Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity

BACKGROUND: Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct. METHODS: Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO(2max)). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria. RESULTS: In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO(2max) than controls, but when compared to normative values, patients scored below the 10(th) percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls. CONCLUSION: Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls

Reference values for maximum oxygen uptake relative to body mass in Dutch/Flemish subjects aged 6-65 years: the LowLands Fitness Registry

Background: The maximum oxygen uptake (VO 2max) during cardiopulmonary exercise testing (CPET) is considered the best measure of cardiorespiratory fitness. Aim: To provide up-to-date reference values for the VO 2max per kilogram of body mass (VO 2max/kg) obtained by CPET in the Netherlands and Flanders. Methods: The Lowlands Fitness Registry contains data from health checks among different professions and was used for this study. Data from 4612 apparently healthy subjects, 3671 males and 941 females, who performed maximum effort during cycle ergometry were analysed. Reference values for the VO 2max/kg and corresponding centile curves were created according to the LMS method. Results: Age had a negative significant effect (p <.001) and males had higher values of VO 2max/kg with an overall difference of 18.0% compared to females. Formulas for reference values were developed:Males: VO 2max/kg = − 0.0049 × age 2 + 0.0884 × age + 48.263 (R 2 = 0.9859; SEE = 1.4364)Females: VO 2max/kg = − 0.0021 × age 2 − 0.1407 × age + 43.066 (R 2 = 0.9989; SEE = 0.5775). Cross-validation showed no relevant statistical mean difference between measured and predicted values for males and a small but significant mean difference for females. We found remarkable higher VO 2max/kg values compared to previously published studies. Conclusions: This is the first study to provide reference values for the VO 2max/kg based on a Dutch/Flemish cohort. Our reference values can be used for a more accurate interpretation of the VO 2max in the West-European population

Practical aspects of cardiopulmonary exercise testing in children

The use of cardiopulmonary exercise testing (CPET) in pediatrics provides critical insights into potential physiological causes of unexplained exercise-related complaints or symptoms, as well as specific pathophysiological patterns based on physiological responses or abnormalities. Furthermore, CPET helps evaluate exercise performance in children with chronic (lung/heart) diseases. For instance, it can ascertain any adverse reaction to exercise and estimate the effects of specific treatment measures. It affords a global assessment of the pathophysiological patterns, responses and abnormalities to exercise that is inadequately reflected by resting lung function and/or cardiac function assessment. Clinical interpretation of the results of a CPET in pediatrics requires specific knowledge regarding pathophysiological responses and interpretative strategies that can be adapted to address concerns specific to the child's medical condition or disability

Микротопонимика воинской части. Часть 1.

Целью же данной статьи является выяснение места и значения микротопонимики воинской части в структуре военной субкультуры

Cardiopulmonary Exercise Testing in Pediatrics

Aerobic fitness is an important determinant of overall health. Higher aerobic fitness has been associated with many health benefits. Because myocardial ischemia is rare in children, indications for exercise testing differ in children compared to adults. Pediatric exercise testing is imperative to unravel the physiological mechanisms of a reduced aerobic fitness and to evaluate intervention effects in children and adolescents with a chronic disease or disability. Cardiopulmonary exercise testing includes the measurement of respiratory gas exchange and is the gold standard for determining aerobic fitness, as well as for examining the integrated physiological responses to exercise in pediatric medicine. As the physiological responses to exercise change during growth and development, appropriate pediatric reference values are essential for an adequate interpretation of the cardiopulmonary exercise test

Clinical recommendations for cardiopulmonary exercise testing in children with respiratory diseases

Introduction: Cardiopulmonary exercise testing (CPET) quantitates and qualitates the integrated physiological response of a person to incremental exercise and provides additional information compared to static lung function tests alone.Areas covered: This review covers rationale for the use of CPET parameters beyond the usual parameters like peak oxygen uptake and peak minute ventilation in children with respiratory disease.Expert opinion: CPET provides a wealth of data from rest, submaximal and maximal exercise and data during recovery from exercise. In this review an interpretative approach is described for analyzing CPET data in children with respiratory disease

Design of the muscles in motion study: a randomized controlled trial to evaluate the efficacy and feasibility of an individually tailored home-based exercise training program for children and adolescents with juvenile dermatomyositis

BACKGROUND: Juvenile dermatomyositis (JDM) is a rare, often chronic, systemic autoimmune disease of childhood, characterized by inflammation of the microvasculature of the skeletal muscle and skin. Prominent clinical features include significant exercise intolerance, muscle weakness, and fatigue. Despite pharmacological improvements, these clinical features continue to affect patients with JDM, even when the disease is in remission. Exercise training is increasingly utilized as a non-pharmacological intervention in the clinical management of (adult) patients with chronic inflammatory conditions; however no randomized controlled trials (RCT) have been performed in JDM. In the current study, the efficacy and feasibility of an exercise training program in patients with JDM will be examined. METHODS/DESIGN: Subjects (n = 30) will include 8–18 year olds diagnosed with JDM. The intervention consists of an individually tailored 12-weeks home-based exercise training program in which interval training on a treadmill is alternated with strength training during each session. The program is based on previous literature and designed with a defined frequency, intensity, time, and type of exercise (FITT principles). Primary outcome measures include aerobic exercise capacity, isometric muscle strength, and perception of fatigue. The study methodology has been conceived according to the standards of the CONSORT guidelines. The current study will be a multi-center (4 Dutch University Medical Centers) RCT, with the control group also entering the training arm directly after completion of the initial protocol. Randomization is stratified according to age and gender. DISCUSSION: The current study will provide evidence on the efficacy and feasibility of an individually tailored 12-week home-based exercise training program in youth with JDM. TRIAL REGISTRATION: Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands: 11–336; Netherlands Trial Register (NTR): NTR 3184