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      The Impact of Severe Acute Respiratory Syndrome on the Physical Profile and Quality of Life


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          Lau HM-C, Lee EW-C, Wong CN-C, Ng GY-F, Jones AY-M, Hui DS-C. The impact of severe acute respiratory syndrome on the physical profile and quality of life. Arch Phys Med Rehabil 2005;86:1134–40.


          To investigate the impact of severe acute respiratory syndrome (SARS) on the physical fitness and health-related quality of life (HRQOL) among SARS survivors.


          A cohort study.


          An outpatient physiotherapy department in a major hospital in Hong Kong.


          SARS patients (N=171) discharged from the hospital. Their mean age was 37.36±12.65 years, and the average number of days of hospitalization was 21.79±9.93 days.


          Not applicable.

          Main Outcome Measures

          Subjects’ cardiorespiratory (6-minute walk test [6MWT], Chester step test for predicting maximal oxygen uptake [V̇o 2max]), musculoskeletal (proximal/distal muscle strength and endurance test), and HRQOL status (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were measured and compared with the normative data matched for age and sex.


          Seventy-eight (45.61%) patients continued to require prednisolone (<0.5mg·kg −1·d −1) for residual lung opacities when data were collected. The values of 6MWT distance, predicted V̇o 2max, proximal and distal muscle strength, and the scores from all SF-36 domains, particularly perceived role-physical, were significantly lower than the normative data ( P<.05).


          SARS survivors had deficits in cardiorespiratory and musculoskeletal performance, and their HRQOL appeared to be significantly impaired.

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          Most cited references18

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          Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong

          Summary Background Health authorities worldwide, especially in the Asia Pacific region, are seeking effective public-health interventions in the continuing epidemic of severe acute respiratory syndrome (SARS). We assessed the epidemiology of SARS in Hong Kong. Methods We included 1425 cases reported up to April 28, 2003. An integrated database was constructed from several sources containing information on epidemiological, demographic, and clinical variables. We estimated the key epidemiological distributions: infection to onset, onset to admission, admission to death, and admission to discharge. We measured associations between the estimated case fatality rate and patients’age and the time from onset to admission. Findings After the initial phase of exponential growth, the rate of confirmed cases fell to less than 20 per day by April 28. Public-health interventions included encouragement to report to hospital rapidly after the onset of clinical symptoms, contact tracing for confirmed and suspected cases, and quarantining, monitoring, and restricting the travel of contacts. The mean incubation period of the disease is estimated to be 6.4 days (95% Cl 5.2–7.7). The mean time from onset of clinical symptoms to admission to hospital varied between 3 and 5 days, with longer times earlier in the epidemic. The estimated case fatality rate was 13.2% (9.8–16.8) for patients younger than 60 years and 43.3% (35.2–52.4) for patients aged 60 years or older assuming a parametric γ distribution. A non-parametric method yielded estimates of 6.8% (4.0–9.6) and 55.0% (45.3–64.7), respectively. Case clusters have played an important part in the course of the epidemic. Interpretation Patients’age was strongly associated with outcome. The time between onset of symptoms and admission to hospital did not alter outcome, but shorter intervals will be important to the wider population by restricting the infectious period before patients are placed in quarantine. Published online May 7, 2003 http://image.thelancet.com/extras/03art4453web.pdf
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            American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults.

            ACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 d.wk-1, at less than 40-50% of VO2R, and for less than 10 min-1 is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations. In the interpretation of this position stand, it must be recognized that the recommendations should be used in the context of participant's needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for the cardiorespiratory, muscular strength and endurance, and flexibility components of the program. An appropriate warm-up and cool-down period, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.
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              Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years.

              R Bohannon (1997)
              Only a few studies have provided reference values for muscle strength obtained by hand-held dynamometry. Such values are essential for establishing the degree to which an individual's strength is impaired. This descriptive study was conducted to provide reference values for the strength of 10 extremity muscle actions. SUBJECTS AND INSTRUMENTATION: A convenience sample of 106 men and 125 women volunteers was tested twice with an Ametek digital hand-held dynamometer. The measurements were found to be reliable. Predictive equations are provided for the measurements. Reference values generated are expressed in Newtons and as a percentage of body weight and are organized by gender, decade of age, and side. The values can be employed in a clinical setting to document whether an individual is impaired relative to healthy subjects of the same gender and age.

                Author and article information

                Role: FACP
                Role: FRACP, FRCP
                Arch Phys Med Rehabil
                Arch Phys Med Rehabil
                Archives of Physical Medicine and Rehabilitation
                W.B. Saunders
                1 June 2005
                June 2005
                1 June 2005
                : 86
                : 6
                : 1134-1140
                [a ]Physiotherapy Department, Prince of Wales Hospital, Shatin
                [b ]Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon
                [c ]Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China.
                Author notes
                [* ]Reprint requests to Edwin Wai-Chi Lee, MPhil, Physiotherapy Dept, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region, China edwinlee@ 123456cuhk.edu.hk
                Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.


                muscles,oxygen consumption,physical endurance,quality of life,rehabilitation,sars virus


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