Background and Purpose. Patients requiring prolonged mechanical ventilation (PMV) are frequently deconditioned because of respiratory failure precipitated by the underlying disease, the adverse effects of medications, and a period of prolonged immobilization. The effects of 6 weeks of physical training on the strength of respiratory and limb muscles, on ventilator-free time, and on functional status in patients requiring PMV were examined. Subjects. Thirty-nine patients with PMV were initially enrolled in the study and were assigned to either a treatment group (n=20) or a control group (n=19). Three subjects in the treatment group and 4 subjects in the control group died during the 6-week intervention period and thus their data were excluded from the final analysis. Methods. Subjects in the treatment group received physical training 5 days a week for 6 weeks. Strength of respiratory and limb muscles, ventilator-free time, and functional status, which was measured by the Barthel Index of Activities of Daily Living (BI) and Functional Independence Measure (FIM), were examined at baseline and at the third and sixth weeks of the study period. Results. Respiratory and limb muscle strength improved significantly at the third and sixth weeks in the treatment group compared with baseline measurements. Total BI and FIM scores increased significantly in the treatment group and remained unchanged in the control group. Effect sizes of the BI and FIM scores were 2.02 and 1.93, respectively, at the sixth week. Discussion and Conclusion. The results show that a 6-week physical training program may improve limb muscle strength and ventilator-free time and thus improve functional outcomes in patients requiring PMV. [Chiang LL, Wang LY, Wu CP, et al. Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther. 2006;86:1271–1281.]

Background: Numerous studies have reported the relationship between sleep duration and obesity in elderly adults; however, little is known about the relationship of sleep duration and sarcopenia. Objective: We examined the relationship of sleep duration with obesity and sarcopenia in community-dwelling older adults. Methods: A total of 488 community-dwelling adults (224 men and 264 women) aged ≥65 years were included in the analysis. Self-reported sleep duration and anthropometric data were collected. Skeletal muscle mass was estimated using the predicted equation from a bioelectrical impedance analysis measurement. Obesity and sarcopenia were defined according to the body mass index and the skeletal muscle mass index, respectively. Results: The association between sleep duration and sarcopenia exhibited a U shape in older adults. Compared to adults with 6-8 h of sleep, adults with <6 h of sleep had a nearly 3-fold increased likelihood of sarcopenia (odds ratio, OR: 2.76, 95% confidence interval, CI: 1.28-5.96), while adults with ≥8 h of sleep had a nearly 2-fold increased risk of sarcopenia (OR: 1.89, 95% CI: 1.01-3.54). Older adults with a sleep duration <6 h were more prone to obesity (OR: 2.15, 95% CI: 1.08−4.30). After gender stratification, the association between obesity and short sleep duration was more robust in women. Conclusion: There were significant associations of sleep duration with either obesity or sarcopenia in community-dwelling older adults. Gender differences in these associations were also observed.

Pliance, but the effect of this mass loading, independent of other obesity-related complications on the ventilatory response to exercise is unknown. The purpose of this study was to investigate the effect of chest mass loading on the ventilatory response to exercise. Methods: External chest loading (CL) was used to simulate the effect of moderate obesity (BMI = 32 kg·m−2). Eight healthy nonobese subjects performed two incremental exercise tests on a cycle ergometer with work rate increasing 25 W every 3 min once without (control; CON) and once with CL. Expiratory reserve volume (ERV), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1) were measured before each test. During exercise, inspiratory capacity (IC), to estimate changes in end-expiratory lung volume, and inspiratory (TI) and expiratory (TE) duration, tidal volume (Vt), breathing frequency (Fb), minute ventilation (V̇E), mean inspiratory (Vt/TI) and expiratory (Vt/TE) flow rates, and oxygen consumption (V̇O2) were measured. Results: Baseline ERV, FVC and FEV1 were lower with CL (P < 0.05). Compared with CON, the peak work rate achieved during exercise with CL was lower and V̇O2, V̇E, Fb, Vt/TI, and Vt/TE were higher, and Vt was lower at work rates ≥ 100 W (P < 0.05). IC increased progressively in CON during exercise but remained unchanged with CL. Conclusion: Obesity-related chest loading decreases lung volumes and increases the mechanical ventilatory constraints during exercise and is likely a critical factor in reducing exercise capacity in obesity....