Eccentric cycling (ECC) enables high mechanical power output at a low metabolic cost, yet the influence of cadence on cardiorespiratory and neuromuscular responses during ECC remains poorly defined. This study examined the interactive effects of cadence and power output on metabolic, cardiovascular, and muscle activation responses during ECC. Fifteen healthy men performed randomized incremental ECC trials at 50 and 80 rpm, with successive 4-min stages at 80, 200, and 320 W. Oxygen uptake ( V̇O_2) , gross mechanical efficiency (GME), cardiac output ( Q̇_c) , heart rate (HR), stroke volume (Qs), arteriovenous O2 difference (a-v̄O2), and quadriceps electromyographic activity were measured. Data were analysed using linear mixed-effects models with cadence, power output, and their interaction as fixed effects. A significant cadence × power interaction was observed for V̇O_2 (p = 0.006). V̇O_2 was lower at 80 rpm than at 50 rpm at 200 W (− 0.116 L·min−1, p = 0.007) and 320 W (− 0.187 L·min−1, p < 0.001), with no cadence effect at 80 W (p = 0.89). GME also showed a cadence × power interaction (p = 0.035), with lower GME at 80 rpm at 200 W (− 7.3

RATIONALE:Pulmonary arterial hypertension (PAH) leads to heart failure and impaired exercise capacity. Rehabilitation may improve exercise tolerance, but most previous trials were short-term and open-label. OBJECTIVES:To assess the 12-month efficacy and safety of a 3-month supervised rehabilitation program in PAH. MEASUREMENTS AND MAIN RESULTS:Stable patients from nine French PAH centers were enrolled in a prospective cohort without mention of rehabilitation, and thereafter randomized using a Zelen design either to usual follow-up or to a supervised 3-month rehabilitation program, following a second consent for the latter group. The primary endpoint was endurance time at 75% of maximal workload during cardiopulmonary exercise testing at 12 months (NCT02579954).Between 2015 and 2022, 49 patients were enrolled and 47 randomized (mean age 54.7 years; 27 females; 35 idiopathic PAH; mean mPAP 37.1 mmHg; PVR 5.7 UW; CI 3.0 L/min/m2). Twenty-one patients were assigned to rehabilitation. At baseline, 32 were at low risk, with preserved functional capacity (31 had 6-min walk distance >440 m). Mean (SD) endurance time was 8.7 (8.0) min in the rehabilitation group and 8.1 (4.8) min in controls. At 12 months, mean endurance time was 16.8 ± 20.0 minutes in the rehabilitation arm versus 8.0 ± 7.2 minutes in the control arm (adjusted p = 0.047). Clinical worsening risk tended lower with rehabilitation (RR 0.17, 95%CI 0.02-1.27; p = 0.055). No deaths occurred. CONCLUSIONS:In this multicenter trial using a design limiting performance bias, a 3-month supervised rehabilitation program significantly improved exercise endurance at 12 months and may reduce clinical worsening.

BACKGROUND:Cirrhosis induces multi-organ dysfunction, yet the specific physiological determinants underlying reduced cardiorespiratory fitness (CRF) remain poorly defined. AIM:To compare patients with cirrhosis to healthy controls to assess and identify their major CRF physiological contributors. METHODS:Forty-five patients with cirrhosis and 45 age- and sex-matched controls underwent incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. The pulmonary, cardiac, vascular, and muscular components of CRF were measured, including peak oxygen uptake (VO2Peak), ventilatory efficiency (VE/VCO2), oxygen uptake efficiency slope (OUES), and chronotropic response. Non-invasive hemodynamic monitoring (Physioflow) was used to estimate cardiac output and arteriovenous oxygen difference (a-vO2). RESULTS:Patients with cirrhosis exhibited markedly reduced CRF compared with controls (VO2Peak: 15.4 ± 5.5 vs. 29.3 ± 7.5 mL.min-1.kg-1, p < 0.001) and the decline was proportional to Child-Pugh score. Kinetic parameters (OUES, Lowest VE/VCO2, Wilkoff index) were also significantly impaired and chronotropic incompetence was highly prevalent (89%). Cardiac output was preserved but a-vO2 was lower (10.7 ± 3.0 vs. 14.1 ± 1.1 mlO2.dL-1, p = 0.002), indicating a defective peripheral oxygen extraction in patients with cirrhosis. Multivariate regression analysis (r2 = 0.79) identified maximal heart rate and muscle performance (5-sit to stand) as independent predictors of VO2Peak. CONCLUSION:Reduced CRF in cirrhosis appears to primarily result from impaired skeletal muscle oxygen utilization, compounded by chronotropic incompetence. These findings emphasize the value of integrative functional evaluation in cirrhosis management.

Objectives To evaluate and compare the discriminative ability of the TUG, SPPB, and BBS tests for identifying individuals with chronic non-neurological diseases and a previous history of falls. Design Cross-sectional analysis of baseline data from the EVALMOB (Evaluation de la mobilité) cohort. Setting Clinical assessments conducted between March 2020 and December 2023. Participants 430 adults aged 18-90 years (mean age 66.8 ± 10.2 years; 53.5% women; mean BMI 30.2 ± 6.6 kg/m²) with chronic conditions affecting mobility were included; neurological diseases were excluded. 19.1% (n = 82) reported ≥ 1 fall in the past year. Interventions Participants completed TUG, SPPB, and BBS assessments. Quadriceps strength was isometrically measured in Newton-metre (Nm). Participants performed 3 repetitions of maximum effort in a concentric mode. The best result was retained as the peak torque (PT) value and was normalized to patients' weight. Balance confidence (ABC-S) and physical activity (GPAQ) were evaluated using validated questionnaires. Main Outcome Measures Association between previous fall history and TUG, SPPB, and BBS scores (linear regression, structural equation modelling) and discriminative ability of each test and their combinations (ROC/AUC, multinomial logistic regression). Results Fallers had lower quadriceps strength (p < 0.01) and ABC-S scores (p < 0.001); GPAQ did not differ (p = 0.177). After adjustment, previous falls were associated with longer TUG (β = +1.85 s), lower SPPB (β = -1.07), and lower BBS (β = -3.63) (all p < 0.001). Individually, tests showed limited discrimination (AUC 0.57-0.58); combined abnormal TUG+BBS or TUG+SPPB were more strongly associated with previous falls (RRR 4.9 and 2.6). Conclusions Isolated functional tests showed limited discriminative ability for previous falls, but combining abnormal results, particularly TUG and BBS, improved discrimination. Multidimensional assessment is recommended over single-test evaluation in adults with chronic non-neurological diseases. Prospective studies should confirm predictive value for future falls.

INTRODUCTION:Severe COVID-19 infection leads to profound pulmonary, cardiovascular, and neuromuscular impairments, resulting in marked exercise deconditioning and reduced functional walking capacity after hospital discharge. Eccentric cycling offers high mechanical load with low metabolic cost and may therefore represent a relevant rehabilitation strategy to restore functional capacity in people after COVID-19. AIM:To compare functional recovery after 8 weeks of eccentric (ECC) or concentric (CON) training in individuals discharged 1 month previously after a COVID-19 infection. METHODS AND ANALYSIS:The CovExc trial was a multicenter, randomized, controlled, open-label study conducted in 3 centers. Adults (<80 years) at least 1 month after hospital discharge for severe COVID-19 were randomized (1:1) to 8 weeks of ECC or concentric CON ergometer training (3 30-min sessions per week). The primary outcome was change in the 6-minute walk test (6MWT) distance between baseline and post-intervention (M2). Secondary outcomes included physical performance, muscle strength (handgrip), fatigue, and quality of life. Analyses were conducted in the modified intention-to-treat (mITT) population using mixed models. RESULTS:Of the 60 participants enrolled, 56 (median age (IQR): 54.5 (48; 62)) were included in the modified intention-to-treat population, including 33 men (59%). Forty-four participants completed the program. Intergroup analysis showed no significant differences between the ECC and CON for any variable. However, within-group analyses of the primary endpoint (mITT and per-protocol) revealed a significant change between baseline and 2 months (P = 0.002 and P = 0.001 for ECC and CON groups on mITT and P = 0.001 for ECC and CON groups on per-protocol). 6MWT improved by 18 m in ECC (0; 72) and 28 m in CON (0; 53) (median difference -10 m; 95% CI (-42 to 22). CONCLUSION:Both eccentric and concentric training improved walking distance in participants after COVID-19, with no difference between groups. Further randomized controlled trials are needed to confirm the effectiveness of these approaches for people who survived COVID-19. TRIAL REGISTRATION:NCT04649086.

Objective: To investigate the relationship between the occurrence of falls and the time taken to perform the Timed Up and Go (TUG) test in a population of patients with Charcot-Marie-Tooth disease type 1A (CMT1A). Design: We conducted a longitudinal, single-center, exploratory study involving adult patients with CMT1A, followed for 1 year. Physical, functional, and analytical tests, including the TUG test, gait analysis, and muscle strength assessment, were performed at baseline, 6 months, and 12 months. Patients also completed questionnaires on physical capabilities, fatigue, falls, and the impact on quality of life and psychological health. The study was conducted between September 2020 and February 2025. Setting: This study was conducted at a university hospital. Participants: Patients (n=40) included in this study had to be adults, have a molecular biology-confirmed diagnosis of CMT1A, have quadriceps strength >2 of 5, and have a proficient oral and written understanding of French. Interventions: Not applicable. Main outcome measures: The primary outcome was the time (in s) required to complete the TUG test, analyzed according to the frequency of self-reported falls. Secondary outcome measures included balance performance assessed with the Berg Balance Scale (BBS) and walking endurance evaluated by the distance covered during the 6-minute walk test (6MWT). Physical, functional, and analytical tests were conducted at baseline, 6 months, and 12 months. Results: We included 40 patients with CMT1A, predominantly women (62.5%), with a median (interquartile range) age of 52 (42-67) years. Analysis of the TUG test results according to fall frequency revealed no significant difference between groups (no fall, 1-2 falls, and >2 falls) with respect to the median (interquartile range) time: 9.3 (6.9-10.8), 9.0 (7.5-10.4), and 9.5 (7.8-11.0) seconds, respectively (P=.710). Median BBS and 6MWT values at baseline were 52 (47-55) and 422 (335-480) m, respectively, showing no significant change after 1 year of follow-up. Conclusions: When used alone, the TUG test is not a suitable tool for fall risk screening in patients with CMT1A. Balance (BBS) and walking endurance (6MWT) also remained stable over 1 year. Global assessment is crucial for detecting physical impairments and preventing falls. A future study could include a larger sample and a more precise categorization of falls.

PURPOSE:Inasmuch as they are deemed valid, noninvasive measurement of cardiac output techniques present advantages of ease and safety for use in humans. Few studies have compared the use of thoracic bioimpedance and inert gas rebreathing techniques for cardiac output (CO) assessment at rest and exercise. This manuscript reports on differences between Physioflow® and Innocor® CO measurements at rest and during cycling in a population of healthy subjects. METHODS:Fifty healthy subjects (52 ± 16 years) underwent an incremental cycle exercise testing (IET) during which standardized Physioflow® and Innocor® CO assessments were achieved. Measurements were completed in a subgroup of twelve subjects during two constant-load 10-min cycling bouts at moderate and high intensities. RESULTS:Mean difference between Physioflow® and Innocor® was of 0.002 ± 0.98 l/min at rest and 0.38 ± 1.31 l/min during IET without statistical difference. Correlation coefficient values were higher for exercise (r = 0.83) than resting (r = 0.40) measurements. Good reproducibility of the two devices was observed on different graded exercises with intraindividual variability lower than 6%, except for rest Innocor® CO measurements (CV = 18%). CONCLUSION:Physioflow® and Innocor® can be easily used concomitantly for noninvasive measurement of CO. Despite finding a strong agreement between techniques for exercise CO, results should not be interpreted as being interchangeable as values are derived from different flow measurements: systemic blood flow for Physioflow® and pulmonary blood flow for Innocor®. However, the concomitant use of both techniques could be of value in clinical setting for noninvasive intrathoracic shunt quantification.

Despite its well-known benefits, respiratory rehabilitation (RR) remains underutilized among people with chronic obstructive lung disease (COPD) due to both patient- and physician-related barriers. This qualitative study (October 2023-March 2024) used two questionnaires: one for people with COPD to assess disease severity and access challenges, and another for pulmonologists to identify prescription obstacles. Distributed via associations and mailing lists, the survey reached 3,000 people with COPD and 500 pulmonologists, revealing shared concerns about facility shortages, poor information, and transportation issues. Enhancing RR access through better training, patient education, and expanded facilities should be a public health priority.

Muscle weakness is a key contributor to functional limitation in individuals with hip (HOA) or knee osteoarthritis (KOA). Identifying accessible and objective tools to estimate muscle strength could improve clinical assessment and rehabilitation monitoring. This exploratory cross-sectional study investigated the relationship between parameters derived from the instrumented Timed Up and Go test (iTUG), and isokinetic quadriceps and hamstring strength in individuals with KOA or HOA. Thirty-six participants with KOA and 21 with HOA were assessed. Quadriceps and hamstring peak torques were measured at 60°/s using an isokinetic dynamometer. The iTUG was performed with a sacrum-mounted inertial measurement unit. Correlations between iTUG parameters and lower-limb muscle strength were weak-to-moderate in KOA (r = −0.398 to −0.516, p < 0.05) and moderate-to-strong in HOA (r= −0.537 to −0.843, p < 0.05). Total iTUG duration strongly correlated with the traditional stopwatch TUG (r = 0.91, p < 0.01), suggesting that the classic stopwatch-based TUG may offer comparable clinical insights to certain iTUG-derived temporal metrics. The iTUG test reflects lower-limb muscle weakness, especially in HOA, with vertical push-off power and temporal metrics showing the strongest relationships. These results support the use of iTUG as an accessible tool for estimating muscle weakness when isokinetic testing is unavailable. However, these findings should be interpreted with caution given the small sample size.

AbstractThis systematic review summarizes the available evidence on respiratory muscle endurance training involving voluntary isocapnic hyperpnoea among patients with chronic diseases. It includes both randomized and non‐randomized controlled trials implementing this exercise training modality performed either alone or in combination with other interventions. It was conducted using the following databases: PubMed, Google Scholar, Physiotherapy Evidence Database (PEDro), Embase, CINAHL, CENTRAL, Cochrane and ReeDOC. It was drafted in accordance with the PRISMA guidelines. The final analysis was conducted on 12 studies (n = 257). There was heterogeneity in participants, training modalities and comparators used. The underpowered level of evidence is attributable to the lack of robustness of the original studies, including a lack of description of the intervention, lack of blinding, and missing data. Respiratory muscle endurance training is an exercise training modality that is both safe and feasible, even in the setting of the patient's home. It increases respiratory endurance time. However, its effect on peak oxygen consumption at exercise, maximal work rate, 6‐min walking distance, quality of life, dyspnoea and fatigue remains to be confirmed. In conclusion, this systematic review shows that respiratory muscle endurance training increases respiratory endurance among patients with chronic diseases. The populations that benefit the most and the mechanisms involved remain to be investigated. Further high‐quality studies are needed to understand its role, whether it is performed alone or as an add‐on modality to usual pulmonary rehabilitation programmes.

Background Critical illness is associated with hypercatabolism, systemic inflammatory dysregulation and low serum concentration of testosterone (T) leading to intensive care unit (ICU) acquired weakness and altered outcome. T supplementation benefit has been reported in several illnesses but data in non-burned ICU patients are scarce. In this context, the purpose of the TestICUs-1 study was to assess the pharmacokinetic and safety of T-gel administration in ICU patients. Methods TestICUs-1 was an open, monocentric, randomized controlled study carried out in ICU patients receiving vasopressors, and mechanical ventilation for at least two days. Exclusion criteria included prostate or breast cancer, PSA levels >4 ng/mL and age ≥ 80 years. The T group received a 14-day administration of T transdermal gel (Androgel©). The primary endpoint was the percentage of patients with serum Total T value within normal ranges on days 4, 7, 10 and 14. The safety of T-gel was also assessed. Results 30 patients were included, 19 (63 %) were men. At inclusion, none of the men and half of the women presented a serum Total T values within normal range. On days 4, 7, 10 and 14, the percentage of patients with a normal serum Total T value did not differ between T administered patients and controls. No significant differences between groups were reported in terms of cardiovascular events and cytolysis. Conclusions The administration of T-gel did not increase significantly the percentage of patients with normal serum T values as compared to control.

To determine the prevalence of functional, respiratory and renal impairments and of post-intensive-care-syndrome (PICS) among patients who had attended a post-ICU multidisciplinary consultation (post-ICU-MC) around 3 months after ICU discharge, we performed a retrospective, monocentric observational study, at Clermont Ferrand University hospital, France. We included patients who had attended a post-ICU-MC. Their characteristics during ICU stay and at the post-ICU-MC were collected. Functional status was assessed by the 6-min-walking test, handgrip test and peak inspiratory pressure, respiratory function by exploratory functional outcomes, mental status by SF-36 score, and quality of life by SF-36 score and European Quality of Life 5 Dimensions questionnaire. Overall, we enrolled 67 patients, of whom 70%, 74%, and 68% had functional, respiratory, and renal impairments, respectively, at the post-ICU-MC. Additionally, 40%, 28%, 19%, and 2.5% had three, two, one, and none of these impairments, respectively. All patients experienced mental disorders and a decline in quality of life. Functional impairment correlated with frailty score and sex, and respiratory function with age. To conclude, the prevalence of PICS in our cohort was high, as was that of functional, respiratory and renal failure.

Individuals with constitutional thinness have been presented with a lower muscular energy metabolism at the cellular level but their effective aerobic capacities and exercise-related energy efficiency remains unexplored. The present study compares maximal and sub-maximal aerobic capacities between subjects with constitutional thinness and age-matched normal-weight ones. Anthropometric measures, body composition (Dual-X-ray absorptiometry), physical activity and sedentary time (GT3x actigraphs), and maximal aerobic capacities (cycling V̇O 2peak test) were assessed in 18 constitutionally thin (CT—body mass index < 17.5 kg m−2) and 17 normal-weight (NW—body mass index between 20 and 25 kg m−2) women. Energy efficiency was assessed during a submaximal cycling test and a walking exercise. CT had a lower body mass and body mass index compared to NW. Absolute peak oxygen uptake and maximal aerobic power were lower in CT subjects compared to NW (ES: − 1.63 [− 2.40; − 0.86] and − 1.32 [− 2.05; − 0.58], p < 0.001). V̇O 2peak related to body mass was not different between groups. Gross and net efficiency (ES: − 0.78 [− 1.48; − 0.06], p = 0.03 and ES: − 0.73 [− 1.43; − 0.01], p = 0.05) were lower in CT compared to NW during the submaximal cycling exercise. The gross energy cost of walking related to body mass was lower in subjects with CT (ES: − 1.80 [− 2.60; − 0.97, p = 0.05), with no difference for the net one. Perceived exertion was similar between groups in responses to both submaximal exercises. Constitutionally thin women do not show impaired aerobic capacities at moderate to maximal intensities despite lower energy efficiency while cycling and walking at low-to-moderate intensities.

BackgroundIn osteoarthritis quadriceps strength is an important outcome to assess exercise capacity and recovery after arthroplasty. However, its measurement is limited due to lack of time and the need for trained personnel and equipment whose accuracy is verified.ObjectivesTo find out the determinants of a reduced quadriceps strength and to establish a score to screen for it.MethodsIn an observational prospective study, we evaluated patients presenting with an unilateral knee (KOA) or a hip (HOA) osteoarthritis before a scheduled arthroplasty. We measured body composition, exercise capacity, muscle strength, balance, WOMAC score, quality of life and physical activity. Isometric maximal voluntary quadriceps force (MVCq) was determined on both lower limbs and a reduced strength was retained when at least one measurement was lower than 1 standard deviation of normal value.ResultsWe included 376 patients, 247 (66%) with KOA and 129 (34%) with HOA. Their mean age was 67±8 years, and mean BMI 31.4±6.9 kg/m2. MVCq was reduced in 217 (58%). Compared those with a preserved MVCq, these patients had a significant higher BMI and lean mass, a sex ratio (more men), an altered field physical tests and WOMAC score. The best logistic regression model for a decreased quadriceps force included pathology, age, sex, BMI, five sit to stand test (FTSST) and maximal gait speed (AUC was 0.87 [95%CI 0.83-0.90]). We developed a predictive equation for a reduced MVCq as follows: Y = 1/1+ exp[-(-0.051*age -1.25*max gait speed + 0.09*FTSST + 0.16*BMI + 1.1 (for KOA) + 2.41 (for male) -1.79].ConclusionMVCq is reduced with a high prevalence on patients with KOA or HOA. A low performance in one the selected field physical test associated with age and BMI allows to screen for those in whom a measurement of MVCq could be of interest before arthroplasty.

Background & Aims Sarcopenia and myosteatosis are proving to be major factors to predict mortality in intensive care patients. Few studies are currently focusing on evaluating the functional impact after intensive care discharge and none has considered sarcopenia and myosteatosis as prognostic factors.The aim of our study was to determine whether sarcopenia and myosteatosis are reliable prognostic factors for mid-term functional impact in critical patients a few months after intensive care discharge. Methods We carried out a retrospective monocentric study using computed-tomography scanner performed on intensive care admission and/or three months after discharge to assess sarcopenia and myosteatosis in 43 patients with critical illnesses who underwent a multidisciplinary evaluation on a multidisciplinary consultation’s day hospital.We used L3 and/or T4 computed-tomography-scan levels to assess sarcopenia with the skeletal muscle index and myosteatosis with skeletal muscle density. These data were compared with main patient characteristics on intensive care admission and during intensive care stay and with functional assessments at the post intensive care multidisciplinary consultations, based on hand grip strength test, 6-minute walking test, and peak inspiratory pressure. Results We found a good correlation of both skeletal muscle index and skeletal muscle density for T4 and L3 levels. Skeletal muscle index was correlated with hand grip strength test, and skeletal muscle density with 6-minute walking test, which are both functional tests recommended in the algorithm of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia. Peak inspiratory pressure was correlated with both skeletal muscle index and skeletal muscle density and also with other functional tests. Conclusions We confirmed the reliability of thoracic computed-tomography-scan to assess sarcopenia and myosteatosis. We found that skeletal muscle index and skeletal muscle density are independent but complementary predictive factors for functional impact at mid-term in intensive care patients. Peak inspiratory pressure could be a useful tool for the assessment and management of sarcopenia.

BackgroundCardiovascular comorbidities are increasingly being recognised in early stages of chronic obstructive pulmonary disease (COPD) yet complete cardiorespiratory functional assessments of individuals with mild COPD or presenting with COPD risk factors are lacking. This paper reports on the effectiveness of the cardiocirculatory-limb muscles oxygen delivery and utilisation axis in smokers exhibiting no, or mild to moderate degrees of airflow obstruction using standardised cardiopulmonary exercise testing (CPET).MethodsPost-bronchodilator spirometry was used to classify participants as ‘ever smokers without’ (n=88), with ‘mild’ (n=63) or ‘mild-moderate’ COPD (n=56). All underwent CPET with continuous concurrent monitoring of oxygen uptake (V’O2) and of bioimpedance cardiac output (Qc) enabling computation of arteriovenous differences (a-vO2). Mean values of Qc and a-vO2were mapped across set ranges of V’O2and Qc isolines to allow for meaningful group comparisons, at same metabolic and circulatory requirements.ResultsPeak exercise capacity was significantly reduced in the ‘mild-moderate COPD’ as compared with the two other groups who showed similar pulmonary function and exercise capacity. Self-reported cardiovascular and skeletal muscle comorbidities were not different between groups, yet disease impact and exercise intolerance scores were three times higher in the ‘mild-moderate COPD’ compared with the other groups. Mapping of exercise Qc and a-vO2also showed a leftward shift of values in this group, indicative of a deficit in peripheral O2extraction even for submaximal exercise demands. Concurrent with lung hyperinflation, a distinctive blunting of exercise stroke volume expansion was also observed in this group.ConclusionContrary to the traditional view that cardiovascular complications were the hallmark of advanced disease, this study of early COPD spectrum showed a reduced exercise O2delivery and utilisation in individuals meeting spirometry criteria for stage II COPD. These findings reinforce the preventive clinical management approach to preserve peripheral muscle circulatory and oxidative capacities.