This study investigated 1) red blood cells (RBC) rigidity and 2) lactate influxes into RBCs in en... more This study investigated 1) red blood cells (RBC) rigidity and 2) lactate influxes into RBCs in endurance-trained athletes with and without exercise-induced hypoxemia (EIH). Nine EIH and six non-EIH subjects performed a submaximal steady-state exercise on a cyclo-ergometer at 60% of maximal aerobic power for 10 min, followed by 15 min at 85% of maximal aerobic power. At rest and at the end of exercise, arterialized blood was sampled for analysis of arterialized pressure in oxygen, and venous blood was drawn for analysis of plasma lactate concentrations and hemorheological parameters. Lactate influxes into RBCs were measured at three labeled [U-14C]lactate concentrations (1.6, 8.1, and 41 mM) on venous blood sampled at rest. The EIH subjects had higher maximal oxygen uptake than non-EIH ( P < 0.05). Total lactate influx was significantly higher in RBCs from EIH compared with non-EIH subjects at 8.1 mM (1,498.1 ± 87.8 vs. 1,035.9 ± 114.8 nmol·ml−1·min−1; P < 0.05) and 41 mM (2,56...
The contribution of respiratory muscle work to the development of the slow component is a point o... more The contribution of respiratory muscle work to the development of the slow component is a point of controversy since it has been shown that the increased ventilation in hypoxia is not associated with a concomitant increase in V slow component. The first purpose of this study
Aim.—To define in chronic obstructive pulmonary disease patients (COPD) moderately hypoxemic in r... more Aim.—To define in chronic obstructive pulmonary disease patients (COPD) moderately hypoxemic in resting conditions, if controlled acute oxygen supplementation was always able to increase exercise tolerance when partial oxygen saturation SpO2 was corrected. Results.—In hyperoxia, endurance time (TLIM) was significantly and consistently increased in 14 COPD (+68%) and decreased in seven others (—36%). These two subgroups exhibited no difference in resting values or in their disease severity. COPD with a decreased TLIM under hyperoxic conditions had an abnormal response to O2: unchanged cardiac output and ventilation, increased breathing frequency. Conclusion.—This work shows that acute O2 supplementation responses in COPD are not univocal, either on exercise tolerance or cardio-respiratory variables typically affected by hyperoxia.
tion (VO2) slow component is a point of controversy because it has been shown that the increased ... more tion (VO2) slow component is a point of controversy because it has been shown that the increased ventilation in hypoxia is not associated with a concomitant increase in VO2 slow com- ponent. The first purpose of this study was thus to test the hypothesis of a direct relationship between respiratory mus- cle work and VO2 slow component by manipulating inspira-
Introduction : Si la littérature montre des bénéfices au sortir d'un programme de réhabilitation ... more Introduction : Si la littérature montre des bénéfices au sortir d'un programme de réhabilitation respiratoire, le maintien de ces progrès reste limité dans le temps si les patients sont laissés seuls face à la maladie, entre 6 et 18 mois selon les paramètres mesurés. Nous faisons l'hypothèse qu'au sein d'un réseau de professionnels de la réhabilitation, un programme de suivi multidisciplinaire en association locale de patients maintiendra, voire améliorera, les bénéfices acquis lors d'un premier séjour de réhabilitation. Méthodes : Après avoir participé à un premier séjour de réhabilitation, 40 patients BPCO ont été consécutivement inclus dans le groupe post-réhabilitation (n = 14 ; 61,9 ± 7,4 ans ; VEMS = 52,6 ± 16,4 % théo.) ou le groupe contrôle (n = 26 ; 60,7 ± 9,6 ans ; VEMS = 46,7 ± 9,3 % théo.). Les évaluations ont été réalisées à l'entrée du centre, à la sortie, 6 et 12 mois après le programme initial. Les mesures comprenaient une exploration fonctionnelle respiratoire, un test de marche de 6 minutes (TDM-6 min), une épreuve d'effort, les dimensions spécifiques de qualité de vie du Saint-George (SGRQ), les dimensions génériques du World Health Organization Quality Of Life (WHOQOL), les 6 items fonctionnels mesurés avec une échelle visuelle analogique (EVA) et une enquête économique. Résultats : Les patients ayant bénéficié de l'année de post-réhabilitation associative montrent une amélioration de la distance au TDM-6 min (+ 32,1 mètres), de la puissance maximale (+ 7,8 Watts), des scores aux 3 dimensions du SGRQ (symptômes = -13,5 % ; activités = -16,1 % ; impact = -13,6 %), aux dimensions physique (+ 1,0) et QV générale (+ 2,2) du WHOQOL et à l'item condition physique (+ 2,4) des EVA. En revanche, les résultats du groupe contrôle montrent une détérioration de la distance au TDM-6 min (-33,3 mètres) et des scores des dimensions activité (+ 10,2) et impact (+ 15,5) du SGRQ, après 12 mois. Comparé au groupe contrôle, le groupe post-réhabilitation montre moins de journées d'hospitalisations pour cause respiratoire dans l'année de suivi (0,0 comparé à 5,0 jours). Conclusions : Ces résultats indiquent que pour les patients atteints de BPCO, une combinaison d'intervention coordonnée dans un réseau de santé avec des associations locales de patients est un dispositif innovant et efficace pour améliorer les bénéfices d'un premier séjour de réhabilitation au niveau de la tolérance à l'effort, des scores spécifiques et génériques de la qualité de vie et des coûts directs de santé.
The efficacy of pulmonary rehabilitation in the short term for patients with Chronic Obstructive ... more The efficacy of pulmonary rehabilitation in the short term for patients with Chronic Obstructive Pulmonary Disease (COPD) is now clearly established. However, several studies have shown that these benefits last only for between 6 months to one year. On the basis of the current literature, the authors believe that a follow-up of rehabilitation "post-rehabilitation" is necessary not only to maintain benefits but also to reinforce them. We review studies that have focused specifically on post-rehabilitation and found a heterogeneity of tested solutions. As with conventional pulmonary rehabilitation, a multidisciplinary approach including physical activity, health education and psychosocial supports seem to be the key to successfully maintain rehabilitation's gains. Further randomised and controlled research will be needed to confirm the medical and economic effectiveness of this combination of intervention in patients with different severities of COPD. Individualised, obj...
Master athletes are often considered to represent the ideal rate of decline of aerobic function; ... more Master athletes are often considered to represent the ideal rate of decline of aerobic function; however, most of the studies interested in active elderly people are often limited to people younger than 75. We aimed to determine the physiological adaptations and aerobic fitness in a selected European population of active octogenarians during maximal and submaximal exercise tests. Aerobic capacity was measured during maximal incremental tests on treadmill (TR) and cycle-ergometer (CE) and functional capacity during a 6-minute walk test (6-MWT) in 17 subjects aged 81.2 +/- 0.8 years. Pulmonary gas exchange and heart rate (HR) were continuously measured during the different exercise tests. Maximal oxygen consumption (V.O (2max)) on TR and CE was significantly higher than predicted values (TR: 28.7 +/- 1.2 vs. 17 +/- 0.5 ml . kg (-1) . min (-1); CE: 23 +/- 1.2 vs. 16 +/- 0.6 ml . kg (-1) . min (-1) for measured and predicted values respectively). V.O (2max) and HR (max), as well as V.O ...
Journal of applied physiology (Bethesda, Md. : 1985), 2003
The contribution of respiratory muscle work to the development of the O(2) consumption (Vo(2)) sl... more The contribution of respiratory muscle work to the development of the O(2) consumption (Vo(2)) slow component is a point of controversy because it has been shown that the increased ventilation in hypoxia is not associated with a concomitant increase in Vo(2) slow component. The first purpose of this study was thus to test the hypothesis of a direct relationship between respiratory muscle work and Vo(2) slow component by manipulating inspiratory resistance. Because the conditions for a Vo(2) slow component specific to respiratory muscle can be reached during intense exercise, the second purpose was to determine whether respiratory muscles behave like limb muscles during heavy exercise. Ten trained subjects performed two 8-min constant-load heavy cycling exercises with and without a threshold valve in random order. Vo(2) was measured breath by breath by using a fast gas exchange analyzer, and the Vo(2) response was modeled after removal of the cardiodynamic phase by using two monoexpo...
Patients with chronic obstructive pulmonary disease (COPD) present many neurological disorders of... more Patients with chronic obstructive pulmonary disease (COPD) present many neurological disorders of unknown origin. Although hypoxemia has long been thought to be responsible, several studies have shown evidence of neuronal damage and dysfunction even in non-hypoxemic patients with COPD. Adaptive mechanisms protect the brain from hypoxia: when arterial oxygen tension (PaO2) decreases, the cerebral blood flow (CBF) increases, ensuring continuously adequate oxygen delivery to the brain. However, this mechanism is abolished during non-rapid eye movement (NREM) sleep. Any drop in PaO2 during NREM sleep is therefore not compensated by increased CBF, causing decreased cerebral oxygen delivery with subsequent brain hypoxia. Patients with may therefore be exposed to neuronal damage during this critical time. This mechanism is of vital importance for patients with COPD because of the potentially deleterious cortical effects. Nocturnal desaturation is quite frequent in COPD and affects approxim...
Introduction : Malgré son efficacité reconnue chez les malades atteints de broncho-pneumopathie c... more Introduction : Malgré son efficacité reconnue chez les malades atteints de broncho-pneumopathie chronique obstructive (BPCO), la mise en place de la réhabilitation respiratoire (RR) reste un problème actuel en Tunisie. Cette RR est une pratique transdisciplinaire qui nécessite une formation spécifique. Objectif : Réaliser un Cédérom sur les modalités pratiques d'un programme de RR. Matériels et méthodes : Nous nous sommes basés sur les recommandations des sociétés savantes (SPLF, ATS, GOLD). Nous avons crées des supports vidéo, des logiciels, et nous avons traduits des questionnaires et des échelles. Résultats : Avant la réalisation du programme de RR, les 3 étapes de l'évolution naturelle de la BPCO doivent être évaluées par un ou plusieurs examens spécifiques. La 1 re étape (déficit local) nécessite une évaluation de l'état nutritionnel, de la dyspnée, des fonctions respiratoire et musculaire, et des échanges gazeux. Dans ce cadre, nous avons rappelés les données récentes relatives à ces explorations avec une traduction des échelles de dyspnée de Sadoul et de Borg. La 2 e étape (incapacité fonctionnelle) nécessite la détermination de la tolérance à l'effort par le test de marche de 6 minutes et l'épreuve d'exercice musculaire. Dans ce cadre, nous avons présenté les modalités pratiques de ces tests avec des supports vidéo. Des logiciels facilitant la détermination d'un protocole standardisé et individualisé de l'épreuve d'exercice musculaire, et l'interprétation du test de marche de 6 minutes ont été construits. La 3 e étape (handicap) nécessite l'évaluation par des questionnaires, du niveau d'activité physique, et de la qualité de vie. Dans ce cadre, nous avons traduit en arabe le questionnaire d'activité physique de Voorips, avec création d'un logiciel facilitant le calcul des scores d'activités journalière, de loisir, sportive, et physique. En plus, le Saint-George's Hospital Respiratory Questionnaire, qui s'intéresse à la qualité de vie, a été traduit en arabe. Un programme de soins proposé par la RR comprend plusieurs composantes, dont le réentraînement à l'effort et l'éducation thérapeutique. Nous avons réalisés un support vidéo illustrant le déroulement pratique d'une séance de réentraînement à l'effort, avec toutes ses composantes. Des fiches d'éducations thérapeutiques, à distribuer aux malades, ont été crées. Conclusion : Ce cédérom sera une aide à tous les intervenants dans un tel programme de RR.
Recent studies have shown that muscle alterations cannot totally explain peripheral muscle weakne... more Recent studies have shown that muscle alterations cannot totally explain peripheral muscle weakness in COPD. Cerebral abnormalities in COPD are well documented but have never been implicated in muscle torque production. The purpose of this study was to assess the neural correlates of quadriceps torque control in COPD patients. Fifteen patients (FEV 1 54.163.6% predicted) and 15 age-and sex-matched healthy controls performed maximal (MVCs) and submaximal (SVCs) voluntary contractions at 10, 30 and 50% of the maximal voluntary torque of the knee extensors. Neural activity was quantified with changes in functional near-infrared spectroscopy oxyhemoglobin (fNIRS-HbO) over the contralateral primary motor (M1), primary somatosensory (S1), premotor (PMC) and prefrontal (PFC) cortical areas. In parallel to the lower muscle torque, the COPD patients showed lower increase in HbO than healthy controls over the M1 (p,0.05), PMC (p,0.05) and PFC areas (p,0.01) during MVCs. In addition, they exhibited lower HbO changes over the M1 (p,0.01), S1 (p,0.05) and PMC (p,0.01) areas during SVCs at 50% of maximal torque and altered motor control characterized by higher torque fluctuations around the target. The results show that low muscle force production is found in a context of reduced motor cortex activity, which is consistent with central nervous system involvement in COPD muscle weakness.
Objectives: To characterize the in¯uence of neurological lesion level on the cardiorespiratory an... more Objectives: To characterize the in¯uence of neurological lesion level on the cardiorespiratory and ventilatory responses of two groups of paraplegic athletes during incremental exercise on a treadmill and in the usual conditions for wheelchair exercise. Methods: Cardioventilatory responses evaluated in two groups of paraplegic wheelchair sportsmen designated as high paraplegic athletes (HPA) and low paraplegic athletes (LPA). After 2 min of data collection at rest and 3 min of warm-up at 4 km.h 71 , treadmill speed was increased by 1 km.h 71 every minute until exhaustion. During this test, ventilation and its components, as well as respiratory exchanges, were measured breath by breath (C.P.X. Medical Graphics) every minute by taking the mean of the last 20 s of each increment. Results: Spirometric values presented no signi®cant dierences between groups. At rest, no signi®cant dierence was observed between the two groups for all cardiorespiratory and ventilatory values obtained during the treadmill test. At submaximal exercise, all variables increased with the augmentation in workload. With the exception of R, there were no signi®cant dierences in the classic cardiorespiratory parameters (
The aim of this study was to validate an incremental field test performed by wheelchair dependent... more The aim of this study was to validate an incremental field test performed by wheelchair dependent (WD) athletes. Nine male paraplegic subjects (mean age: 28.9±4.2 years) performed an incremental field test (FT) and a comparable laboratory test (LT) with their own usual wheelchairs. Both tests started with an initial speed of 4 km.hr -I and increased by increments of 1 km.hr -I every minute until volitional exhaustion. The FT was an adapted Leger and Boucher test (ALBT) and was conducted on a 400 m tartan field marked-off every 50 m with pylons. Ventilatory data were collected every 15 s using a portable telemetric system (Cosmed K2, JFB International, Italy). The LT was performed on an adapted treadmill (Sopur, Germany) and ventilatory data were collected every minute using a breath-by-breath automated system (CPX, Medical Graphics, MN, USA). The LT and the FT were not significantly different for duration (8 min 50 ± 1 min 24 vs 9 min 55 ± 29 s), percentage of maximal heart rate (HR, 86.2±3.9 vs 89.7±5.3%), maximal minute ventilation (VE, 101.6±28.5 vs 96.8±28.2 l.min -I ), and peak oxygen uptake (Vo2 peak, 39.7+7.3 vs 36.1 +5.8 m1.kg -l .min -l ) assessed with the CPX and the K2, respectively. We concluded that the FT proposed in the present study is a valid test for direct V02 peak assessment in wheelchair athletes using a portable V02 telemetric system. Nonetheless, the Leger and Mercier model equation did not accurately predict V02 max and further investigation is needed to determine a valid V02 max prediction equation for these subjects during the FT.
This study investigated 1) red blood cells (RBC) rigidity and 2) lactate influxes into RBCs in en... more This study investigated 1) red blood cells (RBC) rigidity and 2) lactate influxes into RBCs in endurance-trained athletes with and without exercise-induced hypoxemia (EIH). Nine EIH and six non-EIH subjects performed a submaximal steady-state exercise on a cyclo-ergometer at 60% of maximal aerobic power for 10 min, followed by 15 min at 85% of maximal aerobic power. At rest and at the end of exercise, arterialized blood was sampled for analysis of arterialized pressure in oxygen, and venous blood was drawn for analysis of plasma lactate concentrations and hemorheological parameters. Lactate influxes into RBCs were measured at three labeled [U-14C]lactate concentrations (1.6, 8.1, and 41 mM) on venous blood sampled at rest. The EIH subjects had higher maximal oxygen uptake than non-EIH ( P < 0.05). Total lactate influx was significantly higher in RBCs from EIH compared with non-EIH subjects at 8.1 mM (1,498.1 ± 87.8 vs. 1,035.9 ± 114.8 nmol·ml−1·min−1; P < 0.05) and 41 mM (2,56...
The contribution of respiratory muscle work to the development of the slow component is a point o... more The contribution of respiratory muscle work to the development of the slow component is a point of controversy since it has been shown that the increased ventilation in hypoxia is not associated with a concomitant increase in V slow component. The first purpose of this study
Aim.—To define in chronic obstructive pulmonary disease patients (COPD) moderately hypoxemic in r... more Aim.—To define in chronic obstructive pulmonary disease patients (COPD) moderately hypoxemic in resting conditions, if controlled acute oxygen supplementation was always able to increase exercise tolerance when partial oxygen saturation SpO2 was corrected. Results.—In hyperoxia, endurance time (TLIM) was significantly and consistently increased in 14 COPD (+68%) and decreased in seven others (—36%). These two subgroups exhibited no difference in resting values or in their disease severity. COPD with a decreased TLIM under hyperoxic conditions had an abnormal response to O2: unchanged cardiac output and ventilation, increased breathing frequency. Conclusion.—This work shows that acute O2 supplementation responses in COPD are not univocal, either on exercise tolerance or cardio-respiratory variables typically affected by hyperoxia.
tion (VO2) slow component is a point of controversy because it has been shown that the increased ... more tion (VO2) slow component is a point of controversy because it has been shown that the increased ventilation in hypoxia is not associated with a concomitant increase in VO2 slow com- ponent. The first purpose of this study was thus to test the hypothesis of a direct relationship between respiratory mus- cle work and VO2 slow component by manipulating inspira-
Introduction : Si la littérature montre des bénéfices au sortir d'un programme de réhabilitation ... more Introduction : Si la littérature montre des bénéfices au sortir d'un programme de réhabilitation respiratoire, le maintien de ces progrès reste limité dans le temps si les patients sont laissés seuls face à la maladie, entre 6 et 18 mois selon les paramètres mesurés. Nous faisons l'hypothèse qu'au sein d'un réseau de professionnels de la réhabilitation, un programme de suivi multidisciplinaire en association locale de patients maintiendra, voire améliorera, les bénéfices acquis lors d'un premier séjour de réhabilitation. Méthodes : Après avoir participé à un premier séjour de réhabilitation, 40 patients BPCO ont été consécutivement inclus dans le groupe post-réhabilitation (n = 14 ; 61,9 ± 7,4 ans ; VEMS = 52,6 ± 16,4 % théo.) ou le groupe contrôle (n = 26 ; 60,7 ± 9,6 ans ; VEMS = 46,7 ± 9,3 % théo.). Les évaluations ont été réalisées à l'entrée du centre, à la sortie, 6 et 12 mois après le programme initial. Les mesures comprenaient une exploration fonctionnelle respiratoire, un test de marche de 6 minutes (TDM-6 min), une épreuve d'effort, les dimensions spécifiques de qualité de vie du Saint-George (SGRQ), les dimensions génériques du World Health Organization Quality Of Life (WHOQOL), les 6 items fonctionnels mesurés avec une échelle visuelle analogique (EVA) et une enquête économique. Résultats : Les patients ayant bénéficié de l'année de post-réhabilitation associative montrent une amélioration de la distance au TDM-6 min (+ 32,1 mètres), de la puissance maximale (+ 7,8 Watts), des scores aux 3 dimensions du SGRQ (symptômes = -13,5 % ; activités = -16,1 % ; impact = -13,6 %), aux dimensions physique (+ 1,0) et QV générale (+ 2,2) du WHOQOL et à l'item condition physique (+ 2,4) des EVA. En revanche, les résultats du groupe contrôle montrent une détérioration de la distance au TDM-6 min (-33,3 mètres) et des scores des dimensions activité (+ 10,2) et impact (+ 15,5) du SGRQ, après 12 mois. Comparé au groupe contrôle, le groupe post-réhabilitation montre moins de journées d'hospitalisations pour cause respiratoire dans l'année de suivi (0,0 comparé à 5,0 jours). Conclusions : Ces résultats indiquent que pour les patients atteints de BPCO, une combinaison d'intervention coordonnée dans un réseau de santé avec des associations locales de patients est un dispositif innovant et efficace pour améliorer les bénéfices d'un premier séjour de réhabilitation au niveau de la tolérance à l'effort, des scores spécifiques et génériques de la qualité de vie et des coûts directs de santé.
The efficacy of pulmonary rehabilitation in the short term for patients with Chronic Obstructive ... more The efficacy of pulmonary rehabilitation in the short term for patients with Chronic Obstructive Pulmonary Disease (COPD) is now clearly established. However, several studies have shown that these benefits last only for between 6 months to one year. On the basis of the current literature, the authors believe that a follow-up of rehabilitation "post-rehabilitation" is necessary not only to maintain benefits but also to reinforce them. We review studies that have focused specifically on post-rehabilitation and found a heterogeneity of tested solutions. As with conventional pulmonary rehabilitation, a multidisciplinary approach including physical activity, health education and psychosocial supports seem to be the key to successfully maintain rehabilitation's gains. Further randomised and controlled research will be needed to confirm the medical and economic effectiveness of this combination of intervention in patients with different severities of COPD. Individualised, obj...
Master athletes are often considered to represent the ideal rate of decline of aerobic function; ... more Master athletes are often considered to represent the ideal rate of decline of aerobic function; however, most of the studies interested in active elderly people are often limited to people younger than 75. We aimed to determine the physiological adaptations and aerobic fitness in a selected European population of active octogenarians during maximal and submaximal exercise tests. Aerobic capacity was measured during maximal incremental tests on treadmill (TR) and cycle-ergometer (CE) and functional capacity during a 6-minute walk test (6-MWT) in 17 subjects aged 81.2 +/- 0.8 years. Pulmonary gas exchange and heart rate (HR) were continuously measured during the different exercise tests. Maximal oxygen consumption (V.O (2max)) on TR and CE was significantly higher than predicted values (TR: 28.7 +/- 1.2 vs. 17 +/- 0.5 ml . kg (-1) . min (-1); CE: 23 +/- 1.2 vs. 16 +/- 0.6 ml . kg (-1) . min (-1) for measured and predicted values respectively). V.O (2max) and HR (max), as well as V.O ...
Journal of applied physiology (Bethesda, Md. : 1985), 2003
The contribution of respiratory muscle work to the development of the O(2) consumption (Vo(2)) sl... more The contribution of respiratory muscle work to the development of the O(2) consumption (Vo(2)) slow component is a point of controversy because it has been shown that the increased ventilation in hypoxia is not associated with a concomitant increase in Vo(2) slow component. The first purpose of this study was thus to test the hypothesis of a direct relationship between respiratory muscle work and Vo(2) slow component by manipulating inspiratory resistance. Because the conditions for a Vo(2) slow component specific to respiratory muscle can be reached during intense exercise, the second purpose was to determine whether respiratory muscles behave like limb muscles during heavy exercise. Ten trained subjects performed two 8-min constant-load heavy cycling exercises with and without a threshold valve in random order. Vo(2) was measured breath by breath by using a fast gas exchange analyzer, and the Vo(2) response was modeled after removal of the cardiodynamic phase by using two monoexpo...
Patients with chronic obstructive pulmonary disease (COPD) present many neurological disorders of... more Patients with chronic obstructive pulmonary disease (COPD) present many neurological disorders of unknown origin. Although hypoxemia has long been thought to be responsible, several studies have shown evidence of neuronal damage and dysfunction even in non-hypoxemic patients with COPD. Adaptive mechanisms protect the brain from hypoxia: when arterial oxygen tension (PaO2) decreases, the cerebral blood flow (CBF) increases, ensuring continuously adequate oxygen delivery to the brain. However, this mechanism is abolished during non-rapid eye movement (NREM) sleep. Any drop in PaO2 during NREM sleep is therefore not compensated by increased CBF, causing decreased cerebral oxygen delivery with subsequent brain hypoxia. Patients with may therefore be exposed to neuronal damage during this critical time. This mechanism is of vital importance for patients with COPD because of the potentially deleterious cortical effects. Nocturnal desaturation is quite frequent in COPD and affects approxim...
Introduction : Malgré son efficacité reconnue chez les malades atteints de broncho-pneumopathie c... more Introduction : Malgré son efficacité reconnue chez les malades atteints de broncho-pneumopathie chronique obstructive (BPCO), la mise en place de la réhabilitation respiratoire (RR) reste un problème actuel en Tunisie. Cette RR est une pratique transdisciplinaire qui nécessite une formation spécifique. Objectif : Réaliser un Cédérom sur les modalités pratiques d'un programme de RR. Matériels et méthodes : Nous nous sommes basés sur les recommandations des sociétés savantes (SPLF, ATS, GOLD). Nous avons crées des supports vidéo, des logiciels, et nous avons traduits des questionnaires et des échelles. Résultats : Avant la réalisation du programme de RR, les 3 étapes de l'évolution naturelle de la BPCO doivent être évaluées par un ou plusieurs examens spécifiques. La 1 re étape (déficit local) nécessite une évaluation de l'état nutritionnel, de la dyspnée, des fonctions respiratoire et musculaire, et des échanges gazeux. Dans ce cadre, nous avons rappelés les données récentes relatives à ces explorations avec une traduction des échelles de dyspnée de Sadoul et de Borg. La 2 e étape (incapacité fonctionnelle) nécessite la détermination de la tolérance à l'effort par le test de marche de 6 minutes et l'épreuve d'exercice musculaire. Dans ce cadre, nous avons présenté les modalités pratiques de ces tests avec des supports vidéo. Des logiciels facilitant la détermination d'un protocole standardisé et individualisé de l'épreuve d'exercice musculaire, et l'interprétation du test de marche de 6 minutes ont été construits. La 3 e étape (handicap) nécessite l'évaluation par des questionnaires, du niveau d'activité physique, et de la qualité de vie. Dans ce cadre, nous avons traduit en arabe le questionnaire d'activité physique de Voorips, avec création d'un logiciel facilitant le calcul des scores d'activités journalière, de loisir, sportive, et physique. En plus, le Saint-George's Hospital Respiratory Questionnaire, qui s'intéresse à la qualité de vie, a été traduit en arabe. Un programme de soins proposé par la RR comprend plusieurs composantes, dont le réentraînement à l'effort et l'éducation thérapeutique. Nous avons réalisés un support vidéo illustrant le déroulement pratique d'une séance de réentraînement à l'effort, avec toutes ses composantes. Des fiches d'éducations thérapeutiques, à distribuer aux malades, ont été crées. Conclusion : Ce cédérom sera une aide à tous les intervenants dans un tel programme de RR.
Recent studies have shown that muscle alterations cannot totally explain peripheral muscle weakne... more Recent studies have shown that muscle alterations cannot totally explain peripheral muscle weakness in COPD. Cerebral abnormalities in COPD are well documented but have never been implicated in muscle torque production. The purpose of this study was to assess the neural correlates of quadriceps torque control in COPD patients. Fifteen patients (FEV 1 54.163.6% predicted) and 15 age-and sex-matched healthy controls performed maximal (MVCs) and submaximal (SVCs) voluntary contractions at 10, 30 and 50% of the maximal voluntary torque of the knee extensors. Neural activity was quantified with changes in functional near-infrared spectroscopy oxyhemoglobin (fNIRS-HbO) over the contralateral primary motor (M1), primary somatosensory (S1), premotor (PMC) and prefrontal (PFC) cortical areas. In parallel to the lower muscle torque, the COPD patients showed lower increase in HbO than healthy controls over the M1 (p,0.05), PMC (p,0.05) and PFC areas (p,0.01) during MVCs. In addition, they exhibited lower HbO changes over the M1 (p,0.01), S1 (p,0.05) and PMC (p,0.01) areas during SVCs at 50% of maximal torque and altered motor control characterized by higher torque fluctuations around the target. The results show that low muscle force production is found in a context of reduced motor cortex activity, which is consistent with central nervous system involvement in COPD muscle weakness.
Objectives: To characterize the in¯uence of neurological lesion level on the cardiorespiratory an... more Objectives: To characterize the in¯uence of neurological lesion level on the cardiorespiratory and ventilatory responses of two groups of paraplegic athletes during incremental exercise on a treadmill and in the usual conditions for wheelchair exercise. Methods: Cardioventilatory responses evaluated in two groups of paraplegic wheelchair sportsmen designated as high paraplegic athletes (HPA) and low paraplegic athletes (LPA). After 2 min of data collection at rest and 3 min of warm-up at 4 km.h 71 , treadmill speed was increased by 1 km.h 71 every minute until exhaustion. During this test, ventilation and its components, as well as respiratory exchanges, were measured breath by breath (C.P.X. Medical Graphics) every minute by taking the mean of the last 20 s of each increment. Results: Spirometric values presented no signi®cant dierences between groups. At rest, no signi®cant dierence was observed between the two groups for all cardiorespiratory and ventilatory values obtained during the treadmill test. At submaximal exercise, all variables increased with the augmentation in workload. With the exception of R, there were no signi®cant dierences in the classic cardiorespiratory parameters (
The aim of this study was to validate an incremental field test performed by wheelchair dependent... more The aim of this study was to validate an incremental field test performed by wheelchair dependent (WD) athletes. Nine male paraplegic subjects (mean age: 28.9±4.2 years) performed an incremental field test (FT) and a comparable laboratory test (LT) with their own usual wheelchairs. Both tests started with an initial speed of 4 km.hr -I and increased by increments of 1 km.hr -I every minute until volitional exhaustion. The FT was an adapted Leger and Boucher test (ALBT) and was conducted on a 400 m tartan field marked-off every 50 m with pylons. Ventilatory data were collected every 15 s using a portable telemetric system (Cosmed K2, JFB International, Italy). The LT was performed on an adapted treadmill (Sopur, Germany) and ventilatory data were collected every minute using a breath-by-breath automated system (CPX, Medical Graphics, MN, USA). The LT and the FT were not significantly different for duration (8 min 50 ± 1 min 24 vs 9 min 55 ± 29 s), percentage of maximal heart rate (HR, 86.2±3.9 vs 89.7±5.3%), maximal minute ventilation (VE, 101.6±28.5 vs 96.8±28.2 l.min -I ), and peak oxygen uptake (Vo2 peak, 39.7+7.3 vs 36.1 +5.8 m1.kg -l .min -l ) assessed with the CPX and the K2, respectively. We concluded that the FT proposed in the present study is a valid test for direct V02 peak assessment in wheelchair athletes using a portable V02 telemetric system. Nonetheless, the Leger and Mercier model equation did not accurately predict V02 max and further investigation is needed to determine a valid V02 max prediction equation for these subjects during the FT.
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