Testing simple physical abilities may help predict a person's risk of death, suggests a new study.

Measuring basic capabilities such as grip strength, walking speed, rising from a chair, or balancing on one leg reveal a person's capacity to perform everyday tasks, explained the researchers at University College London in the United Kingdom.

The study authors analyzed 33 studies that examined physical capabilities in people of any age and recorded subsequent deaths among the participants. Overall, those who had poorer results on physical function tests had a consistently higher risk of death.

In 14 studies that included a total of 53,476 people, the death rate was 1.67 times higher for people with the weakest grip strength than for those with the strongest grip.

Five studies that included a total of 14,692 people found that the death rate was 2.87 times higher for the slowest walkers than for the fastest walkers.

Five studies that included a total of 28,036 people found that the death rate was nearly twice as high for people who were slowest to rise from a chair than for those who were quickest at this task.

While most of the studies included older people, the association between grip strength and death risk was also found in younger adults, the researchers said.

The study was published online Sept. 10 in the BMJ.

Screening tests that assess physical abilities may help identify people at increased risk of death who might benefit from targeted interventions such as strength training, the researchers said.

FITNESS LEVEL AFFECTS BARIATRIC SURGERY OUTCOMES
Poor Cardio Fitness Can Lead to Complications After Bariatric Surgery

Morbidly obese patients with poor cardiopulmonary fitness may experience increased complications after bariatric surgery. New research published in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), shows that bariatric surgery patients with low cardiopulmonary fitness levels experienced longer operative times and suffered more postsurgery complications than patients with higher fitness levels. Bariatric surgery, a procedure that involves surgically shrinking the stomach in order to limit food intake, is associated with sustained weight reduction in the morbidly obese.

"Random complications may occur during bariatric surgery," said Peter A. McCullough, MD, MPH, William Beaumont Hospital, Royal Oak, MI. "However, complications may become more apparent in patients with low levels of cardiopulmonary fitness, because they have very little pulmonary reserve and have reduced ability to withstand surgery."

Dr. McCullough and colleagues evaluated the relationship between cardiopulmonary fitness and other clinical variables and postoperative complications after bariatric surgery. Included in the study were 109 morbidly obese patients (75.2 percent women) with a mean body mass index (BMI) of 48.7 ± 7.2. Patients were divided into tertiles, with the first tertile having the highest BMI and lowest cardiopulmonary fitness and the third tertile had the lowest BMI and highest cardiopulmonary fitness.

All patients underwent bariatric surgery (laparoscopic Roux-en-Y gastric bypass surgery), and outcomes were organized into intermediate (operative and reversible), primary (permanent or potential organ damage), and secondary (length of stay and readmission). Overall, patients in the first tertile were seven times more likely to experience primary complications than patients in the next two tertiles. In the first tertile, 16.6 percent of patients experienced primary complications, including death, unstable angina, deep vein thrombosis, pulmonary embolism, renal failure, and/or stroke, compared with 2.8 percent of patients in the second and third tertiles. Operative times were 24.8 minutes longer in the first tertile, compared with the third. In addition, hospital lengths of stay and 30-day readmission rates were highest in the first group, as were intubation duration and estimated blood loss. Patients in the first tertile were more likely to be women, smokers, older, non-Caucasian, and have diabetes and hypertension.

"Morbid obesity is associated with numerous health risks, including cardiovascular disease, respiratory conditions, diabetes, sleep apnea, and an increased rate of death. Bariatric surgery has been shown to reduce comorbidities and long-term mortality in morbidly obese patients," said Dr. McCullough. "The benefits of bariatric surgery clearly outweigh the risks."

To minimize postoperative complications associated with bariatric surgery, researchers recommend measuring cardiopulmonary fitness prior to surgery. For patients with low cardiopulmonary fitness levels, a combination of medical weight loss and physical conditioning is recommended prior to bariatric surgery in order to increase preoperative fitness levels to an acceptable level.

"Physicians and other health-care providers should educate obese patients on current options for healthy and permanent weight loss in order to minimize long-term health complications," said W. Michael Alberts, MD, FCCP, President of the American College of Chest Physicians.

CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at www.chestnet.org.

(Reprint of Article -  August 7, 2006)

 FUNCTIONAL CAPACITY TESTING

The above Functional Capacity Test Data Sheet has been used by me with good success since 1985. While a traditional Stress Test is used to determine the presence or absence of heart disease, a functional capacity treadmill test can be used to determine an appropriate starting point for a prescriptive exercise program. The test start point is less than 2 METS and the incremental progression allows you to note subtle differences in exercise tolerance as the patient progresses through changes in either speed or intensity - for each of the 20 test stages.

This test classifies functional capacity according to the Weber Classification scale (Weber KT, Janicki, JS, Exercise testing for evaluation of chronic cardiac failure - American Journal of Cardiology 55 (Suppl A) 122A-131A, 1985

As a patient progresses throught the various test stages their functional level increases. The lowest level is classified as "E" while the highest is "A."  Patients functioning at Class "D" or "E" - at greatest risk for chronic cardiac failure are referred to a monitored rehabilitation program. Patients at Class "A" while not highly conditioned athletes, are at least risk for chronic cardiac failure while exercising. The data sheet is color coordinated to highlight the various functional levels.

Over the years I have found that assigning a letter grade "A - E" to describe functional capacity works well when conversing with patients or clinicians. While I am certain that some of you will not agree with my test protocol or methodology, it has proven to be very successful for me. Your comments are appreciated. You may download a copy of the Functional Capacity Test Sheet at our FREE DOWNLOAD section.

Barry M. Stein, DPE, Clinical Exercise Physiologist

As health professionals we all recognize that children today are faced with far greater challenges to their health and well-being. The "Age of Convenience" in which we live has reduced our children's need and desire to remain physically active - and has chemically altered almost every food they eat. As a result of this dramatic change in lifestyle over the past 40 years, childhood obesity has reached epidemic proportions and children today are at far greater risk for developing diabetes, heart disease and other serious illness at a young age. If this unhealthy trend continues, we can expect that today's overweight children will become tomorrow's obese adults - and that our healthcare system will become increasingly overburdened. As parents, educations and clinicians we have a responsibility to find creative ways to assist children in developing life-long healthy habits. The ActivityWorks program was designed to help answer this need. Please take a moment to review the ActivityWorks website and help spread the word about this worthwhile project.

Barry M. Stein, DPE, Clinical Exercise Physiologist

 To learn more about ActivityWorks CLICK HERE

 To Learn more about my work designing the Kinetic Protocol for  ActivityWorks http://comps.activityworks.com/Barry.php

Learn more about Activity Works on YouTube at http://www.youtube.com/activityworks

The True Age Test said I was 40. Ugh! Today when I went to buy face cream… and the worker at the salon tried to find something good for my skin type - she estimated my age to be “not yet 30″. She said “not yet thirty” ... and that made me happy. Finally, somebody can look at me and guess my true age. 

 Barry M. Stein, DPE  Clinical Exercise Physiologist