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      Effect of a Brief Heat Exposure on Blood Pressure and Physical Performance of Older Women Living in the Community—A Pilot-Study

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          Abstract

          Global climate change is affecting health and mortality, particularly in vulnerable populations. High ambient temperatures decrease blood pressure (BP) in young and middle aged adults and may lead to orthostatic hypotension, increasing the risk of falls in older adults. The aim of this study was to evaluate the feasibility of a test protocol to investigate BP response and aerobic capacity of older adults in a hot indoor environment. BP response and aerobic capacity were assessed in 26 community-dwelling older women (median age 75.5 years) at a room temperature of either 20 °C or 30 °C. The protocol was well tolerated by all participants. In the 30 °C condition systolic and diastolic BP (median difference 10 and 8 mmHg, respectively) and distance walked in 6 min (median difference 29.3 m) were lower than in the 20 °C condition (all p < 0.01). Systolic BP decreased after standing up from a lying position in the 30 °C (17.4 mmHg) and 20 °C (14.2 mmHg) condition (both p < 0.001). In conclusion, the protocol is feasible in this cohort and should be repeated in older adults with poor physical performance and impaired cardio-vascular response mechanisms. Furthermore, aerobic capacity was reduced after exposure to hot environmental temperatures, which should be considered when recommending exercise to older people during the summer months.

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          Heat Stroke

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            The development of a comorbidity index with physical function as the outcome.

            Physical function is an important measure of success of many medical and surgical interventions. Ability to adjust for comorbid disease is essential in health services research and epidemiologic studies. Current indices have primarily been developed with mortality as the outcome, and are not sensitive enough when the outcome is physical function. The objective of this study was to develop a self-administered Functional Comorbidity Index with physical function as the outcome. The index was developed using two databases: a cross-sectional, simple random sample of 9,423 Canadian adults and a sample of 28,349 US adults seeking treatment for spine ailments. The primary outcome measure was the SF-36 physical function (PF) subscale. The Functional Comorbidity Index, an 18-item list of diagnoses, showed stronger association with physical function (model R(2) = 0.29) compared with the Charlson (model R(2) = 0.18), and Kaplan-Feinstein (model R(2) = 0.07) indices. The Functional Comorbidity Index correctly classified patients into high and low function, in 77% of cases. This new index contains diagnoses such as arthritis not found on indices used to predict mortality, and the FCI explained more variance in PF scores compared to indices designed to predict mortality.
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              The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure.

              Cycle and treadmill exercise tests are unsuitable for elderly, frail and severely limited patients with heart failure and may not reflect capacity to undertake day-to-day activities. Walking tests have proved useful as measures of outcome for patients with chronic lung disease. To investigate the potential value of the 6-minute walk as an objective measure of exercise capacity in patients with chronic heart failure, the test was administered six times over 12 weeks to 18 patients with chronic heart failure and 25 with chronic lung disease. The subjects also underwent cycle ergometer testing, and their functional status was evaluated by means of conventional measures. The walking test proved highly acceptable to the patients, and stable, reproducible results were achieved after the first two walks. The results correlated with the conventional measures of functional status and exercise capacity. The authors conclude that the 6-minute walk is a useful measure of functional exercise capacity and a suitable measure of outcome for clinical trials in patients with chronic heart failure.
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                Author and article information

                Contributors
                Role: External Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                05 December 2014
                December 2014
                : 11
                : 12
                : 12623-12631
                Affiliations
                [1 ]Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, 70376 Stuttgart, Germany; E-Mails: anja.stotz@ 123456gmx.de (A.S.); kilian.rapp@ 123456rbk.de (K.R.); jochen.klenk@ 123456rbk.de (J.K.); clemens.becker@ 123456rbk.de (C.B.)
                [2 ]Physical Work Capacity Team, Finnish Institute of Occupational Health, 90220 Oulu, Finland; E-Mail: juha.oksa@ 123456ttl.fi
                [3 ]Institute of Applied Health Research, Glasgow Caledonian University, Scotland, G4 0BA, UK; E-Mail: dawn.skelton@ 123456gcu.ac.uk
                [4 ]Musculoskeletal Rehabilitation Research Unit, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, 2400 NV Copenhagen, Denmark; E-Mail: ninabeyer.privat@ 123456gmail.com
                [5 ]Institute of Epidemiology, Ulm University, 89081 Ulm, Germany
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: ulrich.lindemann@ 123456rbk.de ; Tel.: +49-711-8101-2231; Fax: +49-711-8101-6116.
                Article
                ijerph-11-12623
                10.3390/ijerph111212623
                4276636
                25489997
                aa1ce4db-5e1a-4c62-9dfd-eeba37b2a1d5
                © 2014 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 08 October 2014
                : 17 November 2014
                : 28 November 2014
                Categories
                Article

                Public health
                aerobic capacity,blood pressure,heat,older women
                Public health
                aerobic capacity, blood pressure, heat, older women

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