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Papers by Amandine Rapin
Respiratory Research
Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a signific... more Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a significant reduction in quality of life and an increased mortality risk. Current guidelines strongly recommend pulmonary rehabilitation (PR) after a severe exacerbation. Studies reporting referral for PR are scarce, with no report to date in Europe. Therefore, we assessed the proportion of French patients receiving PR after hospitalization for COPD exacerbation and factors associated with referral. Methods This was a national retrospective study based on the French health insurance database. Patients hospitalized in 2017 with COPD exacerbation were identified from the exhaustive French medico-administrative database of hospitalizations. In France, referral to PR has required as a stay in a specialized PR center or unit accredited to provide multidisciplinary care (exercise training, education, etc.) and admission within 90 days after discharge was assessed. Multivariate logistic regression was ...
Journal of Clinical Medicine
COVID-19 has probably contributed as a risk factor for sleep disturbance. Actigraphy has been use... more COVID-19 has probably contributed as a risk factor for sleep disturbance. Actigraphy has been used to evaluate sleep complaints in self-isolated populations and frontline doctors during the COVID-19 pandemic. This systematic review aims to summarize the impact of the COVID-19 pandemic on sleep through wrist actigraphy, estimating sleep latency, total sleep time, awakening-after-sleep onset, and sleep efficiency. Searches were conducted of observational studies on the PubMed, Embase, Scopus, Web of Science, and PEDro databases from 1 December 2019 to 31 December 2022. Ninety articles were found, and given the eligibility criteria, fifteen were selected. Six studies were classified by the National Health and Medical Research Council as evidence level IV, two studies as level III-3, and seven studies as level III-2. According to the ACROBAT-NRSI instrument, three studies were classified as having a “serious” risk of bias, two as having “critical” risk, four as having “moderate” risk, a...
Bioengineering
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
International Journal of Environmental Research and Public Health
Introduction: COVID-19 is a public health emergency all around the world. Severe illness occurred... more Introduction: COVID-19 is a public health emergency all around the world. Severe illness occurred in about 14% of patients and 5% of patients developed critical illness, but the prognosis for these patients remains unclear. Objective: To describe the prognosis in hospitalized adults with COVID-19. Methods: The MEDLINE, EMBASE, AMED, and COCHRANE databases were searched for studies published up to 28 June 2021 without language restrictions. Descriptors were related to “COVID-19” and “prognosis”. Prospective inception cohort studies that assessed morbidity, mortality and recovery in hospitalized people over 18 years old with COVID-19 were included. Two independent reviewers selected eligible studies and extracted the available data. Acute respiratory distress syndrome (ARDS) and multiple organ failure (MOFS) were considered as outcomes for morbidity and discharge was considered for recovery. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Analyses were p...
Biology
Background: Data describing patients hospitalized in medical rehabilitation wards after the acute... more Background: Data describing patients hospitalized in medical rehabilitation wards after the acute phase of COVID-19 could help to better understand the rehabilitation needs in the current pandemic situation. Methods: Cohort including all patients with COVID-19 hospitalized in a single, large university hospital in Northeast France from 25 February to 30 April 2020. Results: 479 patients were admitted with COVID-19 during the study period, of whom 128 died (26.7%). Among the 351 survivors, 111 were referred to rehabilitation units, including 63 (17.9%) referred to physical and rehabilitation medicine (PRM) units. The median age of patients referred to rehabilitation units was 72 years. Patients who had been in intensive care, or who had had a long hospital stay, required referral to PRM units. Two biomarkers were associated with referral to rehabilitation units, namely, elevated troponin (p = 0.03) and impaired renal function (p = 0.03). Age was associated with referral to PRM units ...
Annals of Physical and Rehabilitation Medicine, 2015
Post-intensive care rehabilitation is a concept born in the 2000th years to designate the rehabil... more Post-intensive care rehabilitation is a concept born in the 2000th years to designate the rehabilitation of the patients with consciousness troubles and/or severe visceral impairments, after intensive care units. Methods The Bouffard-Vercelli Centre obtains, in 1982, the authorization for 20 beds of ''rehabilitation in intensive care'', become, in 2002, ''post-intensive care rehabilitation''. The capacity of this unit, dedicated to coma awakening and to take care for visceral impairments, particularly respiratory ones, varied from 20 to 30 beds (currently 22 beds + 8 beds dedicated to chronic vegetative and little relationship status. We have studied its activity. Results During 33 years, the unit received 1948 patients (59 by year on average), with a medium stay of 154 days, 66% of brain injured patients (half in awakening phase), 25% of spinal cord injured patients (with artificial respiration) and 9% of others pathologies (peripheral nervous, cardiovascular or respiratory ones). The death level is 17%, the return to home level, directly or after specialized rehabilitation, is 49%. The others (34%) are institutionalized. Discussion The post-intensive care rehabilitation is a particular reality within continuation and rehabilitation care, particularly specialized for the care in nervous system disease. It's out of the 2008 decrees and its place within this care is discussed.
La Lettre de médecine physique et de réadaptation, 2009
Journal de Réadaptation Médicale : Pratique et Formation en Médecine Physique et de Réadaptation, 2011
Annals of Physical and Rehabilitation Medicine, 2011
Discussion and conclusion.-The PariS-TBI study data base enables analysis of long-term outcomes a... more Discussion and conclusion.-The PariS-TBI study data base enables analysis of long-term outcomes and predictive factors in severe TBI patients thanks to this homogeneous prospective inception cohort. So far, preliminary results four years after the accident showed major sequelae and impact on TBI patients and their relatives life.
Annals of Physical and Rehabilitation Medicine, 2011
Annals of Physical and Rehabilitation Medicine, 2010
Post-polio syndrome (PPS) refers to a clinical disorder affecting polio survivors with sequelae y... more Post-polio syndrome (PPS) refers to a clinical disorder affecting polio survivors with sequelae years after the initial polio attack. These patients report new musculoskeletal symptoms, loss of muscular strength or endurance. PPS patients are tired, in pain and experience new and unusual muscular deficits, on healthy muscles as well as deficient muscles initially affected by the Poliovirus. Once a clinical diagnosis is established, the therapeutic options can be discussed. Some pathophysiological mechanisms have been validated by research studies on PPS (inflammatory process in cerebrospinal fluid [CSF] and cytokines of the immune system). Several studies have been conducted to validate medications (pyridostigmine, immunoglobulin, coenzyme Q10) or physical exercises protocols. This article focuses on the relevance and efficacy that can be expected from these therapeutics. Very few studies reported some improvements. Medications combined to individual and supervised exercise training programs are promising therapeutic strategies for PPS patients care management.
Annals of Physical and Rehabilitation Medicine, 2012
C'est plus souvent à l'injection du produit qu'au passage de la peau que l'enfant réagit. Conclus... more C'est plus souvent à l'injection du produit qu'au passage de la peau que l'enfant réagit. Conclusion.-Ce travail ne permet pas de justifier l'utilité de l'application d'une crème anesthésique avant d'effectuer des injections de toxine botulinique chez l'enfant et l'adolescent paralysé cérébral afin de diminuer la douleur induite.
Annals of Physical and Rehabilitation Medicine, 2012
Annals of Physical and Rehabilitation Medicine, 2012
Conclusion.-Malgré des capacités d'effort maximales et des paramètres hémodynamiques cardiaques c... more Conclusion.-Malgré des capacités d'effort maximales et des paramètres hémodynamiques cardiaques comparables à l'effort, les sujets coronariens présentaient une diminution dans certains domaines cognitifs avec des variabilités de l'oxygénation cérébrale à l'effort, en particulier selon leur âge et leur tolérance à l'effort.
Annals of Physical and Rehabilitation Medicine, 2013
vertigo'' is rarely true vertigo but there are several experimental and clinical arguments in fav... more vertigo'' is rarely true vertigo but there are several experimental and clinical arguments in favour of a possible origin of cervical postural instability. A correct perception of the body balance during head movement requires both a vestibular signal and precise cervical static and dynamic proprioceptive information. This finding alone is sufficient to validate the concept of a feeling of instability of cervical origin, called by some authors ''cervical vertigo''. A vascular mechanism is very rarely involved in the presence of two functional vertebral arteries and a normal Willis polygon. The increase in the gain of cervical-ocular reflex or the presence of a cervical nystagmus are not convincing arguments for a cervical origin of dizziness. Diagnostic criteria proposed in the literature require a temporal relationship between neck pain and postural instability even during recurrences, and the lack of neck pain excludes this diagnosis. Finally, other causes of dizziness should be eliminated. Further reading Brooks JX, Cullen KE. Multimodal integration in rostral fastigial nucleus provides an estimate of body movement.
Annals of Physical and Rehabilitation Medicine, 2013
Actualités dans la prise en charge des insuffisances respiratoires sévères chez les patients souf... more Actualités dans la prise en charge des insuffisances respiratoires sévères chez les patients souffrant de maladies neuromusculaires : recommandations internationales
Annals of Physical and Rehabilitation Medicine, 2013
Annals of Physical and Rehabilitation Medicine, 2013
Discussion et conclusion.-Ce résultat serait en faveur de l'intérêt du MEOPA dans la mobilisation... more Discussion et conclusion.-Ce résultat serait en faveur de l'intérêt du MEOPA dans la mobilisation d'une articulation raide notamment dans le cadre d'un SDRC-I permettant une amélioration algo-fonctionnelle et articulaire ayant permis à notre patiente de reprendre son travail antérieur.
Annals of Physical and Rehabilitation Medicine, 2013
Introduction.-Hypopituitarism is common after traumatic brain injury (TBI) and may decline sponta... more Introduction.-Hypopituitarism is common after traumatic brain injury (TBI) and may decline spontaneously. The purpose of our work is to report a case of late-onset anterior pituitary dysfunction, comparing to the current literature and screening strategy. Case report.-A 19-year-old man, suffered from a frontal syndrome involving disinhibition, boulimic behavior with weight gain of 8 kg at 3 months postsevere TBI. The systematic endocrine assessment, at that moment, is normal. We check it 6 months later because of the persistence of weight gain, 7 kg over the pre-TBI weight, despite restrictive diet. A thyrotropic deficiency was found associated with an hypocortisolism. Overweight persisted despite adapted substitutive treatment. Discussion.-In a study involving 48 cases, thyrotropic deficiency is found, in only one patient at 6 months after the TBI, while it was normal before [1]. However, the cortisol deficiency is often reported. A screening strategy emerges from the expert conference of 2011 about screening endocrine deficits after TBI. They advise the early morning basal cortisol measure, in TBI's patient hospitalized at least 24 h, presenting tomographic abnormalities or clinical signs of hypocorticolism. The endocrine assessment should be performed at 6 months if clinical findings suggest hypopituitarism, and systematically at 12 months. After the first year, in severe TBI, no new onset hormone deficiency was defined, then, no more investigation is required [2]. In addition, unspecific clinical signs, as in our case, major weight gain, should sound a warning to the need to repeat the endocrine assessment during the first year in severe TBI. This reason must be raised especially if there are behavioral or cognitive disorders. References [1] Agha A,
Annals of Physical and Rehabilitation Medicine, 2013
Introduction.-Exercise testing's protocol and exercise limitation of the patients affected by Par... more Introduction.-Exercise testing's protocol and exercise limitation of the patients affected by Parkinson's disease is rarely described. The study of the adaptation to the efforts appears nevertheless an interesting prerequisite to build a program of rehabilitation individualized. The physical activity demonstrated its endogenous dopamino-secretory effects. Objective.-To describe and determine the parameters that limit the physical efforts of patients affected by Parkinson's disease. Materials and methods.-Retrospective and descriptive study of exercise tests in 13 patients affected by Parkinson's disease, 11 men and 2 women, with an average age of 61-year-old [46-78], between January 2008 and March 2013 at the university hospital of Reims. Eight patients were quoted at a stage I and II according to Hoehn and Yahr and 5 patients were quoted at a stage III. Results.-Eight tests were maximal. All the patients presented an intolerance to physical efforts [1], severe for 8 of them (61.5%). The test was stopped because of the impossibility of keeping the rhythm of pedalling for 4 of the patients (31%) and because of myalgia or tiredness for 4 other patients (31%). The first threshold was premature in 38.5% of the cases (n = 5) that implies a limit of peripheral origin. There was a defect of recruitment of the volumes in 31% of the cases (n = 4) and ventilatory equivalents raised in 61.5% of the cases (n = 8). The kinetics of the pulse of O 2 were correct, but 77% presented a pulse of insufficient final O 2 (n = 10). Conclusion.-The first limiting factors is peripheral. But cardiac and pulmonary system seems to be involved to, even if exploration at rest are normal. The cardiac and pulmonary adaptability is element that would be more explore, particularly by embarked measures for the cardiac output during physical effort. Reference [1] Préfaut C, Piperno D. Value and indications of exercise test in pneumology.
Respiratory Research
Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a signific... more Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a significant reduction in quality of life and an increased mortality risk. Current guidelines strongly recommend pulmonary rehabilitation (PR) after a severe exacerbation. Studies reporting referral for PR are scarce, with no report to date in Europe. Therefore, we assessed the proportion of French patients receiving PR after hospitalization for COPD exacerbation and factors associated with referral. Methods This was a national retrospective study based on the French health insurance database. Patients hospitalized in 2017 with COPD exacerbation were identified from the exhaustive French medico-administrative database of hospitalizations. In France, referral to PR has required as a stay in a specialized PR center or unit accredited to provide multidisciplinary care (exercise training, education, etc.) and admission within 90 days after discharge was assessed. Multivariate logistic regression was ...
Journal of Clinical Medicine
COVID-19 has probably contributed as a risk factor for sleep disturbance. Actigraphy has been use... more COVID-19 has probably contributed as a risk factor for sleep disturbance. Actigraphy has been used to evaluate sleep complaints in self-isolated populations and frontline doctors during the COVID-19 pandemic. This systematic review aims to summarize the impact of the COVID-19 pandemic on sleep through wrist actigraphy, estimating sleep latency, total sleep time, awakening-after-sleep onset, and sleep efficiency. Searches were conducted of observational studies on the PubMed, Embase, Scopus, Web of Science, and PEDro databases from 1 December 2019 to 31 December 2022. Ninety articles were found, and given the eligibility criteria, fifteen were selected. Six studies were classified by the National Health and Medical Research Council as evidence level IV, two studies as level III-3, and seven studies as level III-2. According to the ACROBAT-NRSI instrument, three studies were classified as having a “serious” risk of bias, two as having “critical” risk, four as having “moderate” risk, a...
Bioengineering
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
International Journal of Environmental Research and Public Health
Introduction: COVID-19 is a public health emergency all around the world. Severe illness occurred... more Introduction: COVID-19 is a public health emergency all around the world. Severe illness occurred in about 14% of patients and 5% of patients developed critical illness, but the prognosis for these patients remains unclear. Objective: To describe the prognosis in hospitalized adults with COVID-19. Methods: The MEDLINE, EMBASE, AMED, and COCHRANE databases were searched for studies published up to 28 June 2021 without language restrictions. Descriptors were related to “COVID-19” and “prognosis”. Prospective inception cohort studies that assessed morbidity, mortality and recovery in hospitalized people over 18 years old with COVID-19 were included. Two independent reviewers selected eligible studies and extracted the available data. Acute respiratory distress syndrome (ARDS) and multiple organ failure (MOFS) were considered as outcomes for morbidity and discharge was considered for recovery. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Analyses were p...
Biology
Background: Data describing patients hospitalized in medical rehabilitation wards after the acute... more Background: Data describing patients hospitalized in medical rehabilitation wards after the acute phase of COVID-19 could help to better understand the rehabilitation needs in the current pandemic situation. Methods: Cohort including all patients with COVID-19 hospitalized in a single, large university hospital in Northeast France from 25 February to 30 April 2020. Results: 479 patients were admitted with COVID-19 during the study period, of whom 128 died (26.7%). Among the 351 survivors, 111 were referred to rehabilitation units, including 63 (17.9%) referred to physical and rehabilitation medicine (PRM) units. The median age of patients referred to rehabilitation units was 72 years. Patients who had been in intensive care, or who had had a long hospital stay, required referral to PRM units. Two biomarkers were associated with referral to rehabilitation units, namely, elevated troponin (p = 0.03) and impaired renal function (p = 0.03). Age was associated with referral to PRM units ...
Annals of Physical and Rehabilitation Medicine, 2015
Post-intensive care rehabilitation is a concept born in the 2000th years to designate the rehabil... more Post-intensive care rehabilitation is a concept born in the 2000th years to designate the rehabilitation of the patients with consciousness troubles and/or severe visceral impairments, after intensive care units. Methods The Bouffard-Vercelli Centre obtains, in 1982, the authorization for 20 beds of ''rehabilitation in intensive care'', become, in 2002, ''post-intensive care rehabilitation''. The capacity of this unit, dedicated to coma awakening and to take care for visceral impairments, particularly respiratory ones, varied from 20 to 30 beds (currently 22 beds + 8 beds dedicated to chronic vegetative and little relationship status. We have studied its activity. Results During 33 years, the unit received 1948 patients (59 by year on average), with a medium stay of 154 days, 66% of brain injured patients (half in awakening phase), 25% of spinal cord injured patients (with artificial respiration) and 9% of others pathologies (peripheral nervous, cardiovascular or respiratory ones). The death level is 17%, the return to home level, directly or after specialized rehabilitation, is 49%. The others (34%) are institutionalized. Discussion The post-intensive care rehabilitation is a particular reality within continuation and rehabilitation care, particularly specialized for the care in nervous system disease. It's out of the 2008 decrees and its place within this care is discussed.
La Lettre de médecine physique et de réadaptation, 2009
Journal de Réadaptation Médicale : Pratique et Formation en Médecine Physique et de Réadaptation, 2011
Annals of Physical and Rehabilitation Medicine, 2011
Discussion and conclusion.-The PariS-TBI study data base enables analysis of long-term outcomes a... more Discussion and conclusion.-The PariS-TBI study data base enables analysis of long-term outcomes and predictive factors in severe TBI patients thanks to this homogeneous prospective inception cohort. So far, preliminary results four years after the accident showed major sequelae and impact on TBI patients and their relatives life.
Annals of Physical and Rehabilitation Medicine, 2011
Annals of Physical and Rehabilitation Medicine, 2010
Post-polio syndrome (PPS) refers to a clinical disorder affecting polio survivors with sequelae y... more Post-polio syndrome (PPS) refers to a clinical disorder affecting polio survivors with sequelae years after the initial polio attack. These patients report new musculoskeletal symptoms, loss of muscular strength or endurance. PPS patients are tired, in pain and experience new and unusual muscular deficits, on healthy muscles as well as deficient muscles initially affected by the Poliovirus. Once a clinical diagnosis is established, the therapeutic options can be discussed. Some pathophysiological mechanisms have been validated by research studies on PPS (inflammatory process in cerebrospinal fluid [CSF] and cytokines of the immune system). Several studies have been conducted to validate medications (pyridostigmine, immunoglobulin, coenzyme Q10) or physical exercises protocols. This article focuses on the relevance and efficacy that can be expected from these therapeutics. Very few studies reported some improvements. Medications combined to individual and supervised exercise training programs are promising therapeutic strategies for PPS patients care management.
Annals of Physical and Rehabilitation Medicine, 2012
C'est plus souvent à l'injection du produit qu'au passage de la peau que l'enfant réagit. Conclus... more C'est plus souvent à l'injection du produit qu'au passage de la peau que l'enfant réagit. Conclusion.-Ce travail ne permet pas de justifier l'utilité de l'application d'une crème anesthésique avant d'effectuer des injections de toxine botulinique chez l'enfant et l'adolescent paralysé cérébral afin de diminuer la douleur induite.
Annals of Physical and Rehabilitation Medicine, 2012
Annals of Physical and Rehabilitation Medicine, 2012
Conclusion.-Malgré des capacités d'effort maximales et des paramètres hémodynamiques cardiaques c... more Conclusion.-Malgré des capacités d'effort maximales et des paramètres hémodynamiques cardiaques comparables à l'effort, les sujets coronariens présentaient une diminution dans certains domaines cognitifs avec des variabilités de l'oxygénation cérébrale à l'effort, en particulier selon leur âge et leur tolérance à l'effort.
Annals of Physical and Rehabilitation Medicine, 2013
vertigo'' is rarely true vertigo but there are several experimental and clinical arguments in fav... more vertigo'' is rarely true vertigo but there are several experimental and clinical arguments in favour of a possible origin of cervical postural instability. A correct perception of the body balance during head movement requires both a vestibular signal and precise cervical static and dynamic proprioceptive information. This finding alone is sufficient to validate the concept of a feeling of instability of cervical origin, called by some authors ''cervical vertigo''. A vascular mechanism is very rarely involved in the presence of two functional vertebral arteries and a normal Willis polygon. The increase in the gain of cervical-ocular reflex or the presence of a cervical nystagmus are not convincing arguments for a cervical origin of dizziness. Diagnostic criteria proposed in the literature require a temporal relationship between neck pain and postural instability even during recurrences, and the lack of neck pain excludes this diagnosis. Finally, other causes of dizziness should be eliminated. Further reading Brooks JX, Cullen KE. Multimodal integration in rostral fastigial nucleus provides an estimate of body movement.
Annals of Physical and Rehabilitation Medicine, 2013
Actualités dans la prise en charge des insuffisances respiratoires sévères chez les patients souf... more Actualités dans la prise en charge des insuffisances respiratoires sévères chez les patients souffrant de maladies neuromusculaires : recommandations internationales
Annals of Physical and Rehabilitation Medicine, 2013
Annals of Physical and Rehabilitation Medicine, 2013
Discussion et conclusion.-Ce résultat serait en faveur de l'intérêt du MEOPA dans la mobilisation... more Discussion et conclusion.-Ce résultat serait en faveur de l'intérêt du MEOPA dans la mobilisation d'une articulation raide notamment dans le cadre d'un SDRC-I permettant une amélioration algo-fonctionnelle et articulaire ayant permis à notre patiente de reprendre son travail antérieur.
Annals of Physical and Rehabilitation Medicine, 2013
Introduction.-Hypopituitarism is common after traumatic brain injury (TBI) and may decline sponta... more Introduction.-Hypopituitarism is common after traumatic brain injury (TBI) and may decline spontaneously. The purpose of our work is to report a case of late-onset anterior pituitary dysfunction, comparing to the current literature and screening strategy. Case report.-A 19-year-old man, suffered from a frontal syndrome involving disinhibition, boulimic behavior with weight gain of 8 kg at 3 months postsevere TBI. The systematic endocrine assessment, at that moment, is normal. We check it 6 months later because of the persistence of weight gain, 7 kg over the pre-TBI weight, despite restrictive diet. A thyrotropic deficiency was found associated with an hypocortisolism. Overweight persisted despite adapted substitutive treatment. Discussion.-In a study involving 48 cases, thyrotropic deficiency is found, in only one patient at 6 months after the TBI, while it was normal before [1]. However, the cortisol deficiency is often reported. A screening strategy emerges from the expert conference of 2011 about screening endocrine deficits after TBI. They advise the early morning basal cortisol measure, in TBI's patient hospitalized at least 24 h, presenting tomographic abnormalities or clinical signs of hypocorticolism. The endocrine assessment should be performed at 6 months if clinical findings suggest hypopituitarism, and systematically at 12 months. After the first year, in severe TBI, no new onset hormone deficiency was defined, then, no more investigation is required [2]. In addition, unspecific clinical signs, as in our case, major weight gain, should sound a warning to the need to repeat the endocrine assessment during the first year in severe TBI. This reason must be raised especially if there are behavioral or cognitive disorders. References [1] Agha A,
Annals of Physical and Rehabilitation Medicine, 2013
Introduction.-Exercise testing's protocol and exercise limitation of the patients affected by Par... more Introduction.-Exercise testing's protocol and exercise limitation of the patients affected by Parkinson's disease is rarely described. The study of the adaptation to the efforts appears nevertheless an interesting prerequisite to build a program of rehabilitation individualized. The physical activity demonstrated its endogenous dopamino-secretory effects. Objective.-To describe and determine the parameters that limit the physical efforts of patients affected by Parkinson's disease. Materials and methods.-Retrospective and descriptive study of exercise tests in 13 patients affected by Parkinson's disease, 11 men and 2 women, with an average age of 61-year-old [46-78], between January 2008 and March 2013 at the university hospital of Reims. Eight patients were quoted at a stage I and II according to Hoehn and Yahr and 5 patients were quoted at a stage III. Results.-Eight tests were maximal. All the patients presented an intolerance to physical efforts [1], severe for 8 of them (61.5%). The test was stopped because of the impossibility of keeping the rhythm of pedalling for 4 of the patients (31%) and because of myalgia or tiredness for 4 other patients (31%). The first threshold was premature in 38.5% of the cases (n = 5) that implies a limit of peripheral origin. There was a defect of recruitment of the volumes in 31% of the cases (n = 4) and ventilatory equivalents raised in 61.5% of the cases (n = 8). The kinetics of the pulse of O 2 were correct, but 77% presented a pulse of insufficient final O 2 (n = 10). Conclusion.-The first limiting factors is peripheral. But cardiac and pulmonary system seems to be involved to, even if exploration at rest are normal. The cardiac and pulmonary adaptability is element that would be more explore, particularly by embarked measures for the cardiac output during physical effort. Reference [1] Préfaut C, Piperno D. Value and indications of exercise test in pneumology.