Arnengsih Nazir

Background: Cardiorespiratory fitness (CRF) and physical activity are important indicators of long-term health. However, evidence regarding these measures among medical students in Indonesia following COVID-19 social restrictions remains limited. This study aimed to describe CRF, physical activity levels, and sedentary behavior among medical students enrolled in 2021. Methods: This descriptive cross-sectional study involved 84 medical students, including 48 women and 36 men. CRF was assessed using predicted maximal oxygen uptake (VO2max) derived from the 6-minute walk test (6-MWT). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) and expressed as metabolic equivalent minutes per week (MET-min/week). Daily sedentary time was also recorded. Results: The median 6-MWT distance was 518.5 m, corresponding to a median predicted VO2max of 19.5 mL/kg/min. All participants were classified as having low or very low CRF based on predicted VO2max. Mean weekly physical activity was 3,808 MET-min/week among men and 2,227 MET-min/week among women. Work/study-related activities contributed the largest proportion of overall physical activity, followed by recreational and transport-related activities. Mean daily sedentary time was 428 minutes among men and 463 minutes among women. Although most participants had moderate or high physical activity levels, low CRF and prolonged sedentary time were common. Conclusion: Medical students exhibited low CRF and prolonged sedentary time despite predominantly moderate-to-high physical activity levels. These findings suggest that total physical activity volume alone may not ensure adequate CRF. Structured aerobic exercise and strategies to reduce sedentary time may help improve fitness in this population. Future longitudinal studies should examine the associations between exercise modalities, body composition, nutritional factors, and changes in CRF.

Introduction: Cardiovascular disease (CVD) remained the leading cause of morbidity and mortality in Indonesia, with a high prevalence posing challenges for medical and rehabilitation management. The unequal distribution of CVD and its risk factors hindered government efforts to allocate healthcare workers, limiting access to cardiac rehabilitation (CR) programs, particularly in underserved areas. Methods: This review analyzed various articles in English and Indonesian, retrieved through Google using relevant keywords, reference exploration, and communication with professional organizations. Results and Discussion: Despite being introduced over 40 years ago, hospital-based CR programs remained scarce, especially in rural regions. Barriers included comorbidities, socioeconomic status, limited accessibility, low referral rates, lack of patient motivation, insurance constraints, insufficient supervised CR facilities, and employment-related issues. Additionally, government challenges in coordination and staffing further restricted CR expansion. However, the high number of CVD patients and individuals at risk presented opportunities for improvement. Strategies such as strengthening referral systems, increasing facilities, regulating healthcare workforce distribution, implementing telerehabilitation, and enhancing government policies on service coverage were crucial to expanding CR access. Conclusion: Although CR in Indonesia has been developed for decades, its availability remains inadequate. Challenges mirrored those of other developing nations, yet the increasing burden of CVD underscored the urgent need to expand CR programs through improved infrastructure, policies, and workforce distribution.

Burnout is a multidimensional occupational syndrome characterized by emotional exhaustion (EE), depersonalization, and low personal accomplishment. Nurses are particularly vulnerable due to sustained physical, emotional, and organizational stressors. Physical activity (PA) and cardiorespiratory...

Lung transplantation (LTx) is the definitive therapy for patients with end-stage lung disease and improves survival. However, many recipients continue to experience exercise intolerance, reduced physical capacity, and limitations in daily activities despite improved postoperative lung function. These impairments are multifactorial and closely associated with quality of life (QoL) and long-term outcomes. Pulmonary rehabilitation (PR) is a multidisciplinary intervention aimed at improving exercise capacity, physical fitness, and QoL and has demonstrated benefits across various chronic lung diseases. This narrative review synthesizes current evidence on PR in LTx recipients. A literature review was conducted to summarize PR program characteristics, safety, and reported outcomes across lung function, functional capacity, muscle fitness, activity and participation, and QoL, considering heterogeneity in study design and intervention protocols. Across the reviewed studies, PR participation was consistently associated with improvements in cardiorespiratory fitness, muscle strength, functional capacity, and QoL. In contrast, changes in spirometric parameters were generally modest. Functional improvements appear to be largely mediated by peripheral adaptations, including enhanced oxygen utilization and neuromuscular performance. These findings highlight the potential role of PR as an important component of short- and long-term management in LTx recipients, particularly during pre-transplant conditioning and post-transplant functional recovery phases.

Aim. This review evaluated the effects of physical and breathing exercises on functional outcomes, respiratory capacity, and quality of life (QoL) in patients with myasthenia gravis (MG). A structured search was conducted in PubMed, Web of Science, and Google Scholar, complemented by manual citation screening. Eligible studies included intervention trials and observational reports in English or Indonesian. Seven eligible studies, mainly intervention-based, were identified addressing the effects of physical and breathing exercises in MG. Evidence showed benefits in muscle strength, functional capacity, QoL, and respiratory function, with breathing exercises helping prevent complications. Physical and breathing exercises provide significant benefits for patients with MG. Interventions such as aerobic exercise, resistance exercise, respiratory muscle endurance training, and inspiratory muscle training improve pulmonary function, functional capacity, and reduce dyspnea and fatigue, accompanied by increased peripheral muscle strength and QoL. The underlying physiological mechanisms include enhanced respiratory muscle strength, ventilatory efficiency, diaphragm activation, and neuromuscular adaptations that mitigate fatigability without exacerbating MG symptoms. Progressive resistance exercise further supports peripheral oxygenation and neuromuscular plasticity. From a safety perspective, structured exercise programs are proven safe in patients with stable MG, without causing clinical exacerbations or neuromuscular deterioration. Mild side effects are transient and rarely require medical intervention. Adherence levels are high, with dropout rates more often influenced by non-medical factors. Conclusion. Physical and respiratory exercise yield measurable improvements in respiratory capacity, functional outcomes, and QoL in patients with MG, supporting their role as an effective disease management component.

Cardiomyopathy with concomitant heart failure and potentially malignant arrhythmia in patients with morbid obesity and mild restrictive lung disease causes significant functional impairment. Low-grade systemic inflammation accompanies the presence of these diseases. A 48-year-old woman undergoing phase II cardiac rehabilitation complained of easy fatigue. Cardiac rehabilitation consisting of moderate-intensity continuous training (MICT) 3 times 60 minutes with treadmill, arm, and leg ergometer, and resistance training was given. During MICT, the patient developed bigeminy without subjective complaint. After 6 weeks of exercise, an increase in VO2 max predicted by a 6-minute walking test (14.33 to 16.67), improvement in physical activity (low to moderate activity), and improvement in fatigue severity scale (43 to 27) were seen. Muscular fitness was also improved; muscle thickness showed an average increase of 0.25 centimeters with an increase in muscle strength. Body composition (2% decrease in body fat percentage and 4-level decrease in visceral fat) was also noted. Previous studies found that exercise increases VO2 max, improves endothelial function, and improves myocardial reserve flow. Muscle fiber adaptations also occur and include increased cross-sectional area of muscle, selective hypertrophy of fast-twitch fibers, decreased or maintained mitochondrial number and capillary density of muscle, and possible changes in energy sources. Combined exercise results in higher peak work capacity and VO2 peak than resistance or aerobic exercise alone. Although precautions must be taken due to the high risk of cardiovascular events as seen in this case, combined aerobic and resistance exercises can be prescribed to increase cardiorespiratory and muscular fitness and improve body composition.

Introduction: Parapneumonic effusions (PPE) can progress to pleural empyema (PE), a severe condition associated with increased morbidity and mortality. Pleural empyema impairs lung function due to pleural inflammation, fluid accumulation, and restricted diaphragm movement. Patients with severe PPE and PE often require intensive care, where prolonged immobilization and mechanical ventilation further exacerbate respiratory decline. Early rehabilitation (ER) has shown promise in reducing complications associated with prolonged intensive care unit (ICU) stays, but its role in preventing PE remains unclear. This review aimed to assess the impact of ER on PE prevention and on clinical outcomes. Methods: A literature search was conducted using PubMed and Google Scholar, focusing on original research and case reports related to PE, ICU care, and ER interventions. Only full-text English articles were included. Results: Ten studies met the inclusion criteria, comprising four original research articles and six case reports. Early rehabilitation, including respiratory physiotherapy, early mobilization, and targeted exercises, has been shown to enhance lung expansion, prevent atelectasis, and reduce postoperative pulmonary complications. It also improved oxygenation, secretion clearance, functional capacity, and psychological well-being. Patients receiving structured ER programs had shorter hospitalizations and better overall outcomes. Conclusion: Early rehabilitation plays a crucial role in mitigating respiratory complications in critically ill patients by reducing the incidence of PE, improving pulmonary mechanics, and preventing pleural adhesions. While further large-scale studies are needed, current evidence supports integrating ER into ICU protocols to optimize respiratory function, enhance recovery, and improve quality of life in patients at risk of PE.

Introduction: Phase II cardiac rehabilitation (CR) was the primary intervention used to improve functional capacity (FC) and facilitate patients with coronary artery disease (CAD) in returning to their pre-illness functional activities. This case report described the implementation of super-circuit training (SCT) as a novel exercise modality to assess its efficacy and safety. Case Description: A 37-year-old man underwent phase II CR eight weeks after percutaneous coronary intervention with an FC of 5.4 metabolic equivalents, which limited his activities. Fear of recurrent heart attacks further contributed to these limitations. The patient participated in a six-week SCT program aimed at improving FC as the primary cause of functional impairment. After completing the program, improvements in FC, muscular fitness, and psychological well-being were observed, leading to enhanced daily, vocational, and sexual activities. No adverse events occurred during the CR program. Discussion: The SCT protocol was a novel form of circuit training combining high-intensity aerobic exercise (AE) and resistance training (RT), specifically designed for CAD and heart failure patients with reduced ejection fraction. In this case, the protocol was adapted with modified RT intensity and type. AE was performed at 75%-85% of heart rate reserve, while RT included calisthenic exercises at 50% of repetition to failure. Physiologically, this regimen effectively increased metabolic and hemodynamic demand, improving muscular endurance, strength, and cardiorespiratory fitness. SCT was found to be safe and beneficial, consistent with previous studies. Conclusion: The implementation of SCT in a CAD patient undergoing phase II CR resulted in significant FC improvement and was considered safe.

Background: This study aims to assess differences in cardiorespiratory fitness improvement after phase II cardiac rehabilitation in coronary artery bypass grafting patients with various risk factor profiles and to investigate their correlation. Methods: Between October 2023 and March 2024, a total of 45 patients (35 males, 10 females; mean age: 59.5±8.5 years; range, 55 to 64 years) who underwent phase II cardiac rehabilitation following coronary artery bypass grafting were retrospectively analyzed. Obesity, hypertension, diabetes mellitus, and dyslipidemia were assessed. The patients were classified according to the specific risk factors and risk factor count. Cardiorespiratory fitness parameters including 6-minute walk distance, maximal oxygen consumption, and metabolic equivalents before and after cardiac rehabilitation were recorded. Results: The average risk factor count was 2.3 per patient, with dyslipidemia most prevalent (73.3%). The highest improvement in cardiorespiratory fitness was shown in patients with four risk factors and those who had obesity. A significant improvement in the cardiorespiratory fitness was observed in all patients, groups with one to four risk factors, and all specific risk factor groups (p0.05). Conclusion: Cardiac rehabilitation significantly improved cardiorespiratory fitness in all post-coronary artery bypass grafting patients, regardless of risk factor profiles, with notably greater improvements observed in patients with obesity. Clinically, these findings underscore the importance of universally recommending phase II cardiac rehabilitation in this patient group, particularly emphasizing tailored interventions in individuals with obesity to maximize rehabilitation outcomes and potentially reduce cardiovascular morbidity and mortality.

Coronary artery bypass grafting (CABG) is a common surgical approach for advanced coronary artery disease unresponsive to conservative or percutaneous treatments. Despite its benefits in symptom relief and long-term outcomes, CABG is associated with notable postoperative respiratory complications. As such, respiratory physiotherapy plays a crucial role in recovery. The active cycle of breathing technique (ACBT) is a non-invasive, evidence-based method that promotes lung ventilation, secretion clearance, and respiratory function. This review aimed to describe the effectiveness of the ACBT in enhancing physiological and functional outcomes following CABG surgery. A review of PubMed and Google Scholar studies was conducted, with relevant articles analyzed for study design, patient profiles, intervention protocols, and clinical outcomes. Fifteen articles were included, encompassing studies on pulmonary complications following CABG, dosage and application of ACBT, its preventive role in postoperative pulmonary complications (PPCs), and its effects on respiratory and functional outcomes. The results of this review are expected to enhance clinicians’ insight into selecting physical therapy to prevent PPCs. Pulmonary complications, including atelectasis and impaired gas exchange, are common after CABG and are primarily associated with anesthesia, surgical trauma, systemic inflammatory response, and impaired airway clearance. ACBT, consisting of breathing control, thoracic expansion, and forced expiration techniques, is a structured, non-invasive intervention designed to mobilize secretions and improve ventilation. It is typically applied 2– 3 times per day over 2– 5 days and often combined with incentive spirometry and conventional chest physiotherapy. The reviewed studies suggest that ACBT enhances oxygenation, improves lung volumes, and increases functional capacity. Additionally, ACBT helps reduce postoperative pain and dyspnea, contributing to overall recovery without reported adverse events. To conclude, ACBT is a safe, practical, and effective physiotherapeutic approach to support postoperative pulmonary recovery in CABG patients. Further well-designed trials are needed to validate and standardize its clinical use.