Francesca Cecchi

Fondazione Don Carlo Gnocchi, Milano, Lombardy, Italy

Are you Francesca Cecchi?

Claim your profile

Publications (14)28.91 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Although the six-minute walk test (6MWT) is widely used in cardiac rehabilitation, little is known about the ventilatory strategies adopted by older patients who have recently undergone median sternotomy, in order to meet the increased metabolic demand in the 6MWT. Methods: Using a portable gas-analyser we assessed the breathing patterns in the 6MWT before and after a 3-week rehabilitation programme in 84 older patients, 58 men and 26 women, mean age 71 years (standard deviation (SD) 6 years), who had undergone median sternotomy. Results: After rehabilitation, patients increased end-test ventilation (33.1 l (SD 9.8) vs 30.9 l (SD 8.4), p < 0.001) by increasing tidal volume (1.158 l (SD 0.298) vs 1.065 l (SD 0.255), p < 0.001), while breathing frequency remained unchanged (29.9 bpm (SD 5.4) vs 30.2 bpm (SD 5.8), p = 0.621). As a consequence, the ventilatory equivalent for CO2, was significantly improved (39.9 (SD 5.3) vs 43.5 (SD 7.4), p < 0.001). Furthermore, the improvement in ventilatory efficiency was significantly (p < 0.001) correlated with the improvement in the distance walked on the 6MWT. Conclusion: Older patients who have undergone median sternotomy meet the increased metabolic demand on the 6MWT after cardiac rehabilitation by increasing tidal volume. Accordingly, we should consider including as a routine specific exercises for inspiratory muscle training in current rehabilitation programmes to reduce inspiratory muscle effort and further improve ventilatory efficiency.
    Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 03/2013; · 1.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To walk a given distance older persons consume more metabolic energy than younger adults across all speeds. As physical activity interventions improve a variety of physical performance measures in older persons, including walking speed, in this study we hypothesized that the improvement of walking speed might be associated with the reduction of the metabolic cost of walking and we tested our hypothesis in a selected sample of older patients receiving cardiac rehabilitation. In 120 patients (88 men and 32 women, mean age 74.1 years±SD 5.0) we assessed energy expenditure during the 6-min Walk Test (6mWT) before and after the rehabilitation using a portable system for direct calorimetry. On the 6mWT performed after the rehabilitation patients significantly increased total energy expenditure (28.0 kcal±SD 8.3 vs. 25.7 kcal±SD 7.6, p<0.001), the distance walked (398 m±SD 93 vs. 343 m±SD 95, p<0.001) and, consequently, walking speed (1.11 m/s±SD 0.26 vs. 0.95m/s±SD 0.26, p<0.001) while the metabolic cost of walking, i.e. the amount of energy used to move a body mass of 1 kg for a distance of 1m, was significantly reduced (1.00 cal/kg/m±SD 0.19 vs. 1.11 cal/kg/m±SD 0.32, p<0.001). In older patients receiving cardiac rehabilitation the improvement of walking speed is associated with the improvement of walking economy. This might be a contributory factor to the favourable effects of physical activity interventions on physical performance measures.
    Gait & posture 12/2011; 35(3):458-61. · 2.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this prospective randomized controlled study was to compare the long-term effects of a structured physical activity intervention with those of aerobic exercises alone, in a cohort of elderly patients who had undergone elective cardiac surgery, and who were classified as frail at the end of rehabilitation based on their Short Physical Performance Battery (SPPB) score. At the end of rehabilitation, 140 frail elderly patients were randomly allocated either to the intervention group (IG) or to the control group (CG). CG participants received the usual aerobic exercise prescription, while IG participants were also taught additional exercises for strength, flexibility, balance and coordination. The improvement in SPPB score after 1 year was the outcome of the study. IG showed a significant improvement in SPPB score (9.0 ± 1.1 vs. 7.7 ± 1.4, p < 0.001), while no significant change was found in CG (7.7 ± 1.6 vs. 7.6 ± 1.5, p = 0.252). IG also showed a significantly higher proportion of participants who improved their SPPB score of at least 1 point (70 vs. 37%, p < 0.001). In conclusions, our structured physical activity intervention significantly improves the SPPB score in frail elderly patients who have undergone elective cardiac surgery. An intervention that improves the SPPB score might delay the occurrence of mobility disability.
    Internal and Emergency Medicine 07/2011; · 2.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Postoperative atrial fibrillation (AF) is a frequent complication after cardiac surgery. AF may also occur after hospital discharge during postacute rehabilitation. Several studies have addressed the AF that occurs in the hospital after surgery, and predictors have already been identified. Postoperative AF that occurs after hospital discharge has not been investigated thoroughly, and predictors are still unknown. In this study, we hypothesized that moderate-intensity physical activity in the year before surgery might favorably affect the incidence of AF during postacute rehabilitation. We tested our hypothesis in a cohort of 158 older patients admitted to a medical rehabilitation facility for postacute inpatient rehabilitation after coronary surgery and continuously monitored by telemetry for the duration of the rehabilitation. Independent of potential confounders, patients who reported low-intensity physical activity in the year before surgery showed a significantly higher incidence of AF during postacute rehabilitation when compared with those who reported moderate-intensity physical activity (32.1% vs. 8.1%; P = 0.029). Other independent predictors of AF during postacute rehabilitation were the occurrence of AF during the patients' stay in hospital, larger left atrial volume, and lower left atrial emptying fraction. These findings confirm our hypothesis that physical activity in the year before surgery affects the incidence of postoperative AF during postacute rehabilitation. The results also provide information regarding possible predictors that may assist in identifying patients who could benefit from preventive treatments.
    American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 04/2011; 90(4):308-15. · 1.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Older patients who receive postacute cardiac rehabilitation improve their physical performance in terms of distance walked at the 6-min walk test. However, the slower and more complicated recovery, along with age-related chronic comorbidities, remarkably limits the intensity of aerobic training, which actually represents the core of cardiac rehabilitation. The aim of this study was to verify whether postacute cardiac rehabilitation also improves the cardiovascular adjustment to exercise, despite low-intensity aerobic training. Using a portable gas analyzer, we assessed the O(2) uptake kinetics during the 6-min walk test at the beginning and at the end of the rehabilitation in 84 patients aged 65 yrs and above. All patients significantly improved the distance walked at the 6-min walk test. The comparison of the time constants of O(2) uptake kinetics showed that 40% of patients also significantly improved the hemodynamic response to exercise. This improvement was independently associated with the report of sedentary lifestyle or low-intensity physical activity in the year before surgery and with longer time constants before physical training. Low-intensity aerobic training improves the cardiovascular adjustment to exercise selectively in patients with physical deconditioning. This confirms the notion that elderly frail patients are those who benefit most from cardiac rehabilitation.
    American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 12/2010; 89(12):953-60. · 1.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to describe the clinical course of patients with chronic, non-specific neck pain undergoing a public health covered, exercise-based rehabilitation program and to identify predictors of poor outcome. A prospective cohort study was carried out on patients with non-specific neck pain (6 months or longer), referred by their general practitioner to a 6-session program, including education and individually tailored exercise. The primary outcome measure for the course of neck pain was the Northwick neck pain questionnaire (NPQ) administered on baseline, discharge, and 1 year from discharge. Poor outcome was defined as NPQ score improving <30% (minimal clinically important difference-MCID-NPQ). The potential predictors included demographics, general health and psychological factors, neck pain history, and the clinical features described by NPQ. From January 2008 to June 2009, 212 patients were consecutively assessed for eligibility: 178 were enrolled and 162 completed follow-up (mean age = 65.3; 75% women). Baseline NPQ average score (40.7 + 17.1) improved by MCID on discharge (26.1 + 16.3) and at 1 year (28.5 + 17.3%). The poor outcome was reported by 45% patients on discharge and by 56% at follow-up. Pain-related medication intake independently predicted poor short- (OR 4.24; 95% CI 1.83-9.84; p = 0.001) and long-term (OR 2.69; 95% CI 1.19-6.06; p = 0.017) outcome, and catastrophizing (OR 2.91; 95% CI 1.31-6.48; p = 0.009) predicted poor outcome at 1 year. Our cohort of patients with chronic neck pain undergoing an exercise-based rehabilitation program reported improvement by or beyond MICD-NPQ in 55% cases on discharge and in 44% cases at 1 year. Poor outcome was predicted by pain-related medication intake in the short and long term, and by catastrophizing in the long term.
    Internal and Emergency Medicine 12/2010; 6(5):413-21. · 2.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain. Randomized trial, 12-month follow-up. Outpatient rehabilitation department. 210 patients with chronic, non-specific low back pain, 140/210 women, age 59 +/- 14 years. Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: group exercise, education/ ergonomics; individual physiotherapy: exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20'-sessions once-a-week. Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. 205 patients completed the study. At discharge, disability score decreased by 3.7 +/- 4.1 for back school, 4.4 +/- 3.7 for individual physiotherapy, 6.7 +/- 3.9 for manipulation; pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1, respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation; pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P < 0.001); pain recurrences and drug intake were also reduced compared to back school (P < 0.05) or individual physiotherapy (P < 0.001). Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.
    Clinical Rehabilitation 01/2010; 24(1):26-36. · 2.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Promoting an active lifestyle through an appropriate physical exercise prescription is one of the major targets of cardiac rehabilitation. However, information on the effectiveness of cardiac rehabilitation in promoting lifestyle changes in elderly patients is still scant. In 131 patients over the age of 65 yrs (86 men, and 45 women, mean age 75 yrs +/- 6 SD) who have attended postacute inpatient cardiac rehabilitation after cardiac surgery, we tested the 1-yr adherence to the physical exercise prescription received at the end of the cardiac rehabilitation by using a questionnaire on physical activity and the 6-min walk test. All of the 36 patients who reported an active lifestyle and 49 of the 95 patients who reported a sedentary lifestyle in the year preceding the cardiac operation reported at least 1 hr/day on 5 days each week of light regular physical activity in the year after the cardiac rehabilitation. Further, the distance walked at the follow-up 6-min walk test was significantly related to the physical activity score gathered from the questionnaire. Our data show that 65% of the elderly patients who have attended postacute inpatient cardiac rehabilitation after cardiac surgery are still capable of recovering or even increasing their regular physical activity and of maintaining these favorable lifestyle changes at least for 1 yr.
    American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 10/2009; 88(9):727-34. · 1.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hip pain (HP) and knee pain (KP) may specifically affect function and performance; few studies investigate the functional impact of HP or KP in the same population. Population-based sample of older individuals living in the Chianti area (Tuscany, Italy) (1998-2000); 1006 persons (564 women and 442 men) were included in this analysis; 11.9% reported HP and 22.4% reported KP in the past 4 weeks. Self-reported disability and lower extremity performance, measured by 400-m walk test and by the short physical performance battery (SPPB, including standing balance, chair raising, and 4-m walk test), were compared in participants reporting HP or KP versus those free of these conditions; the relationship of HP or KP with performance and self-reported disability was studied, adjusting for age, sex, hip or knee flexibility, muscle strength, multiple joint pain, major medical conditions, and depression. Participants reporting HP were more likely to report disability in shopping, cutting toenails, carrying a shopping bag, and using public transportation; those with KP reported more disability in cutting toenails and carrying a shopping bag. Participants reporting HP or KP had significantly lower SPPB scores. Adjusting by SPPB, pain no longer predicted self-reported disability, except for "HP-carrying a shopping bag." In our cohort of older persons, those with HP reported disability in a wider range of activities than those with KP. Physical performance measured by SPPB was impaired in both conditions. Reduced lower extremity performance captures the excess disability associated with either HP or KP.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 10/2009; 64(12):1316-24. · 4.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Physical activity in older adults improves fitness, but few studies have examined the short- and long-term effects on physical performance. This analysis is preliminary to a RCT investigating physical activity effects on performance over time in older persons with musculoskeletal impairment. Fifty sedentary participants, aged 65+, with musculoskeletal impairment and difficulties in complex mobility, but independent in basic activities of daily living (ADLs) were randomly assigned to 3- monthly, twice-a-week, supervised physical exercise (E) or unsupervised regular walking (W), and advised to keep active. Assessments: baseline (T0), discharge (T1), 6 (T2) and 9 (T3) months from baseline. Outcome: Summary of Performance Score (SPS), strength, flexibility; general mental health (GMH), vitality, and self reported disability. All participants completed follow-ups. At T3, only 12 E and 2 W participants reported exercising regularly. Each outcome, except for GMH, trunk flexibility and basic ADLs, changed over time significantly more in E than in W. After training, E increased SPS (1 point), along with muscle strength, flexibility, vitality, and reduced difficulties in complex mobility. At 9 months, all parameters, except passive hip flexion and shoulder abduction, had reverted to baseline levels. In the same time-frame, W progressively decreased SPS, knee flexion/ extension strength and passive flexion, and increased difficulties in basic and complex mobility. In this physically impaired sample, a 3- month exercise program, compared with unsupervised regular walking, was associated with improved performance, fitness and vitality after discharge, and to delayed physical decline in the next 6-month follow-up.
    Aging clinical and experimental research 05/2009; 21(2):122-8. · 1.01 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous studies have shown that oxidative protein damage is independently associated with low grip strength and that dietary intake and circulating levels of antioxidant vitamins are positive predictors of muscle strength among older persons. Since uric acid (UA), has strong antioxidant properties, we tested the hypothesis that UA levels is cross-sectionaly associated with muscle strength and protective against the decline of strength over the aging process. 789 InCHIANTI Study participants underwent baseline serum UA, handgrip and knee extension torque measurements. Of these, 497 participants (226 men and 271 women, mean age 76.0+/-5.4 years) also had follow-up strength measures. Lifestyle, comorbidities, nutritional profile, inflammatory markers and other laboratory measures were considered as potential confounders. Follow-up strength measures significantly increased across baseline UA tertiles. After adjusting for potential confounders and analogous baseline strength measures, higher baseline UA levels still remained significantly associated with higher follow-up strength measures. Our findings suggest that higher levels of UA might represent a protective reaction aimed at counteracting the excessive production of free radicals that cause muscle protein damage and eventually contribute to the decline of muscle mass and strength.
    Mechanisms of Ageing and Development 10/2008; 129(9):522-7. · 3.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinicoepidemiologic study in the Chianti area (Tuscany, Italy). To evaluate whether performance measures of lower extremity function confounds the association of low back pain (LBP) with self-report disability in specific basic and instrumental activities of daily living (IADLs). LBP is high prevalent in older population and has a negative impact on functional status. Studies on the pathway leading from LBP to disability are limited and often the role played by important confounders is not considered. A total of 956 InCHIANTI study participants aged 65 and older able to complete performance-based tests of lower extremity function were included in this analysis. LBP was defined as a self-report of back pain "quite often-almost every day" in the past 12 months. Lower extremity function was evaluated administering the Short Physical Performance Battery. In addition, participants were asked to walk on a 7-m course and collect an object from the ground. Depressive symptoms (CES-D score), trunk flexion-extension range of motion, and hip-knee-foot pain were also considered in the pathway from LBP to disability. Compared with participants who did not report LBP, those with LBP were more likely to report difficulty in performing most activities of daily living. LBP was also associated with disability in the activities of bathing, doing the laundry, performing heavy household chores, cutting toenails, shopping, and carrying a shopping bag. The association between LBP and disability in selected ADLs and IADLs was no longer statistical significant, after adjustment for performance in lower extremity function, with exception of the activity of "carrying a shopping bag". The cross-sectional association between LBP and self-reported disability, in specific tasks is modulated by performance measures. Specific performance-based tests that explore the functional consequences of LBP may help design specific interventions of disability prevention and treatment in patients with LBP.
    Spine 01/2008; 32(26):E809-15. · 2.16 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinico-epidemiologic study in the Chianti area (Tuscany, Italy). To describe prevalence and correlates of back pain in a representative sample of the population. Back pain is common in old age and is related to functional limitations, but back pain characteristics and correlates in older adults, which may be targeted by specific interventions, are still underinvestigated. A total of 1,299 persons aged 65 or older were selected from the city registry of Greve in Chianti and Bagno a Ripoli; 1,008 (565 women; 443 men) were included in this analysis. Back pain in the past 12 months was ascertained using a questionnaire. Potential correlates of back pain were identified in age- and sex-adjusted regression analyses, and their independent association with back pain was tested in a multivariate model. The prevalence of frequent back pain was 31.5%. Back pain was reported less often by men and the very old, was primarily located in the dorsolumbar and lumbar spine, was moderate in intensity and mainly elicited by carrying, lifting, and pushing heavy objects. Among participants who reported frequent back pain, 76.3% had no back pain-related impairments; 7.4% of the overall study population had back pain-related functional limitation. Back pain participants were significantly more likely to report difficulty in heavy household chores, carrying a shopping bag, cutting toenails, and using public transportation. Limited trunk extension, depression, low levels of prior-year physical activity, and hip, knee, and foot pain were independent correlates of back pain. Frequent back pain is highly prevalent in the older population and is often associated with conditions that are potentially reversible.
    Spine 06/2006; 31(10):1149-55. · 2.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A key feature in physiotherapeutic treatment of patients with motion disturbances is the appropriate ranging of the trunk and pelvis motility. Eighty subjects randomly selected and free from known pathology of the muscular-skeletal and/or of the neurological system classed into four groups according to the age and the sex have been assessed, by using a new, simple and easy administrable tool. Our results demonstrate that the new measurement tool showed a very low intra- and inter-observer variability, that healthy subjects showed a more adduced and elevated right scapula if compared to the contralateral one and, as regard as the pelvic motion, a broader joint excursion in passive motion compared with active motion in the overall group, a broader joint excursion in young subjects compared with elderly ones, and a broader joint excursion in female subjects compared with males subjects. In conclusion our study allowed to identify a range of physiological asymmetry and pelvis motility. Such a range of physiological asymmetry might be useful as a reference for the physiotherapists.
    Italian journal of anatomy and embryology = Archivio italiano di anatomia ed embriologia 01/2002; 107(2):85-91.