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    Evaluation of primary and accessory respiratory muscles and their influence on exercise capacity and dyspnea in pulmonary arterial hypertension
    (Mosby-Elsevier, 2023) Durdu, Habibe; Demir, Rengin; Zeren, Melih; Basturk, Pinar; Arabaci, Hidayet Ozan; Sinan, Umit Yasar; Kucukoglu, Mehmet Serdar
    Background: Skeletal and respiratory muscle disfunction has been described in pulmonary arterial hypertension (PAH), however, involvement of accessory respiratory muscles and their association with symptomatology in PAH is unclear. Objectives: To assess the primary and accessory respiratory muscles and their influence on exercise tolerance and dyspnea. Methods: 27 patients and 27 healthy controls were included. Serratus anterior (SA), pectoralis muscles (PM) and sternocleidomastoid (SCM) muscle strength were evaluated as accessory respiratory muscles, maximal inspiratory (MIP) and expiratory pressures (MEP) as primary respiratory muscles, and quadriceps as peripheral muscle. Exercise capacity was evaluated with 6-min walk test (6MWT), dyspnea with modified Medical Council Research (MMRC) and London Chest Activity of Daily Living (LCADL) scales. Results: All evaluated muscles, except SCM, and 6MWT were decreased in patient group (p < 0.01). SA was the most affected muscle among primary and accessory respiratory muscles (Cohen's-d = 1.35). All evaluated muscles significantly correlated to 6MWT (r = 0.428-0.525). A multivariate model including SA, SCM and MIP was the best model for predicting 6MWT (R = 0.606; R-2 = 0.368; p = 0.013) and SA strength had the most impact on the 6MWT (B =1.242; beta = 0.340). None of the models including respiratory muscles were able to predict dyspnea, however PM and SA strength correlated to LCADL(total) (r =-0.493) and MMRC (r =-0.523), respectively. Conclusion: SCM may be excessively used in PAH since it retains its strength. Considering the relationship of accessory respiratory muscles with exercise tolerance and dyspnea, monitoring the strength of these muscles in the clinical practice may help providing better management for PAH. (C) 2022 Elsevier Inc. All rights reserved.
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    The Effect of Computerized Wobble Board and Core Stabilization Exercises on Balance Performance and Exercise Capacity in Patients With Heart Failure: A Randomized Controlled Trial
    (W B Saunders Co-Elsevier Inc, 2024) Durdu, Habibe; Demir, Rengin; Zeren, Melih; Aydin, Ertan; Gunaydin, Zeki Yuksel; Yigit, Zerrin
    Objective: To investigate the effects of computerized wobble board exercise training (CWBET) and core stabilization exercise training (CSET) on balance performance, and exercise capacity in patients with heart failure (HF). Desing: Single-blind randomized controlled prospective study. Setting: Cardiology department of a local university hospital. Participants: Fifty-one patients with HF with reduced ejection fraction, whose clinical status and medication had been stable for the previous 3 months, were included (N=51). Nine patients could not complete the follow-up period due to personal reasons. No patient experienced any adverse events during exercise training. Interventions: Patients were randomized to CWBET, CSET, and control group. CWBET and CSET groups participated in their own exercise programs, 3 days a week for 8 weeks. The control group received no exercise program. Main Outcome Measures: All patients were evaluated at baseline and after 8 weeks. Postural stability, static and functional balance, and exercise capacity were evaluated with the Sensamove Balance Test Pro with Miniboard, the one-leg stance test (OLS), the Berg Balance Scale (BBS), and the six-minute walk distance (6MWD), respectively. Core stabilization and health-related quality of life (HRQOL) were assessed with OCTOcore app, and Minnesota Living with Heart Failure Questionnaire, respectively. Results: A mixed model repeated-measures ANOVA revealed significant group x time interaction effect for static postural stability performance (P<.001, eta(2)(p)=0.472), vertical (P<.001, eta(2)(p)=0.513), horizontal performance (P<.001, eta(2)(p)=0.467), OLS (P<.001, eta(2)(p)=0.474), BBS (P<.001, eta(2)(p)=0.440) scores, 6MWD (P<.001, eta(2)(p)=0.706), and HRQOL. Post hoc analysis revealed CWBET and CSET groups had similar improvements balance performance, exercise capacity, and HRQOL and both groups significantly improved compared with control group (P<.001). Core stabilization was significantly improved only in CSET group after 8 weeks. Conclusion: CWBET and CSET programs were equally effective and safe for improving balance performance and exercise capacity in patients with HF. (c) 2024 by the American Congress of Rehabilitation Medicine