On the Functional Capacity and Quality of Life of Patients with Acromegaly: Are They Candidates for Rehabilitation Programs? (original) (raw)
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Journal of Physical Therapy Science, 2015
The six-minute walk test (6MWT) is increasingly being used as an important tool for analyzing functional capacity in patients with multisystem disorders. The aim of this study was to evaluate the effect of body composition, peripheral muscle function, and pulmonary function on the six-minute walk distance (6MWD) in acromegalic patients. [Subjects and Methods] Thirty-two patients with active acromegaly, with a mean age of 48.6 ± 12.1 years, underwent an evaluation of body composition using electrical bioimpedance, isometric dynamometry with surface electromyography, tests of pulmonary function, and the 6MWT. [Results] The mean ± SD values for the 6MWD, fat-free mass (FFM), and maximal expiratory pressure (MEP) were 65.5 ± 11.7% predicted, 55.1 ± 10.6 kg, and 55.2 ± 16.8% predicted, respectively. There was a significant correlation between the 6MWD and the following parameters: the angle of the linear regression line obtained using the values of the median frequency electromyography signal over time during the fatigability test for the vastus medialis muscle (MDF, r=0.65), FFM (r=0.62), MEP (r=0.60), height (2) /resistance index (r=0.52), resistance (r=−0.50), and forced expiratory volume in 1 second (r=0.50). Multivariate analysis showed that MDF, FFM, and MEP were independent predictors of the 6MWD (R 2 =0.52). [Conclusion] The fatigability of the peripheral muscles, FFM, and MEP are the primary determinants of the 6MWD in acromegalics.
Arquivos Brasileiros de Endocrinologia & Metabologia, 2013
To evaluate the quality of life and its association with daily physical activity and disease control in acromegalic patients. Subjects and methods: A cross-sectional, case series study, composed of 42 patients recruited from the Neuroendocrinology Unit of the University Hospital of Brasilia. Level of physical activity was accessed by the International Physical Activity Questionnaire (IPAQ 6-short-form), which evaluates the weekly time spent on physical activity of moderate to vigorous intensity in different contexts of life. Quality of life was evaluated by The Medical Outcome Study Questionnaire Short Form (SF-36). Data was compared to growth hormone (GH) and insulin-like growth factor (IGF-1) levels. Students' t test and Fisher test were used, p < 0.05, SPSS 17.0. Results: Twenty--two women, aged 51.33 ± 14.33 and 20 men, aged 46.2 ± 13.18 were evaluated. Arthralgia was present in 83% of cases. In men, the most common sites of pain were the knees (73%), spine (47% lumbar, and 53% thoracic and cervical segments), hands and wrists (40%). Higher scores on SF-36 were observed in patients with intermediate or high levels of physical activity, in the domains social functioning (75 CI 57.3-92.6), general health (75.5 CI 60.4-90.5), mental health (70 CI 57.8-82.1). Conclusions: In this study, the presence and severity of physical disability and pain were not associated with initial GH and IGF-1 levels or time of exposure to GH excess. However, the patients considered controlled, with normal a normal age-adjusted IGF-1, presented higher scores in SF-36, in physical and emotional domains, compared with patients with persistent hypersomatotrophism. These findings suggest benefits of metabolic control in self-reported quality of life. Arq Bras Endocrinol Metab. 2013;57 :550-7 Keywords Acromegaly; quality of life; functional capacity; activities in daily life RESUMO Objetivo: Avaliar a qualidade de vida e sua associação com a prática de vida diária e controle metabólico em pacientes portadores de acromegalia. Sujeitos e métodos: Estudo seccional de série de casos, composto por 42 pacientes recrutados na Unidade de Neuroendocrinologia do Hospital Universitário de Brasília. O nível de atividade física foi estimado pelo Questionário Internacional de Atividade Física (IPAQ-6), que avalia o tempo gasto semanalmente em atividades físicas que variam de intensidade em diferentes contextos de vida. A qualidade de vida foi avaliada pelo questionário SF-36. Os dados obtidos foram comparados aos níveis de hormônio do crescimento (GH) e fator de crescimento semelhante à insulina (IGF-1). Os testes t Students e Fisher foram aplicados e p < 0,05 foram considerados significativos, SPSS 17.0. Resultados: Avaliaram-se 22 mulheres com idades de 51,33 ± 14,33 e 20 homens com idades de 46,2 ±13,18. Artralgia foi relatada em 83% dos pacientes. Em homens, os sítios de dor mais comuns foram os joelhos (73%), coluna vertebral (47% lombar, 53% segmentos torácico e cervical), mãos e quadris (40%). Os maiores escores no SF-36 foram observados em pacientes com níveis intermediário ou alto de atividade física, sobretudo nos domínios social (75 CI 57,3-92,6), saúde geral (75,5 CI 60,4-90,5), saúde mental (70 CI 57,8-82,1). Conclusões: A presença e a severidade do prejuízo no desempenho físico e dor não se associaram com Gh e IGF-1 no diagnóstico, tempo de exposição prévio à doença. Todavia, pacientes considerados controlados apresentaram melhores escores nos domínios físico e emocional, comparados com pacientes com hipersomatotrofismo persistente. Tais achados sugerem benefícios do controle metabólico na qualidade de vida. Arq Bras Endocrinol Metab. 2013;57(7):550-7 Descritores Acromegalia; qualidade de vida; capacidade funcional; atividades da vida diária Copyright © ABE&M todos os direitos reservados. 551 Arq Bras Endocrinol Metab. 2013;57/7
The impact of biochemical control on the quality of life of patients with acromegaly
BULLETIN OF INTEGRATIVE PSYCHIATRY
Purpose: Quality of life (Qol) is undoubtedly important for patient case management. The current goal of a treatment extends therefore beyond biochemical monitoring, including the physical, mental and social state of wellbeing. We aimed to correlate disease activity with the perception of Qol in acromegalic patients. Methods: We performed a single center cross-sectional study on 26 patients: 9 men (34.6%) and 17 women (65.4%), with a mean age of 53 ± 11.5 years. Eleven patients (42.3%) had a biochemically controlled disease, while 15 subjects (57.7%) had an active disease. Results: The mean total score of the quality of life was 60.9 ± 12.6 in women, ranging from 40 to 85, while for men, the mean total score was of 64.04 ± 14.78, ranging from 42 to 85 (p=0.575). There was no significant difference between the mean AcroQol scores of patients with controlled or active disease (62.54 ± 13.42 vs 61.23 ± 13.46, p = 0.804). Patients younger than 60 had a significantly lower total score compared to older patients, (58.36 ± 14.17 vs 64.26 ± 12.44, p=0.047). Rural residents also scored lower than patients belonging to the urban region: (58.18 ± 11.21 vs 67.19 ± 14.39, p=0.048). Disease duration was negatively correlated with total score on AcroQol (r =-0.253, p= 0.045). We did not find significant correlations between GH and IGF1 levels and AcroQol (p=0,622 and p = 0.844, respectively). Conclusions: We found no significant differences between males and females, as well as between patients with active and controlled disease regarding the Qol, but other factors like 72/Bulletin of Integrative Psychiatry New Series December 2019 Year XXV No. 4 (83) age or locality provenience may play some role for the perceived health status and quality of life in acromegalic patients
Predictors of Quality of Life in Acromegaly: No Consensus on Biochemical Parameters
Frontiers in Endocrinology, 2017
Background: Quality of life (QoL) in patients with acromegaly is reduced irrespective of disease state. The contributions of multifactorial determinants of QoL in several disease stages are presently not well known. Objective: To systematically review predictors of QoL in acromegalic patients. Methods: Main databases were systematically searched using predefined search terms for potentially relevant articles up to January 2017. Inclusion criteria included separate acromegaly cohort, non-hereditary acromegaly, QoL as study parameter with clearly described method of measurement and quantitative results, N ≥ 10 patients, article in English and adult patients only. Data extraction was performed by two independent reviewers; studies were included using the PRISMA flow diagram. Results: We identified 1,162 studies; 51 studies met the inclusion criteria: 31 cross-sectional observational studies [mean AcroQoL score 62.7 (range 46.6-87.0, n = 1,597)], 9 had a longitudinal component [mean baseline AcroQoL score 61.4 (range 54.3-69.0, n = 386)], and 15 were intervention studies [mean baseline AcroQoL score 58.6 (range 52.2-75.3, n = 521)]. Disease-activity reflected by biochemical control measures yielded mixed, and therefore inconclusive results with respect to their effect on QoL. Addition of pegvisomant to somatostatin analogs and start of lanreotide autogel resulted in improvement in QoL. Data from intervention studies on other treatment modalities were too limited to draw conclusions on the effects of these modalities on QoL. Interestingly, higher BMI and greater degree of depression showed consistently negative associations with QoL. Hypopituitarism was not significantly correlated with QoL in acromegaly. Conclusion: At present, there is insufficient published data to support that biochemical control, or treatment of acromegaly in general, is associated with improved QoL. Studies with somatostatin receptor ligand treatment, i.e., particularly lanreotide autogel 2 Geraedts et al.
Pituitary, 2021
Purpose There is no consensus on quality of life (QOL) in patients with acromegaly requiring medical treatment after surgery compared with those achieving remission by surgery alone. Methods QuaLAT is a cross-sectional study comparing QOL in surgery-only treated acromegaly patients versus those requiring medical treatment post-surgery. Patients attending clinics were identified and divided into—Group 1: patients who had surgery only and were in biochemical remission, Group 2: all patients on medical treatment post-surgery, Group 3: patients from Group 2 with biochemical control. Participants were asked to fill three questionnaires; Acromegaly Quality of Life Questionnaire (ACROQOL), 36-Item Short Form Survey (SF36), and Fatigue Severity Scale (FSS). Results There were 32 patients in Group 1 and 25 in Group 2. There was no difference in QOL scores between groups 1 and 2, as measured by ACROQOL (mean difference [MD] = − 2.5, 95% CI − 16.6 to 11.6; p = 0.72), SF36v2 [Physical component...
Archives of Endocrinology and Metabolism
Objective: To evaluate whether hormonal profile, arterial function, and physical capacity are predictors of fatigue in patients with acromegaly. Subjects and methods: This is a cross-sectional study including 23 patients. The subjects underwent a Modified Fatigue Impact Scale (MFIS) assessment; serum growth hormones (GH) and IGF-1 measurements; pulse wave analysis comprising pulse wave velocity (PWV), arterial compliance (AC), and the reflection index (IR 1,2); dominant upper limb dynamometry (DYN); and the six-minute walking distance test (6MWT). Multiple linear regression models were used to identify predictors for MFIS. The coefficient of determination R 2 was used to assess the quality of the models' fit. The best model was further analyzed using a calibration plot and a limits of agreement (LOA) plot. Results: The mean ± SD values for the participants' age, MFIS,
Static and dynamic balances of patients with acromegaly and impact of exercise on balance
Pituitary, 2019
Purpose Patients with acromegaly may have balance abnormalities due to changes in body composition. We aim to compare static and dynamic balances in patients with acromegaly and healthy volunteers, and to evaluate the effects of exercise on balance in patients with acromegaly. Methods This prospective study included 25 patients with acromegaly followed at endocrinology clinic of Cerrahpasa Medical Faculty and 13 healthy volunteers. The acromegalic patients were divided into 2 groups. Group A (n = 11) attended an exercise program 3 days/week for 3 months, whereas group B (n = 14) and healthy volunteers (Group C) were exercise-free. Bipedal and unipedal stance static and dynamic balance tests were performed using a Prokin 252N device. Results The ages, demographic characteristics, and body compositions were similar. In acromegalic patients, the static balance parameters of displacement of center-of-pressure in anterior-posterior direction (C.o.P.Y) while eyes open (p = 0.002) and on left leg (p = 0.001), in left-right direction (C.o.P.X) on right leg (p = 0.03), eyes-closed average medio-lateral velocity (AMLV) (p = 0.001) and the dynamic parameter of forward/backward front/right standard deviation (FBFRSD) (p = 0.02) were significantly different from healthy controls. When the exercise effect on balance was evaluated between group A and B, there were significant improvements in most parameters of dynamic balance measurements of both forward-backward and medial-lateral sway (FBFRSD, FBDME, and RLBLSD) (p = 0.02, p = 0.02, and p = 0.004, respectively) after exercise in group A. Conclusions Patients with acromegaly had impairments at various static and dynamic balance parameters, especially in posterior direction. After a 3-month exercise program, the dynamic balance profoundly improved, but static balance was relatively preserved in patients with acromegaly.
Isokinetics and Exercise Science, 2016
BACKGROUND: Individuals with acromegaly (IwA) may have alterations in skeletal muscles. Isokinetic testing is the standard method to assess muscle performance through objective, reliable, and reproducible measures. OBJECTIVES: To assess knee muscles performance of IwA with active and controlled disease and to correlate the findings with hormone levels, handgrip strength (HGS), general fatigue, and quality of life. METHODS: Sixteen men with acromegaly (MwA), 21 women with acromegaly (WwA), and 21 healthy controls (nine men and 12 women) underwent knee isokinetic dynamometry at 75 and 240 • /s as well as isometric dynamometry to assess HGS. The subjects were also assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, the Fatigue Impact Scale (FIS), and the Acromegaly Quality of Life Questionnaire (AcroQoL). RESULTS: Compared with healthy controls, MwA and WwA exhibited significant reductions in the peak moment (PM), maximum work repetition, and total work for both extension and flexion at both angular velocities. There were significant differences for the agonist/antagonist ratio at 75 • /s in MwA (44% for active disease vs. 53% for controlled disease vs. 67% for the control group; P = 0.0002) and in WwA (48% for active disease vs. 58% for controlled disease vs. 66% for the control group; P = 0.0003). These patients also exhibited decreased HGS values and FACIT-F scores and increased FIS scores compared with healthy controls. There were significant correlations between measures obtained by isokinetic dynamometry, growth hormone (GH) levels, HGS values, and scores on the general fatigue questionnaires. However, GH levels were more strongly correlated with the isokinetic variables in MwA than in WwA.