2015: David Anekwe
David Anekwe from McGill University is the fourth recipient of the Cardiorespiratory Division Student Research Award. Abstract included below and reprinted with author’s permission.
Pictured from left to right: Jadranka Spahija, David Anekwe & Trisha Parsons (chair of the Cardiorespiratory Division).
VALIDITY AND CORRELATION OF THE MAT-sf WITH PHYSIOLOGICAL PARAMETERS IN PEOPLE WITH COPD
Authors: Anekwe D, Owen B, de Marchie M & Spahija J.
Purpose: To assess the concurrent validity of the MAT-sf & its correlation with physiological parameters in people with COPD
Relevance: Functional capacity is an important outcome in pulmonary rehabilitation. Paper based self-reported measures (PBSRM) are used to assess functional capacity but ambiguity of contextual factors can alter the respondent’s judgement. The Mobility Assessment Tool-short form (MAT-sf) is a video animated self-reported measure that was developed in older adults to address the shortcomings of PBSRM. This instrument has not been validated in people with COPD.
Methods: Twelve individuals with stable COPD were recruited. Using a cross-sectional design, participants completed pulmonary function tests, the 36-Item Short Form Health Survey (SF-36), the MAT-sf, a 6-minute walk test (6MWT) and a cycle incremental exercise test.
Analysis: Spearman’s correlation co-efficient was determined between the MAT-sf and the subscales of the SF-36, 6MWD, peak oxygen consumption (peak VO2), maximum exercise workload (WLmax), FEV1, FEV1/FVC, and body max index (BMI).
Results: Eleven participants (mean age 66±7 years, FEV1 49±16%) completed the study. The MAT-sf had a strong correlation with the 6MWT distance (r=0.91, p<0.001), the physical function subscale of the SF-36 (r = 0.85, p = 0.001), and a moderate correlation with the peak VO2 (r=0.68, p=0.032). No relationship was found between the MAT-sf and WLmax, other subscales of the SF- 36, and with physiological parameters of FEV1, FEV1/FVC and BMI.
Conclusion: The MAT-sf is a valid measure of functional capacity in people with COPD, and may serve as a feasible alternative to PBSRM of physical function.
2014: Cynthia Otfinowski
Cynthia Otfinowski from McGill University was the third recipient of the Cardiorespiratory Division Student Research Award. Abstract included below and reprinted with author’s permission.
Pictured from left to right: Cathy Anderson (co-chair of the Cardiorespiratory Division), Cynthia Otfinowski, Jadranka Spahija & Tom Overend (co-chair of the Cardiorespiratory Division).
THE RELATIONSHIP BETWEEN DEPTH OF BREATHING AND WALKING SPEED IN INDIVIDUALS POST-STROKE
Authors: Otfinowski C, Fung J, and Spahija J.
Purpose/Objectives & Rationale: Consequences of a stroke may include reduced depth of breathing and walking speed. As stroke impairments lead to higher oxygen cost in walking, treating these impairments may improve exercise capacity. Depth of breathing increases with fast walking in healthy people but it is unknown if this adaptation occurs post‐stroke. The purpose of this study was to evaluate if an interaction between tidal volume and walking speed occurs in people post‐stroke, compared to healthy adults.
Relevance: Understanding the relationship between walking speed and tidal volume may provide insight into limitations of exercise capacity and community ambulation in people post‐stroke.
Materials and Methods: Twelve participants with a unilateral, chronic stroke and 11 sex‐ and age‐matched control participants performed one session of four randomized walking trials on a self‐paced motorized treadmill at two different pace (comfortable or fast) and breathing (quietly or deeply) conditions. Tidal volume and respiratory rate were measured with a pneumotachograph while gait parameters (walking speed, step length) were captured and analyzed with a VICON motion analysis system.
Analysis: The interaction between tidal volume and walking speed was analyzed using two‐way repeated measures ANOVA.
Results: Most participants post‐stroke (75%) trended toward increased walking speed >0.055 m/s (% change=20%) with increased depth of breathing during the comfortable pace condition but the interaction was not significant (p=0.14). Conversely, fast (compared to comfortable) pace while deep breathing decreased tidal volume by 8% (p=0.003) with an interaction effect (p=0.02).
Conclusions: Walking at a comfortable pace and deep breathing may be beneficial for people post‐stroke to optimize tidal volume and walking speed.
2013: Sunny Ma
Sunny Ma from Queen's University was the second recipient of the Cardiorespiratory Division Student Research Award. Abstract included below and reprinted with author’s permission.
PHYSIOTHERAPISTS IN HEMODIALYSIS UNITS - FACILITATORS OF EXERCISE REHABILITATION PROGRAMS FOR ONTARIANS LIVING WITH END-STAGE RENAL DISEASE
Authors/Auteurs: Ma S,* Lui J,* Brooks D,† Parsons TL.*
*Queen's University, School of Rehabilitation Therapy, Kingston, ON; †University of Toronto, Department of Physical Therapy, Toronto, ON.
Purpose & Objectives / Intention & objectifs: The primary objective is to characterize the prevalence and nature of exercise rehabilitation programs in hemodialysis facilities across Ontario. Exercise can effectively improve aerobic fitness, muscle composition, and quality of life amongst persons with end-stage renal disease who require long-term hemodialysis treatments. Yet surprisingly, rehabilitation services and physiotherapists are rarely involved in the care provided to these patients.
Relevance/Pertinence: This study is the first in Canada to report on the prevalence of hemodialysis units with exercise programs. This is important information to bring to physiotherapists as they play a key role in the management of chronic kidney disease.
Materials & Methods/Matériel & méthods: We used FluidSurveys(Trademark) to create an online survey containing questions regarding each hemodialysis unit’s renal program and its exercise components. We distributed the survey with an online consent form via email to 95 dialysis facilities across Ontario as identified from the Canadian Organ Replacement Register.
Analysis/Analyse: Survey answers were reported as a ratio between the frequency count of each response and the total number of respondents.
Results/Résultats: We received responses from 58 dialysis facilities, yielding a 61% response rate. Of those, only 8 facilities offered exercise programs, which included intradialytic and cardiac rehabilitation programs. Patient education regarding exercise and the presence of an exercise specialist such as a physiotherapist appeared to be missing elements of the 50 non-exercise facilities.
Conclusions: Introducing a physiotherapist to the dialysis team for safe exercise prescription and monitoring may be a key to offering more exercise options to Canadians living with end-stage renal disease.
Keywords/Mots clés: Hemodialysis, End-stage renal disease, Exercise rehabilitation, Physiotherapist
2012: Anuradha Sawant
Anuradha Sawant was the first recipient of the Cardiorespiratory Division Student Research Award. Anu is a physiotherapist at London Health Sciences Centre and a PhD candidate at Western University. Abstract included below and reprinted with author’s permission.
Pictured from left to right: Cathy Anderson (co-chair of the Cardiorespiratory Division) & Anuradha Sawant.
EXERCISE AS AN ANABOLIC INTERVENTION IN PEOPLE ON MAINTENANCE HEMODIALYSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Sawant A,*† Overend T.‡
*Graduate Program in Health and Rehabilitation Sciences, Physical Therapy Field, ‡School of Physical Therapy, The University of Western Ontario; †London Health Sciences Center, London, Ont.
Purpose/Objectives and Rationale: People with end-stage kidney disease on maintenance haemodialysis (MHD) encounter multiple catabolic processes resulting in muscle atrophy and loss of muscle mass, a proxy for strength and function. Muscle wasting is one of the most significant predictors of morbidity and mortality in this population. The objective of this study was to systematically review the literature on the effect of exercise on muscle mass in adults on MHD.
Relevance to Physiotherapy Practice: Physiotherapy practice includes maintenance and/or restoration of impaired structure and function. Prevention of muscle wasting is thus important clinically and to reduce health care costs.
Materials and Methods: Electronic databases were searched from inception to September 2011. Inclusion criteria included randomized clinical trials published in English, with adult participants on MHD undergoing an exercise intervention, and muscle mass measured as an outcome.
Analysis: Included studies were combined in a meta-analysis. An effect size and 95% confidence interval (CI) of efficacy of exercise intervention was computed using a random effects model. Effect sizes for two moderator variables (type of intervention and measurement tool used for assessing muscle mass), were compared.
Results: The effect size of exercise intervention on muscle mass was statistically significant [0.256 (95% CI, 0.037–0.474)]. The differences in effect sizes for exercise intervention and type of measurement tool were not statistically significant.
Conclusions: These results indicate a small but significant anabolic effect of exercise interventions on muscle mass in people on MHD. Specifics of intensity and duration of exercise leading to increments in muscle mass requires further investigation.