. Group 2 demonstrated significantly lower handgrip strength and a shorter 6MWT distance compared to both Group 1 and Group 3. Additionally, Group 2 required significantly more time to complete the STS10 than Group 1. Following the 6MWT, Group 2 exhibited significantly higher heart rate and systolic blood pressure compared to both Group 1 and Group 3. Diastolic blood pressure was significantly lower in Group 3 compared to the other two groups. Furthermore, Group 2 had significantly lower pulse oxygen saturation than both Group 1 and Group 3. The rate of perceived exertion was significantly lower in Group 1 than in Group 2. Additionally, leg fatigue was significantly lower in Group 1 compared to both Group 2 and Group 3. Conclusions: These findings highlight significant differences in physical performance and physiological responses between post-COVID-19 patients and healthy individuals, emphasizing the potential long-term effects of SARS-CoV-2 infection on cardiorespiratory and musculoskeletal function. Full article