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Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD. J Clin Med 2019; 8:jcm8091460. [PMID: 31540306 PMCID: PMC6780973 DOI: 10.3390/jcm8091460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 01/23/2023] Open
Abstract
Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.
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Adiponectin Expression Is Modulated by Long-Term Physical Activity in Adult Patients Affected by Cystic Fibrosis. Mediators Inflamm 2019; 2019:2153934. [PMID: 31582896 PMCID: PMC6754935 DOI: 10.1155/2019/2153934] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/04/2019] [Indexed: 01/23/2023] Open
Abstract
Cystic fibrosis (CF) is a genetic disease characterized by progressive decline of lung function and chronic airway inflammation. Adipose tissue, through adiponectin and leptin, exerts several effects on energy metabolism and inflammatory processes. This study evaluated the levels of adiponectin and leptin in adult healthy subjects, in patients with CF and their correlation with long-term physical activity. CF patients were divided into two groups (sedentary versus active) based on their regular physical activity over 3 years. Anthropometric and serum biochemical profiles of CF patients and controls were evaluated and compared. Total serum adiponectin and leptin levels were measured by ELISA; adiponectin oligomeric profiles were analysed by western blot. Adiponectin levels were significantly higher while leptin levels were lower in patients with CF than in healthy controls. Furthermore, adiponectin was significantly lower in active compared to sedentary CF (p = 0.047), while leptin was slightly increased in active compared to sedentary CF. In addition, C-reactive protein levels were significantly lower in active than in sedentary CF patients (p = 0.048). Interestingly, only in the active group adiponectin levels were inversely correlated with forced expiratory volume (FEV) 1% decrease/year and FEV1% decrease. Moreover, adiponectin levels negatively correlated with lipid profiles. Our findings indicated that regular, long-term physical activity in CF improves respiratory function, metabolism, and inflammation status. These improvements in patients' conditions are associated with immunometabolic processes involving adiponectin, leptin, and C-reactive protein. Therefore, we propose that both adipokines may be a useful biomarker in the evaluation of metabolic and inflammatory status in patients with CF.
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103
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Lewis A, Hopkinson NS. Tai Chi Movements for Wellbeing - evaluation of a British Lung Foundation pilot. Perspect Public Health 2019; 140:172-180. [PMID: 32414311 DOI: 10.1177/1757913919872515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS In breathless individuals with respiratory disease, pulmonary rehabilitation (PR) can improve exercise capacity, symptoms and ability to cope with their condition. However, access is often limited, and adherence can be poor. Thus, there is interest in developing alternative and complementary forms of exercise intervention and tai chi may be effective in this context. METHOD The British Lung Foundation worked in collaboration with 'Tai Chi Movements for Wellbeing' Training to train leaders to run community-based tai chi groups in the UK. Leaders received funding to run 3 months of once-a-week classes consisting of a 12 movement sequence of tai chi. Participants completed a questionnaire survey to evaluate the service at the start of their first session and again after 3 months. RESULTS Ten tai chi groups recruited 128 participants, 65% women, mean (standard deviation (SD)) age 70.1 (7.4) years at baseline. Seventy individuals completed the follow-up questionnaire at 3 months. Participants demonstrated an improvement in Medical Research Council (MRC) Dyspnoea Score pre 3 (interquartile range (IQR) = 1.8), post 2 (IQR = 1), p = .013 and disease burden; chronic obstructive pulmonary disease (COPD) assessment test score pre 19.4 (8.7), post 17.9 (9.4), mean change -1.5 (confidence interval (CI): -2.89 to -0.127), p = .033. Those who completed the programme had a worse baseline COPD assessment test (CAT) score and were more likely to have participated in maintenance exercise previously. Qualitative feedback suggested that participants felt the classes had helped with breathlessness and relaxation. CONCLUSION Establishing a tai chi for wellbeing programme for people with respiratory disease is feasible, with a reasonable level of compliance, and is perceived to be helpful by participants.
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Affiliation(s)
- A Lewis
- National Heart and Lung Institute, Muscle Laboratory, Imperial College London, Royal Brompton Campus, London SW3 6HP, UK
| | - N S Hopkinson
- National Heart and Lung Institute, Muscle Laboratory, Imperial College London, London, UK
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Li N, Liu Y, Cai J. LncRNA MIR155HG regulates M1/M2 macrophage polarization in chronic obstructive pulmonary disease. Biomed Pharmacother 2019; 117:109015. [DOI: 10.1016/j.biopha.2019.109015] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/13/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022] Open
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Geidl W, Carl J, Cassar S, Lehbert N, Mino E, Wittmann M, Wagner R, Schultz K, Pfeifer K. Physical Activity and Sedentary Behaviour Patterns in 326 Persons with COPD before Starting a Pulmonary Rehabilitation: A Cluster Analysis. J Clin Med 2019; 8:E1346. [PMID: 31470678 PMCID: PMC6780222 DOI: 10.3390/jcm8091346] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
This study applies a cluster analysis to identify typical physical activity (PA) and sedentary behaviour (SB) patterns in people with chronic obstructive pulmonary disease (COPD) before starting pulmonary rehabilitation (PR). We implemented an observational design which assessed baseline data of objectively measured PA and SB from the STAR (Stay Active after Rehabilitation) study. A total of 355 persons wore an accelerometer (Actigraph wGT3X) for seven days before the start of their PR. Sociodemographic and disease-related parameters were assessed at the start of PR. We applied cluster analysis and compared clusters applying univariate variance analyses. Data was available for 326 persons (31.6% women; age ø = 58 years). Cluster analysis revealed four movement clusters with distinct PA and SB patterns: Sedentary non-movers (28.5%), sedentary occasional movers (41.7%), sedentary movers (19.6%), and sedentary exercisers (10.1%). The four clusters displayed varying levels of moderate PA before rehabilitation (Ø daily min: 9; 28; 38; 70). Notably, all four clusters displayed considerably long average sedentary time per day (Ø daily minutes: 644; 561; 490; 446). The clusters differed significantly in disease-related parameters of GOLD severity, FEV1, CAT, and 6-Min-Walk-Test. In addition to PA promotion, PR programs should consider the reduction of sedentary behaviour as a valuable goal.
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Affiliation(s)
- Wolfgang Geidl
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91058 Erlangen, Germany.
| | - Johannes Carl
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91058 Erlangen, Germany
| | - Samuel Cassar
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91058 Erlangen, Germany
| | - Nicola Lehbert
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopedics, 83435 Bad Reichenhall, Germany
| | - Eriselda Mino
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91058 Erlangen, Germany
| | - Michael Wittmann
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopedics, 83435 Bad Reichenhall, Germany
| | - Rupert Wagner
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopedics, 83435 Bad Reichenhall, Germany
| | - Konrad Schultz
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopedics, 83435 Bad Reichenhall, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Division Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91058 Erlangen, Germany
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Minakata Y, Motegi T, Ueki J, Gon Y, Nakamura S, Anzai T, Hirata K, Ichinose M. Effect of tiotropium/olodaterol on sedentary and active time in patients with COPD: post hoc analysis of the VESUTO ® study. Int J Chron Obstruct Pulmon Dis 2019; 14:1789-1801. [PMID: 31496678 PMCID: PMC6689763 DOI: 10.2147/copd.s208081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022] Open
Abstract
Background Patients with COPD are less physically active. This post hoc analysis of a randomized, double-blind, active-controlled, crossover trial assessed the efficacy of once-daily tiotropium/olodaterol combination therapy versus tiotropium monotherapy in Japanese patients with COPD. Patients and methods Patients were provided with a three-axis accelerometer to measure sedentary and active behavior defined as 1.0-1.5 metabolic equivalents (METs), ≥2.0 METs, and ≥3.0 METs, respectively. Of the 182 patients enrolled, 131 satisfied the conditions for the present analysis and were randomized to tiotropium monotherapy (n=62) or tiotropium/olodaterol combination therapy (n=69). Results Tiotropium/olodaterol combination therapy significantly reduced the duration of 1.0-1.5 MET activity by 8.64 mins (p=0.040) and significantly increased the duration of ≥2.0 MET and ≥3.0 MET activity by 6.51 mins (p=0.017) and 2.60 mins (p=0.008), respectively, compared with tiotropium alone. Subgroup analyses showed that better lung function, milder dyspnea, and higher levels of physical activity at baseline were associated with reduced sedentary time and increased duration of physical activity. Conclusion Tiotropium/olodaterol combination therapy significantly reduced sedentary time and improved physical activity compared with tiotropium monotherapy. This trial was registered in ClinicalTrials.gov (NCT02629965).
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Affiliation(s)
- Yoshiaki Minakata
- Department of Respiratory Medicine, National Hospital Organization Wakayama Hospital, Wakayama, Japan
| | - Takashi Motegi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Jun Ueki
- Clinical Research Unit of Respiratory Pathophysiology, Juntendo University Graduate School of Health Care and Nursing, Chiba, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shuhei Nakamura
- Medical Division, Nippon Boehringer Ingelheim Co. Ltd., Tokyo, Japan
| | - Tatsuhiko Anzai
- Clinical Information Division Data Science Center, Statistics Analysis Department 1, EPS Corporation, Tokyo, Japan
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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107
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Tucker S, Abbott L, Anderson R, Eppen K, Laroche H, Paelmo E, Lanningham-Foster L. Implementing Follow-Along Physical Activity Videos with People Living With Chronic Conditions: A Feasibility Study. Worldviews Evid Based Nurs 2019; 16:352-361. [PMID: 31380602 DOI: 10.1111/wvn.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Compelling evidence supports multiple benefits of physical activity (PA) even in small bursts. Less than 50% of Americans achieve recommended PA levels, lower still for individuals living with chronic illness or disease. PURPOSE The purpose of this study was to develop and evaluate the feasibility and preliminary effects of 3-min follow-along video scenarios to promote brief episodes of low-moderate levels of PA among individuals with chronic diseases. METHODS Guided by our previous studies and self-efficacy theory, the program (WellMe in 3© for Patients) was modeled after another program developed for healthcare staff. An advisory panel and a health and fitness expert guided the creation of twelve 3-min video scenarios that included two individuals living with chronic illness and a fitness leader who guided the PA scenarios and how to adapt them based on limitations. The 12 scenarios included 3 min of aerobic activities, stretching, or balance. Preliminary pilot effects were measured among 39 patients living with chronic conditions for one month. Standardized instruments were used to measure PA levels, PA self-efficacy (SE), and quality of life (QoL); usability and satisfaction were assessed using researcher-developed tools. Descriptive and inferential statistics were used to evaluate change over time. RESULTS Twelve video scenarios were created tailored to persons with chronic illness. Thirty-nine participants piloted the program, reporting an average of two chronic conditions. Baseline QoL scores were lower than normative data, self-efficacy scores were low-to-moderate, and PA levels were very low. Participants averaged using one video per day. 62% of participants provided complete self-reported pre- and post-QoL and SE data and 41% provided pre- and post-PA (accelerometer) data. Significant improvements were found for general health and energy scores, and trends were found for self-efficacy scores. PA levels were highly variable with nonsignificant increases from baseline. Effect sizes were low-moderate for several measures. About 79% of participants rated program "Very good"; all recommended the program. LINKING EVIDENCE TO ACTION Physical activity has multiple health benefits for all people including those living with chronic conditions. Even short bouts of physical activity have health benefits. A program of 3-min follow-along PA videoclips for individuals living with chronic disease holds promise for clinicians and researchers.
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Affiliation(s)
- Sharon Tucker
- Translational Research Core, Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Linda Abbott
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Kim Eppen
- Rehabilitation Therapies, Pulmonary Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | - Evan Paelmo
- Clinical Research Unit at Northwestern Memorial Hospital, Evanston, IL, USA
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108
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Abdulai RM, Jensen TJ, Patel NR, Polkey MI, Jansson P, Celli BR, Rennard SI. Deterioration of Limb Muscle Function during Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 197:433-449. [PMID: 29064260 DOI: 10.1164/rccm.201703-0615ci] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Important features of both stable and acute exacerbation of chronic obstructive pulmonary disease (COPD) are skeletal muscle weakness and wasting. Limb muscle dysfunction during an exacerbation has been linked to various adverse outcomes, including prolonged hospitalization, readmission, and mortality. The contributing factors leading to muscle dysfunction are similar to those seen in stable COPD: disuse, nutrition/energy balance, hypercapnia, hypoxemia, electrolyte derangements, inflammation, and drugs (i.e., glucocorticoids). These factors may be the trigger for a downstream cascade of local inflammatory changes, pathway process alterations, and structural degradation. Ultimately, the clinical effects can be wide ranging and include reduced limb muscle strength. Current therapies, such as pulmonary/physical rehabilitation, have limited impact because of low participation rates. Recently, novel drugs have been developed in similar disorders, and learnings from these studies can be used as a foundation to facilitate discovery in patients hospitalized with a COPD exacerbation. Nevertheless, investigators should approach this patient population with knowledge of the limitations of each intervention. In this Concise Clinical Review, we provide an overview of acute muscle dysfunction in patients hospitalized with acute exacerbation of COPD and a strategic approach to drug development in this setting.
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Affiliation(s)
- Raolat M Abdulai
- 1 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,2 Respiratory, Inflammation, and Autoimmunity, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts
| | - Tina Jellesmark Jensen
- 3 Respiratory, Inflammation, and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Naimish R Patel
- 2 Respiratory, Inflammation, and Autoimmunity, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts.,4 Beth Israel Deaconess Hospital, Boston, Massachusetts
| | - Michael I Polkey
- 5 National Institute for Health Research, Respiratory Biomedical Research Unit at the Royal Brompton Hospital and Imperial College London, London, United Kingdom
| | - Paul Jansson
- 3 Respiratory, Inflammation, and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Bartolomé R Celli
- 1 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,6 Harvard Medical School, Boston, Massachusetts
| | - Stephen I Rennard
- 7 Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska; and.,8 Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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109
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Andrianopoulos V, Gloeckl R, Boensch M, Hoster K, Schneeberger T, Jarosch I, Koczulla RA, Kenn K. Improvements in functional and cognitive status following short-term pulmonary rehabilitation in COPD lung transplant recipients: a pilot study. ERJ Open Res 2019; 5:00060-2019. [PMID: 31544112 PMCID: PMC6745414 DOI: 10.1183/23120541.00060-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/20/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) following lung transplantation (LTx) is considered part of the optimal treatment in chronic obstructive pulmonary disease (COPD) for favourable post-operative outcomes. We investigated the effects of a PR intervention in the post-transplant phase with regard to lung function, exercise responses and cognitive function in COPD LTx recipients. METHODS 24 COPD LTx recipients (mean±sd forced expiratory volume in 1 s 75±22% predicted) were assigned to a comprehensive 3-week inpatient PR programme. Changes from PR admission to discharge in lung function variables, 6-min walk test-derived outcomes and cognitive function were assessed and examined for several factors. The magnitude of changes was interpreted by effect size (ES). RESULTS In response to the PR intervention, LTx recipients had improved lung function with regard to diffusing capacity of the lung for carbon monoxide (+4.3%; p=0.012) and static hyperinflation (residual volume/total lung capacity -2.3%; p=0.017), increased exercise capacity (6-min walk test +86 m; p<0.001), and had small to large improvements (ES range 0.23-1.00; all p≤0.34) in 50% of the administered cognitive tests. Learning skills and memory ability presented the greatest benefits (ES composite scores 0.62 and 0.31, respectively), which remained similar after stratification by single or bilateral LTx and sex. CONCLUSIONS PR is an effective treatment for LTx recipients in the post-transplant phase, improving lung function, exercise responses, and domains of cognitive function of learning, memory and psychomotor speed. PR may facilitate the course of post-operative treatment and should be recommended in LTx.
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Affiliation(s)
- Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Dept of Prevention, Rehabilitation and Sport Medicine, Technical University Munich, Munich, Germany
| | - Martina Boensch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Katharina Hoster
- Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
| | - Inga Jarosch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Rembert A. Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
- German Center of Lung Research (DZL), Giessen-Marburg, Germany
| | - Klaus Kenn
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
- German Center of Lung Research (DZL), Giessen-Marburg, Germany
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Measurement of physical activity in clinical practice and research: advances in cancer and chronic respiratory disease. Curr Opin Support Palliat Care 2019; 12:219-226. [PMID: 29979317 DOI: 10.1097/spc.0000000000000372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Physical activity has emerged as an important health outcome and its assessment, in particular with objective monitors, has proliferated in recent years. This review considers recent advances in physical activity measurement and clinical trials in cancer and chronic respiratory diseases where physical activity was a primary or key secondary outcome focusing on methodological learning points. RECENT FINDINGS There is growing data on (i) the validity of commercial 'consumer' physical activity monitors, e.g. FitBit, and (ii) the role of hybrid physical activity assessments; combining objective and subjective measures to understand physical activity quantity and quality. In both cases, adherence is challenging and can be optimized using short monitoring protocols, e.g., 3-4 days, and by providing clear instructions and support materials to participants. Studies in cancer and chronic respiratory disease have found mixed effects from physical activity interventions based on pedometers, behavior change techniques, online resources, and/or therapeutic nutrition. The most responsive physical activity outcomes and minimum clinically important differences are still to be understood. SUMMARY Physical activity measures provide an opportunity to detect changes in health behavior. However, measuring physical activity as a trial endpoint is challenging and focusing effort to ensure optimal participant compliance is important.
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111
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Neder JA, Marillier M, Bernard AC, James MD, Milne KM, O’Donnell DE. The Integrative Physiology of Exercise Training in Patients with COPD. COPD 2019; 16:182-195. [DOI: 10.1080/15412555.2019.1606189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- J. Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
| | - Mathieu Marillier
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
| | - Anne-Catherine Bernard
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
| | - Matthew D. James
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
| | - Kathryn M. Milne
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
- Clinician Investigator Program, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Denis E. O’Donnell
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
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Mihaltan F, Adir Y, Antczak A, Porpodis K, Radulovic V, Pires N, de Vries GJ, Horner A, De Bontridder S, Chen Y, Shavit A, Alecu S, Adamek L. Importance of the relationship between symptoms and self-reported physical activity level in stable COPD based on the results from the SPACE study. Respir Res 2019; 20:89. [PMID: 31088560 PMCID: PMC6518503 DOI: 10.1186/s12931-019-1053-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/16/2019] [Indexed: 03/19/2023] Open
Abstract
Background The burden of symptoms and risk of exacerbations are the main drivers of the overall assessment of the Chronic Obstructive Pulmonary Disease (COPD) and the adequate treatment approaches per current Global Initiative for Chronic Obstructive Lung Disease (GOLD). Physical activity has emerged as both functional outcome and non-pharmacological intervention in COPD patients, despite the lack of standardized measures or guidelines in clinical practice. This study aimed to explore in more depth the 24-h respiratory symptoms, the physical activity level (PAL) and the relationship between these two determinants in stable COPD patients. Methods This was a multinational, multicenter, observational, cross-sectional study conducted in ten European countries and Israel. Dedicated questionnaires for each part of the day (morning, daytime, night) were used to assess respiratory symptoms. PAL was evaluated with self- and interview-reported tools [EVS (exercise as vital sign) and YPAS (Yale Physical Activity Survey)], and physician’s judgement. Patients were stratified in ABCD groups by 2013 and 2017 GOLD editions using the questionnaires currently recommended: modified Medical Research Council dyspnea scale and COPD Assessment Test. Results The study enrolled 2190 patients (mean age: 66.9 years; male: 70.0%; mean % predicted FEV1: 52.6; GOLD groups II-III: 84.5%; any COPD treatment: 98.9%). Most patients (> 90%) reported symptoms in any part of the 24-h day, irrespective of COPD severity. PAL evaluations showed discordant results between patients and physicians: 32.9% of patients considered themselves completely inactive, while physicians judged 11.9% patients as inactive. By YPAS, the overall study population spent an average of 21.0 h/week performing physical activity, and 68.4% of patients were identified as sedentary. In any GOLD ABCD group, the percentage of inactive patients was high. Our study found negative, weak correlations between respiratory symptoms and self-reported PAL (p < 0.001). Conclusions Despite regular treatment, the majority of stable COPD patients with moderate to severe disease experienced daily variable symptoms. Physical activity level was low in this COPD cohort, and yet overestimated by physicians. With evidence indicating the negative consequences of inactivity, its adequate screening, a more active promotion and regular assessment of physical activity are urgently needed in COPD patients for better outcomes. Trial registration NCT03031769, retrospectively registered, 23 Jan 2017. Electronic supplementary material The online version of this article (10.1186/s12931-019-1053-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florin Mihaltan
- Department of Pulmonology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
| | - Yochai Adir
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adam Antczak
- Clinical Department of Pulmonology and Allergology, University Hospital, Lodz, Poland
| | | | - Vesna Radulovic
- Municipal Institute for Lung Diseases and Tuberculosis, Belgrade, Serbia
| | - Nuno Pires
- Hospital Santa Maria Maior, Barcelos, Portugal
| | | | - Andreas Horner
- Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria
| | | | - Yunqin Chen
- AstraZeneca Global R&D Information, Shanghai, China
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Kang N, Shin SH, Gu S, Kang D, Cho J, Jeong HJ, Suh GY, Lee H, Park HY. The impact of low forced vital capacity on behavior restrictions in a population with airflow obstruction. J Thorac Dis 2019; 11:1316-1324. [PMID: 31179073 DOI: 10.21037/jtd.2019.03.77] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Recent studies have suggested that low forced vital capacity (FVC) is related to respiratory symptoms with various comorbid conditions that eventually lead to physical inactivity and may be applied to subjects with airflow obstruction (AO). Therefore, this study aimed to evaluate the association between low FVC and behavior restrictions in subjects with AO. Methods A cross-sectional study was performed using data from the Korea National Health and Nutrition Survey conducted between 2007 and 2015. Participants aged 40 to 79 years with spirometry-defined AO (pre-bronchodilator forced expiratory volume in one second/FVC <70%) were analyzed to evaluate the association between low FVC (defined as FVC <80% predicted) and behavior restrictions. Results A total of 3,345 participants with AO were included. The proportion of subjects with low FVC varied widely according to severity of airflow limitation (0.9%, 35.5%, and 85.1% in the mild, moderate, and severe-to-very-severe AO groups, respectively). Compared to the moderate AO group with normal FVC, those with low FVC were more likely to be older, to be never- or ex-smokers, to have larger waist size with higher body mass index, and to have comorbidities such as diabetes, hypertension, dyslipidemia, and osteoporosis. Low FVC was independently associated with behavior restrictions [adjusted prevalence ratio (aPR), 1.72; 95% confidence interval (CI), 1.43-2.06] among all participants with AO, and this was most prominent in those with moderate AO (aPR, 1.65; 95% CI, 1.27-2.13). Conclusions In subjects with moderate AO, low FVC was independently associated with behavior restrictions even after adjusting for confounding factors.
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Affiliation(s)
- Noeul Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seonhye Gu
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ho Jung Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, South Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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114
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Koolen EH, van Hees HW, van Lummel RC, Dekhuijzen R, Djamin RS, Spruit MA, van 't Hul AJ. "Can do" versus "do do": A Novel Concept to Better Understand Physical Functioning in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2019; 8:E340. [PMID: 30862102 PMCID: PMC6463143 DOI: 10.3390/jcm8030340] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical capacity (PC) and physical activity (PA) represent associated but separate domains of physical function. It remains unknown whether this framework may support a better understanding of the impaired physical function in patients with chronic obstructive pulmonary disease (COPD). The current study had two aims: (1) to determine the distribution of patients with COPD over the PC-PA quadrants, and (2) to explore whether differences exist in clinical characteristics between these quadrants. METHODS In this retrospective study, PC was measured using the six-minute walk distance (6MWD), and PA was assessed with an accelerometer. Moreover, patients' clinical characteristics were obtained. Patients were divided into the following quadrants: (I) low PC (6MWD <70% predicted), low PA, using a step-defined inactivity index (<5000 steps/day, "can't do, don't do" quadrant); (II) preserved PC, low PA ("can do, don't do" quadrant); (III) low PC, preserved PA ("can't do, do do" quadrant); and (IV) preserved PC, preserved PA ("can do, do do" quadrant). RESULTS The distribution of the 662 COPD patients over the quadrants was as follows: "can't do, don't do": 34%; "can do, don't do": 14%; "can't do, do do": 21%; and "can do, do do": 31%. Statistically significant differences between quadrants were found for all clinical characteristics, except for educational levels. CONCLUSIONS This study proves the applicability of the PC-PA quadrant concept in COPD. This concept serves as a pragmatic clinical tool, that may be useful in the understanding of the impaired physical functioning in COPD patients and therefore, may improve the selection of appropriate interventions to improve physical function.
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Affiliation(s)
- Eleonore H Koolen
- Department of Pulmonary Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
| | - Hieronymus W van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
| | | | - Richard Dekhuijzen
- Department of Pulmonary Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
| | - Remco S Djamin
- Department of Pulmonary Diseases, Amphia Hospital, 4819 EV Breda, The Netherlands.
| | - Martijn A Spruit
- Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands.
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 BE Diepenbeek, Belgium.
| | - Alex J van 't Hul
- Department of Pulmonary Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
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115
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Wogksch MD, Howell CR, Wilson CL, Partin RE, Ehrhardt MJ, Krull KR, Brinkman TM, Mulrooney DA, Hudson MM, Robison LL, Ness KK. Physical fitness in survivors of childhood Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort. Pediatr Blood Cancer 2019; 66:e27506. [PMID: 30362255 PMCID: PMC6344300 DOI: 10.1002/pbc.27506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND There are limited data describing fitness and associated health-related quality of life (HRQoL) in survivors of childhood Hodgkin lymphoma (HL). PROCEDURE Fitness was evaluated among 336 adult survivors of childhood-onset HL treated at St. Jude Children's Research Hospital and 327 controls who never had childhood cancer. The controls were frequency matched on age, sex, and race. Associations were examined between chronic disease and fitness and between fitness and HRQoL using a multivariable linear and logistic regression. RESULTS Male survivors had lower endurance (6-min walk [6MW] distance 604.4 ± 7.9 m vs 637.0 ± 7.5 m, P < 0.01), and worse neuropathy (modified Total Neuropathy Score [mTNS] 2.7 ± 0.2 vs 1.4 ± 0.2, P < 0.01) compared to controls. Female survivors had lower endurance (6MW distance 564.5 ± 6.9 m vs 590.6 ± 7.0 m, P < 0.01), quadriceps strength (145.7 ± 4.0 vs 163.4 ± 4.0 N·m per kilogram, P < 0.01), and worse neuropathy (mTNS 3.2 ± 0.2 vs 1.4 ± 0.3, P < 0.01) compared to controls. Moderate, severe/disabling, or life-threatening (grades 2-4) neurological conditions were associated with impaired quadriceps strength (odds ratio [OR] 2.94, 99% confidence interval [CI] 1.24-6.96) and impaired endurance (OR 2.96, 99% CI 1.28-6.69). Cardiovascular (OR 2.36, 99% CI 1.00-5.61) and pulmonary (OR 2.78, 99% CI 1.30-5.94) conditions were associated with impaired endurance. Quadriceps strength (β -6.44 ± 2.01, P < 0.01), endurance (β -4.63 ± 1.54, P < 0.01), and neuropathy (β -4.98 ± 1.14, P < 0.01) were associated with a lower physical component summary on the HRQoL. CONCLUSION Survivors of childhood HL, particularly those with neurological, cardiac, and pulmonary chronic conditions, are at risk for impaired fitness and HRQoL.
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Affiliation(s)
- Matthew D. Wogksch
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R. Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Robyn E. Partin
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J. Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Liacos A, McDonald CF, Mahal A, Hill CJ, Lee AL, Burge AT, Moore R, Nicolson C, O’Halloran P, Cox NS, Lahham A, Gillies R, Holland AE. The Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool predicts reduction in sedentary time following pulmonary rehabilitation in people with chronic obstructive pulmonary disease (COPD). Physiotherapy 2019; 105:90-97. [DOI: 10.1016/j.physio.2018.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/29/2018] [Indexed: 12/20/2022]
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117
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The Effects of Safflower Yellow on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized, Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:5952742. [PMID: 30728848 PMCID: PMC6341243 DOI: 10.1155/2019/5952742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/31/2018] [Indexed: 02/05/2023]
Abstract
Objectives To evaluate the efficacy of safflower yellow in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods In a prospective, randomized, controlled trial, 127 patients who met the inclusion criteria were enrolled and were randomly divided into two groups. The control group included 64 patients treated according to the global strategy for diagnosis, management, and prevention of COPD (www.goldcopd.org, updated 2011). The intervention group included 63 patients who received intravenous infusions of safflower yellow (100 mg of safflower yellow dissolved in 250 ml 0.9% saline) once daily for 14 consecutive days in addition to standard diagnosis and treatment. The difference in the average length of the hospital stay between the two groups of patients was determined. The follow-up period was 28 days; the differences in symptoms, clinical indicators, and 28-day mortality in the two groups were compared. Statistical analysis was conducted using SPSS 22.0 software to determine whether there were statistically significant differences (P <0.05) between groups. Results There were no statistically significant differences between the intervention group and the control group in changes in secondary indicators. There were no statistically significant differences in the 28-day mortality or in the survival curves of the two groups (P=0.496 and P=0.075, respectively). Safflower yellow treatment of AECOPD may relieve the patient's clinical symptoms, such as dyspnoea, shorten the average length of hospital stay (P=0.006, respectively), and decrease the duration of mechanical ventilation. Conclusion Safflower yellow in the treatment of AECOPD has a degree of clinical value. This trial is registered under the identifier ChiCTR-IPR-17014176.
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118
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Blondeel A, Demeyer H, Janssens W, Troosters T. The role of physical activity in the context of pulmonary rehabilitation. COPD 2019; 15:632-639. [DOI: 10.1080/15412555.2018.1563060] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Aging, KU Leuven – University of Leuven, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
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119
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Intermittent Use of Portable NIV Increases Exercise Tolerance in COPD: A Randomised, Cross-Over Trial. J Clin Med 2019; 8:jcm8010094. [PMID: 30650617 PMCID: PMC6352193 DOI: 10.3390/jcm8010094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 12/26/2018] [Accepted: 01/14/2019] [Indexed: 01/20/2023] Open
Abstract
During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip breathing (PLB) on exercise tolerance. Twenty-four COPD patients were randomised to a high-intensity (HI: 2-min at 80% peak work rate (WRpeak) alternated with 2-min recovery; n = 13), or a moderate-intensity (MOD: 6-min at 60% WRpeak alternated with 2-min recovery; n = 11) protocol, and within these groups two tests were performed using pNIV and PLB during recovery in balanced order. Upon completion, patients were provided with pNIV; use over 12 weeks was assessed. Compared to PLB, pNIV increased exercise tolerance (HI: by 5.2 ± 6.0 min; MOD: by 5.8 ± 6.7 min) (p < 0.05). With pNIV, mean inspiratory capacity increased and breathlessness decreased by clinically meaningful margins during recovery compared to the end of exercise (HI: by 140 ± 110 mL and 1.2 ± 1.7; MOD: by 170 ± 80 mL and 1.0 ± 0.7). At 12 weeks, patients reported that pNIV reduced anxiety (median: 7.5/10 versus 4/10, p = 0.001) and recovery time from breathlessness (17/24 patients; p = 0.002); 23/24 used the device at least weekly. pNIV increased exercise tolerance by reducing dynamic hyperinflation and breathlessness in COPD patients.
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120
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Prieto-Centurion V, Casaburi R, Coultas DB, Kansal MM, Kitsiou S, Luo JJ, Ma J, Rand CS, Tan AYM, Krishnan JA. Daily Physical Activity in Patients With COPD After Hospital Discharge in a Minority Population. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6. [PMID: 31647855 DOI: 10.15326/jcopdf.6.4.2019.0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Low physical activity in patients with chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality. To inform the design of a home-based physical activity promotion program for patients with COPD recently discharged from a minority-serving hospital, we conducted a cohort study to evaluate objectively measured daily physical activity and patient-reported outcomes. Methods This was a 12-week prospective cohort study of patients with a physician diagnosis of COPD recently hospitalized (≤ 12 weeks) for respiratory symptoms. Daily physical activity was recorded using wrist-based and "clip-on" pedometers, and analyzed as mean daily step counts averaged over 7 days. Results Twenty-two patients were enrolled a median (interquartile range, [IQR]) of 14 (7 to 29) days after hospital discharge. The median daily step count (IQR) in the first week after enrollment (week 1) was 3710 (1565 to 5129) steps. The median within-person change in daily step count (IQR) from week 1 to week 12 was 314 (-30 to 858) steps (p=0.28). Within-person correlation of week-to-week daily step counts was high (r ≥ 0.75). Time from hospital discharge to enrollment was not correlated with mean daily step counts on week 1 (r= -0.13) and only weakly correlated with change in mean daily step counts from week 1 to week 12 (r=0.37). Conclusions Daily physical activity was variable in this cohort of recently hospitalized patients with COPD, but with little within-person change over a 12-week period. These observations highlight the need for flexible physical activity promotion programs addressing the needs of a heterogeneous patient population.
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Affiliation(s)
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance
| | | | | | | | | | - Jun Ma
- University of Illinois at Chicago
| | | | | | - Jerry A Krishnan
- University of Illinois at Chicago.,Institute for Healthcare Delivery Design, University of Illinois Hospital and Health Sciences System, Chicago
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121
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Pleguezuelos E, Gimeno-Santos E, Hernández C, Mata MDC, Palacios L, Piñera P, Molina J, Chiner E, Miravitlles M. Recommendations on Non-Pharmacological Treatment in Chronic Obstructive Pulmonary Disease From the Spanish COPD Guidelines (GesEPOC 2017). ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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122
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Recomendaciones sobre tratamiento no farmacológico en la enfermedad pulmonar obstructiva crónica de la Guía española de la EPOC (GesEPOC 2017). Arch Bronconeumol 2018; 54:568-575. [DOI: 10.1016/j.arbres.2018.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/29/2018] [Accepted: 06/11/2018] [Indexed: 01/07/2023]
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123
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Blonshine J, Cruz J, Sajnic A, De Brandt J. European Respiratory Society International Congress best abstract preview from the allied respiratory professionals from assembly 9. J Thorac Dis 2018; 10:S3010-S3016. [PMID: 30310691 DOI: 10.21037/jtd.2018.08.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, Portugal.,Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Andreja Sajnic
- Department for Respiratory Diseases "Jordanovac", University Hospital Center, Zagreb, Croatia
| | - Jana De Brandt
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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124
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Varas AB, Córdoba S, Rodríguez-Andonaegui I, Rueda MR, García-Juez S, Vilaró J. Effectiveness of a community-based exercise training programme to increase physical activity level in patients with chronic obstructive pulmonary disease: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1740. [DOI: 10.1002/pri.1740] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/13/2018] [Accepted: 07/11/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Ana Beatriz Varas
- Escuela Universitaria de Fisioterapia de la ONCE; Universidad Autónoma de Madrid; Madrid Spain
| | - Silvia Córdoba
- Escuela Universitaria de Fisioterapia de la ONCE; Universidad Autónoma de Madrid; Madrid Spain
| | | | - Ma. Rocío Rueda
- Escuela Universitaria de Fisioterapia de la ONCE; Universidad Autónoma de Madrid; Madrid Spain
| | - Susana García-Juez
- Escuela Universitaria de Fisioterapia de la ONCE; Universidad Autónoma de Madrid; Madrid Spain
| | - Jordi Vilaró
- Escuela Universitaria de Fisioterapia de la ONCE; Universidad Autónoma de Madrid; Madrid Spain
- Facultad de Ciencias de la Salud Blanquerna, Grupo de Investigación Global Research on Wellbeing (GRoW); Universitat Ramón Llull; Barcelona Spain
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125
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Vaidya T, Beaumont M, de Bisschop C, Bazerque L, Le Blanc C, Vincent A, Ouksel H, Chambellan A. Determining the minimally important difference in quadriceps strength in individuals with COPD using a fixed dynamometer. Int J Chron Obstruct Pulmon Dis 2018; 13:2685-2693. [PMID: 30214186 PMCID: PMC6124469 DOI: 10.2147/copd.s161342] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Measurement of quadriceps muscular force is recommended in individuals with COPD, notably during a pulmonary rehabilitation program (PRP). However, the tools used to measure quadriceps maximal voluntary contraction (QMVC) and the clinical relevance of the results, as well as their interpretation for a given patient, remain a matter of debate. The objective of this study was to estimate the minimally important difference (MID) of QMVC using a fixed dynamometer in individuals with COPD undergoing a PRP. Methods Individuals with COPD undergoing a PRP were included in this study. QMVC was measured using a dynamometer (MicroFET2) fixed on a rigid support according to a standard-ized methodology. Exercise capacity was measured by 6-minute walk distance (6MWD) and evaluation of quality of life with St George's respiratory questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS) total scores. All measures were obtained at baseline and the end of the PRP. The MID was calculated using distribution-based methods. Results A total of 157 individuals with COPD (age 62.9±9.0 years, forced expiratory volume in 1 second 47.3%±18.6% predicted) were included in this study. At the end of the PRP, the patients had improved their quadriceps force significantly by 8.9±15.6 Nm (P<0.001), as well as 6MWD by 42±50 m (P<0.001), SGRQ total score by -9±17 (P<0.001) and HADS total score by -3±6 (P<0.001). MID estimation using distribution-based analysis was 7.5 Nm by empirical rule effect size and 7.8 Nm by Cohen's effect size. Conclusion Measurement of QMVC using a fixed dynamometer is a simple and valuable tool capable of assessing improvement in quadriceps muscle force after a PRP. We suggest an MID of 7.5 Nm to identify beneficial changes after a PRP intervention.
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Affiliation(s)
- Trija Vaidya
- Laboratory MOVE (EA6314), Faculty of Sport Sciences, University of Poitiers, Poitiers, France.,Laboratory "Movement, Interactions, Performance" (EA4334), Faculty of Sport Sciences, University of Nantes, Nantes, France,
| | - Marc Beaumont
- Pulmonary Rehabilitation unit, Morlaix Hospital Centre, Morlaix, France.,EA3878 (G.E.T.B.O), CHU Brest, Brest, France
| | - Claire de Bisschop
- Laboratory MOVE (EA6314), Faculty of Sport Sciences, University of Poitiers, Poitiers, France
| | - Lucie Bazerque
- Institute of Physical Education and Sports Sciences (IFEPSA), Université Catholique de l'Ouest (UCO), Angers, France
| | - Camille Le Blanc
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, Nantes, France
| | - Anne Vincent
- Respiratory Rehabilitation Service, la Tourmaline, UGECAM, Nantes, France
| | - Hakima Ouksel
- Dept of Pulmonary Medicine, Angers University Hospital, Angers, France
| | - Arnaud Chambellan
- Laboratory "Movement, Interactions, Performance" (EA4334), Faculty of Sport Sciences, University of Nantes, Nantes, France, .,l'institut du Thorax, University Hospital of Nantes, Nantes, France,
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126
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Shioya T, Sato S, Iwakura M, Takahashi H, Terui Y, Uemura S, Satake M. Improvement of physical activity in chronic obstructive pulmonary disease by pulmonary rehabilitation and pharmacological treatment. Respir Investig 2018; 56:292-306. [PMID: 29903607 DOI: 10.1016/j.resinv.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 10/14/2022]
Abstract
Physical activity (PA) is defined as bodily movement produced by skeletal muscles with energy expenditure beyond resting levels. PA is closely related to reduced morbidity and mortality in chronic obstructive pulmonary disease (COPD). Self-report questionnaires are often subject to recall bias, correlating poorly with objectively qualified PA, and do not provide an accurate estimate of free-living energy expenditure. PA may be objectively evaluated by newly developed tri-axial accelerometers by quantifying steps or body movements over a period of time. Low-intensity, home-based pulmonary rehabilitation (PR) using pedometer feedback improves PA. Improvement in physiological factors correlates with increased walking time in stable elderly COPD patients. This review focuses on the effects of PR and pharmacological treatment on PA in COPD patients. We selected 32 studies from our literature search evaluating the effects of PR and 11 studies examining the effects of pharmacological treatment on PA. Findings in both categories were inconsistent. Nineteen studies showed a positive effect with PR whereas 13 showed no effect. Eight studies showed a positive effect, while three revealed no effect from pharmacological intervention. As both interventions increase exercise capacity without a consistent effect on PA, counseling with behavioral changes may be necessary to achieve a significant and lasting increase in PA. Changing PA behavior in COPD patients requires an interdisciplinary approach involving specialists in respiratory medicine, rehabilitation, social, and behavioral sciences. Future research in this area is warranted to advance our knowledge in this area, specifically with regard to the interaction of pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Takanobu Shioya
- Akita University Graduate School of Health Sciences, Department of Physical Therapy, Akita, Japan.
| | - Susumu Sato
- Kyoto University Hospital, Department of Rehabilitation & Pulmonary Medicine, Kyoto, Japan.
| | - Masahiro Iwakura
- Akita University Graduate School of Health Sciences, Department of Physical Therapy, Akita, Japan; Akita City General Hospital, Department of Rehabilitation, Akita, Japan.
| | - Hitomi Takahashi
- Akita City General Hospital, Department of Rehabilitation, Akita, Japan.
| | - Yoshino Terui
- Akita University Graduate School of Health Sciences, Department of Physical Therapy, Akita, Japan.
| | - Sachiko Uemura
- Akita University Graduate School of Health Sciences, Department of Physical Therapy, Akita, Japan.
| | - Masahiro Satake
- Akita University Graduate School of Health Sciences, Department of Physical Therapy, Akita, Japan.
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127
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Promoting Physical Activity Using the Internet: Is It Feasible and Acceptable for Patients With Chronic Obstructive Pulmonary Disease and Bronchiectasis? J Aging Phys Act 2018; 26:372-381. [PMID: 28952865 DOI: 10.1123/japa.2017-0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Older people with chronic lung diseases and with low physical activity participation rates are at higher risk of morbidity and mortality. This study assessed the feasibility and acceptability of a purpose-designed Internet-based program (ActivOnline) to monitor and encourage exercise and physical activity. Twelve participants with chronic obstructive pulmonary disease or bronchiectasis were recruited (54-84 years). Primary outcome measures were feasibility measured by frequency of program access, and acceptability measured by semistructured interview, system usability scores, and participant perception of benefit. The results suggest regular participation in physical activity and exercise during the 8-week study period and high usability scores (mean = 90% ± 9%). Major themes were the importance of regular exercise and how sustained lifestyle changes were essential to be physically active, regular contact with clinicians assisted with motivation, and aspects of ActivOnline facilitated individual behavior change and confidence to continue exercising. Most participants (82%) reported a benefit from using ActivOnline, and 55% wished to remain on the program indefinitely.
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128
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Robinson H, Williams V, Curtis F, Bridle C, Jones AW. Facilitators and barriers to physical activity following pulmonary rehabilitation in COPD: a systematic review of qualitative studies. NPJ Prim Care Respir Med 2018; 28:19. [PMID: 29867117 PMCID: PMC5986863 DOI: 10.1038/s41533-018-0085-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022] Open
Abstract
Pulmonary rehabilitation has short-term benefits on dyspnea, exercise capacity and quality of life in COPD, but evidence suggests these do not always translate to increased daily physical activity on a patient level. This is attributed to a limited understanding of the determinants of physical activity maintenance following pulmonary rehabilitation. This systematic review of qualitative research was conducted to understand COPD patients' perceived facilitators and barriers to physical activity following pulmonary rehabilitation. Electronic databases of published data, non-published data, and trial registers were searched to identify qualitative studies (interviews, focus groups) reporting the facilitators and barriers to physical activity following pulmonary rehabilitation for people with COPD. Thematic synthesis of qualitative data was adopted involving line-by-line coding of the findings of the included studies, development of descriptive themes, and generation of analytical themes. Fourteen studies including 167 COPD patients met the inclusion criteria. Seven sub-themes were identified as influential to physical activity following pulmonary rehabilitation. These included: intentions, self-efficacy, feedback of capabilities and improvements, relationship with health care professionals, peer interaction, opportunities following pulmonary rehabilitation and routine. These encapsulated the facilitators and barriers to physical activity following pulmonary rehabilitation and were identified as sub-themes within the three analytical themes, which were beliefs, social support, and the environment. The findings highlight the challenge of promoting physical activity following pulmonary rehabilitation in COPD and provide complementary evidence to aid evaluations of interventions already attempted in this area, but also adds insight into future development of interventions targeting physical activity maintenance in COPD.
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Affiliation(s)
- Hayley Robinson
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK.
| | - Veronika Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ffion Curtis
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | | | - Arwel W Jones
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
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129
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Nolan CM, Maddocks M, Canavan JL, Jones SE, Delogu V, Kaliaraju D, Banya W, Kon SSC, Polkey MI, Man WDC. Reply to Rodrigues et al.: Increasing Physical Activity in Daily Life in Chronic Obstructive Pulmonary Disease: To Solve the Puzzle, Every Piece Counts. Am J Respir Crit Care Med 2018; 197:1089-1090. [PMID: 29206054 DOI: 10.1164/rccm.201711-2213le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Claire M Nolan
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom.,2 Imperial College London London, United Kingdom
| | | | - Jane L Canavan
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom
| | - Sarah E Jones
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom.,2 Imperial College London London, United Kingdom
| | - Veronica Delogu
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom
| | - Djeya Kaliaraju
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom
| | - Winston Banya
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom
| | - Samantha S C Kon
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom.,4 The Hillingdon Hospital NHS Foundation Trust London, United Kingdom
| | - Michael I Polkey
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom.,2 Imperial College London London, United Kingdom
| | - William D-C Man
- 1 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom.,2 Imperial College London London, United Kingdom
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130
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Chen Y, Niu M, Zhang X, Qian H, Xie A, Wang X. Effects of home-based lower limb resistance training on muscle strength and functional status in stable Chronic obstructive pulmonary disease patients. J Clin Nurs 2018; 27:e1022-e1037. [PMID: 29076609 DOI: 10.1111/jocn.14131] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Yi Chen
- Department of Emergency and Critical Care Medicine; The First Affiliated Hospital of Soochow University; Suzhou Jiangsu China
| | - Mei'e Niu
- Department of Nursing; The First Affiliated Hospital of Soochow University; Suzhou Jiangsu China
| | - Xiuqin Zhang
- Respiratory Department; The First Affiliated Hospital of Soochow University; Suzhou Jiangsu China
| | - Hongying Qian
- Respiratory Department; The First Affiliated Hospital of Soochow University; Suzhou Jiangsu China
| | - Anwei Xie
- Department of Infectious Diseases; The Children's Affiliated Hospital of Soochow University; Suzhou Industrial Park Jiangsu China
| | - Xiya Wang
- Gastrointestinal Endoscopy Center; The First Affiliated Hospital of Soochow University; Suzhou Jiangsu China
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131
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Nolan CM, Maddocks M, Canavan JL, Jones SE, Delogu V, Kaliaraju D, Banya W, Kon SSC, Polkey MI, Man WDC. Reply to Sasso et al.: Are All Steps Created Equal? Revisiting Pedometer Use during Pulmonary Rehabilitation for Individuals Living with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2018; 197:406-409. [DOI: 10.1164/rccm.201707-1513le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Claire M. Nolan
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
- Imperial College LondonLondon, United Kingdom
| | | | - Jane L. Canavan
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
| | - Sarah E. Jones
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
- Imperial College LondonLondon, United Kingdom
| | - Veronica Delogu
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
| | - Djeya Kaliaraju
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
| | - Winston Banya
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
| | - Samantha S. C. Kon
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
- Hillingdon HospitalLondon, United Kingdom
| | - Michael I. Polkey
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
- Imperial College LondonLondon, United Kingdom
| | - William D.-C. Man
- Royal Brompton & Harefield NHS Foundation TrustLondon, United Kingdom
- Imperial College LondonLondon, United Kingdom
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132
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Shin KC. Physical activity in chronic obstructive pulmonary disease: clinical impact and risk factors. Korean J Intern Med 2018; 33:75-77. [PMID: 29334725 PMCID: PMC5768551 DOI: 10.3904/kjim.2017.387] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kyeong-Cheol Shin
- Correspondence to Kyeong-Cheol Shin, M.D. Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-640-6683 Fax: +82-53-654-3486 E-mail:
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133
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Martinez CH. Adding Pedometers to Pulmonary Rehabilitation Did Not Result in Greater Physical Activity. An Important Answer, but What Was the Question? Am J Respir Crit Care Med 2017; 195:1284-1285. [PMID: 28504600 DOI: 10.1164/rccm.201612-2437ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Carlos H Martinez
- 1 Division of Pulmonary and Critical Care Medicine University of Michigan Health System Ann Arbor, Michigan
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134
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Rochester CL, Spruit MA. Maintaining the Benefits of Pulmonary Rehabilitation. The Holy Grail. Am J Respir Crit Care Med 2017; 195:548-551. [PMID: 28248138 DOI: 10.1164/rccm.201609-1925ed] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Carolyn L Rochester
- 1 Section of Pulmonary, Critical Care and Sleep Medicine Yale University School of Medicine New Haven, Connecticut.,2 Department of Internal Medicine VA Connecticut Healthcare System West Haven, Connecticut
| | - Martijn A Spruit
- 3 Department of Research and Education CIRO+, Center of Expertise for Chronic Organ Failure Horn, the Netherlands.,4 REVAL - Faculty of Medicine and Life Sciences Hasselt University Diepenbeek, Belgium and.,5 NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Medical Centre Maastricht, the Netherlands
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135
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Houben-Wilke S, Augustin IM, Wouters BB, Stevens RA, Janssen DJ, Spruit MA, Vanfleteren LE, Franssen FM, Wouters EF. The patient with a complex chronic respiratory disease: a specialist of his own life? Expert Rev Respir Med 2017; 11:919-924. [PMID: 29025350 DOI: 10.1080/17476348.2017.1392242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The independent and central role of the patient with a complex chronic respiratory disease in targeted, personalized disease management strategies is becoming increasingly important. Patients are the ones living with the disease and are finally responsible for their lives underlining their role as essential members of the interdisciplinary treatment team. Areas covered: The present paper narratively reviews existing research and discusses the special, as well as specialized, role of the patient with a complex chronic respiratory disease in the healthcare system and highlights fundamental elements of the (future) relationship between patient and healthcare professionals. Expert commentary: Since the chronic respiratory disease at hand is part of the patient's entire life, we need holistic, personalized approaches optimizing patients' quality of life by not only treating the disease but considering the patients' whole environment and where healthcare professionals and patients are co-creating value care.
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Affiliation(s)
| | | | - Birgit Bref Wouters
- b Department of Health, Ethics and Society, Faculty of Health , Medicine and Life Science, CAPHRI School for Public Health and Primary Care , Maastricht , The Netherlands
| | - Rosita Ah Stevens
- a Department of Research and Education , CIRO , Horn , The Netherlands
| | - Daisy Ja Janssen
- a Department of Research and Education , CIRO , Horn , The Netherlands.,c Centre of Expertise for Palliative Care , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Martijn A Spruit
- a Department of Research and Education , CIRO , Horn , The Netherlands.,d Department of Respiratory Medicine , Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism , Maastricht , The Netherlands
| | - Lowie Egw Vanfleteren
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Frits Me Franssen
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Emiel Fm Wouters
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
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136
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Iepsen UW, Munch GW, Ryrsø CK, Secher NH, Lange P, Thaning P, Pedersen BK, Mortensen SP. Muscle α-adrenergic responsiveness during exercise and ATP-induced vasodilation in chronic obstructive pulmonary disease patients. Am J Physiol Heart Circ Physiol 2017; 314:H180-H187. [PMID: 29030339 DOI: 10.1152/ajpheart.00398.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sympathetic vasoconstriction is blunted in exercising muscle (functional sympatholysis) but becomes attenuated with age. We tested the hypothesis that functional sympatholysis is further impaired in chronic obstructive pulmonary disease (COPD) patients. We determined leg blood flow and calculated leg vascular conductance (LVC) during 1) femoral-arterial Tyramine infusion (evokes endogenous norepinephrine release, 1 µmol·min-1·kg leg mass-1), 2) one-legged knee extensor exercise with and without Tyramine infusion [10 W and 20% of maximal workload (WLmax)], 3) ATP (0.05 µmol·min-1·kg leg mass-1) and Tyramine infusion, and 4) incremental ATP infusions (0.05, 0.3, and 3.0 µmol·min-1·kg leg mass-1). We included 10 patients with moderate to severe COPD and 8 age-matched healthy control subjects. Overall, leg blood flow and LVC were lower in COPD patients during exercise ( P < 0.05). Tyramine reduced LVC in both groups at 10-W exercise (COPD: -3 ± 1 ml·min-1·mmHg-1 and controls: -3 ± 1 ml·min-1·mmHg-1, P < 0.05) and 20% WLmax (COPD: -4 ± 1 ml·min-1·mmHg-1 and controls: -3 ± 1 ml·min-1·mmHg-1, P < 0.05) with no difference between groups. Incremental ATP infusions induced dose-dependent vasodilation with no difference between groups, and, in addition, the vasoconstrictor response to Tyramine infused together with ATP was not different between groups (COPD: -0.03 ± 0.01 l·min-1·kg leg mass-1 vs. CONTROLS -0.04 ± 0.01 l·min-1·kg leg mass-1, P > 0.05). Compared with age-matched healthy control subjects, the vasodilatory response to ATP is intact in COPD patients and their ability to blunt sympathetic vasoconstriction (functional sympatholysis) as evaluated by intra-arterial Tyramine during exercise or ATP infusion is maintained. NEW & NOTEWORTHY The ability to blunt sympathetic vasoconstriction in exercising muscle and ATP-induced dilation in chronic obstructive pulmonary disease patients remains unexplored. Chronic obstructive pulmonary disease patients demonstrated similar sympathetic vasoconstriction in response to intra-arterial Tyramine during exercise and ATP-induced vasodilation compared with age-matched healthy control subjects.
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Affiliation(s)
- U W Iepsen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet, Copenhagen , Denmark
| | - G W Munch
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet, Copenhagen , Denmark
| | - C K Ryrsø
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet, Copenhagen , Denmark
| | - N H Secher
- Department of Anesthesiology, The Copenhagen Muscle Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen , Denmark
| | - P Lange
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet, Copenhagen , Denmark.,Medical Department O, Respiratory Section, Herlev and Gentofte Hospital, Copenhagen , Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen , Copenhagen , Denmark
| | - P Thaning
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet, Copenhagen , Denmark.,Medical Department O, Respiratory Section, Herlev and Gentofte Hospital, Copenhagen , Denmark
| | - B K Pedersen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet, Copenhagen , Denmark
| | - S P Mortensen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet, Copenhagen , Denmark.,Department of Cardiovascular and Renal Research, University of Southern Denmark, Denmark
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137
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de Torres JP, Marin JM, Martinez-Gonzalez C, de Lucas-Ramos P, Cosio B, Casanova C. The importance of symptoms in the longitudinal variability of clusters in COPD patients: A validation study. Respirology 2017; 23:485-491. [DOI: 10.1111/resp.13194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/28/2017] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jose M. Marin
- Pulmonary Department; University Hospital Miguel Servet; Zaragoza Spain
- CIBER of Respiratory Diseases (CIBERES); Health Institute Carlos III; Madrid Spain
| | | | | | - Borja Cosio
- CIBER of Respiratory Diseases (CIBERES); Health Institute Carlos III; Madrid Spain
- Pulmonary Department; Son Espases Hospital; Palma de Mallorca Spain
| | - Ciro Casanova
- Pulmonary Department; Ntra Sra de Candelaria Hospital; Tenerife Spain
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138
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Young J, Jordan RE, Adab P, Enocson A, Jolly K. Interventions to promote referral, uptake and adherence to pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD). Hippokratia 2017. [DOI: 10.1002/14651858.cd012813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Jane Young
- School of Nursing and Midwifery, Anglia Ruskin University; Senior Lecturer in Community Nursing; Cambridge UK
- University of Birmingham; Institute of Applied Health Research; Birmingham UK
| | - Rachel E Jordan
- University of Birmingham; Institute of Applied Health Research; Birmingham UK
| | - Peymane Adab
- University of Birmingham; Institute of Applied Health Research; Birmingham UK
| | - Alexandra Enocson
- University of Birmingham; Institute of Applied Health Research; Birmingham UK
| | - Kate Jolly
- University of Birmingham; Institute of Applied Health Research; Birmingham UK
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139
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Korpershoek YJG, Bruins Slot JC, Effing TW, Schuurmans MJ, Trappenburg JCA. Self-management behaviors to reduce exacerbation impact in COPD patients: a Delphi study. Int J Chron Obstruct Pulmon Dis 2017; 12:2735-2746. [PMID: 28979116 PMCID: PMC5608232 DOI: 10.2147/copd.s138867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Little is known about which self-management behaviors have the highest potential to influence exacerbation impact in COPD patients. We aimed to reach expert consensus on the most relevant set of self-management behaviors that can be targeted and influenced to maximize reduction of exacerbation impact. MATERIALS AND METHODS A 2-round Delphi study was performed using online surveys to rate the relevance and feasibility of predetermined self-management behaviors identified by literature and expert opinion. Descriptive statistics and qualitative analyses were used. RESULTS An international expert panel reached consensus on 17 self-management behaviors focusing on: stable phase (n=5): pharmacotherapy, vaccination, physical activity, avoiding stimuli and smoking cessation; periods of symptom deterioration (n=1): early detection; during an exacerbation (n=5): early detection, health care contact, self-treatment, managing stress/anxiety and physical activity; during recovery (n=4): completing treatment, managing stress/anxiety, physical activity and exercise training; and after recovery (n=2): awareness for recurrent exacerbations and restart of pulmonary rehabilitation. CONCLUSION This study has provided insight into expert opinion on the most relevant and feasible self-management behaviors that can be targeted and influenced before, during and after an exacerbation to exert the highest magnitude of influence on the impact of exacerbations. Future research should focus at developing more comprehensive patient-tailored interventions supporting patients in these exacerbation-related self-management behaviors.
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Affiliation(s)
- Yvonne JG Korpershoek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
- Research Group Chronic Illnesses, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Joyce C Bruins Slot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
| | - Tanja W Effing
- Department of Respiratory Medicine, Southern Adelaide Local Health Network
- School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Marieke J Schuurmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
- Research Group Chronic Illnesses, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Jaap CA Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
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140
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Arbillaga-Etxarri A, Gimeno-Santos E, Barberan-Garcia A, Benet M, Borrell E, Dadvand P, Foraster M, Marín A, Monteagudo M, Rodriguez-Roisin R, Vall-Casas P, Vilaró J, Garcia-Aymerich J. Socio-environmental correlates of physical activity in patients with chronic obstructive pulmonary disease (COPD). Thorax 2017; 72:796-802. [PMID: 28250201 PMCID: PMC5738536 DOI: 10.1136/thoraxjnl-2016-209209] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/12/2017] [Accepted: 02/05/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Study of the causes of the reduced levels of physical activity in patients with COPD has been scarce and limited to biological factors. AIM To assess the relationship between novel socio-environmental factors, namely dog walking, grandparenting, neighbourhood deprivation, residential surrounding greenness and residential proximity to green or blue spaces, and amount and intensity of physical activity in COPD patients. METHODS This cross-sectional study recruited 410 COPD patients from five Catalan municipalities. Dog walking and grandparenting were assessed by questionnaire. Neighbourhood deprivation was assessed using the census Urban Vulnerability Index, residential surrounding greenness by the satellite-derived Normalized Difference Vegetation Index, and residential proximity to green or blue spaces as living within 300 m of such a space. Physical activity was measured during 1 week by accelerometer to assess time spent on moderate-to-vigorous physical activity (MVPA) and vector magnitude units (VMU) per minute. FINDINGS Patients were 85% male, had a mean (SD) age of 69 (9) years, and post-bronchodilator FEV1 of 56 (17) %pred. After adjusting for age, sex, socio-economic status, dyspnoea, exercise capacity and anxiety in a linear regression model, both dog walking and grandparenting were significantly associated with an increase both in time in MVPA (18 min/day (p<0.01) and 9 min/day (p<0.05), respectively) and in physical activity intensity (76 VMU/min (p=0.05) and 59 VMUs/min (p<0.05), respectively). Neighbourhood deprivation, surrounding greenness and proximity to green or blue spaces were not associated with physical activity. CONCLUSIONS Dog walking and grandparenting are associated with a higher amount and intensity of physical activity in COPD patients. TRIAL REGISTRATION NUMBER Pre-results, NCT01897298.
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Affiliation(s)
- Ane Arbillaga-Etxarri
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Physical Activity and Sports Sciences, Faculty of Psychology and Education, University of Deusto, Donostia-San Sebastián, Spain
| | - Elena Gimeno-Santos
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Anael Barberan-Garcia
- Respiratory Clinic Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marta Benet
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Payam Dadvand
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Maria Foraster
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alicia Marín
- Pneumology Department, Hospital Germans Trias i Pujol, CIBER Respiratory Diseases (CIBERES), Badalona, Spain
| | - Mònica Monteagudo
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Robert Rodriguez-Roisin
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pere Vall-Casas
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Jordi Vilaró
- FCS Blanquerna, Research Group on Health, Physical Activity and Sport (SAFE), Ramon Llull University, Barcelona, Spain
| | - Judith Garcia-Aymerich
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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141
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Geidl W, Semrau J, Streber R, Lehbert N, Wingart S, Tallner A, Wittmann M, Wagner R, Schultz K, Pfeifer K. Effects of a brief, pedometer-based behavioral intervention for individuals with COPD during inpatient pulmonary rehabilitation on 6-week and 6-month objectively measured physical activity: study protocol for a randomized controlled trial. Trials 2017; 18:396. [PMID: 28851462 PMCID: PMC5576331 DOI: 10.1186/s13063-017-2124-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary rehabilitation programs often fail to substantially enhance long-term physical activity in patients with chronic obstructive pulmonary disease (COPD). The reasons for successful physical activity changes in patients with COPD are not well understood. The need to better understand the determinants of physical activity in patients with COPD and effective rehabilitation strategies to improve physical activity is evident. Methods/design The STAR study (Stay Active after Rehabilitation) investigates, in a randomized controlled trial, the additional effect of a pedometer-based behavior-change intervention during inpatient pulmonary rehabilitation on objectively measured physical activity 6 weeks and 6 months post rehabilitation. The intervention uses the behavior-change techniques (1) instruction on how, where and when to perform the behavior, (2) prompt goal setting for physical activity, (3) prompt self-monitoring of behavior, and (4) feedback on behavior. The primary outcome of physical activity will be measured using a physical activity monitor (Actigraph wGT3X-BT) for a period of 7 days, firstly 2 weeks before rehabilitation begins (t0) as well as 6 weeks and 6 months after rehabilitation (t3, t4). Additionally, to predict physical activity progression after rehabilitation, a complex personal diagnostics battery, including questionnaires as well as functional assessments, is to be carried out at the start and end of rehabilitation (t1, t2). This battery is based on the foundational ideas of the Physical Activity-Related health Competence model. Five hundred and two patients with COPD, aged 18 years or older and admitted for an approved pulmonary rehabilitation, will be enrolled in the STAR study. Discussion The STAR study is designed as a randomized controlled trial to gain a better understanding of the personal determinants of physical activity in patients with COPD and to evaluate a pedometer-based physical activity-change intervention in the context of inpatient pulmonary rehabilitation. The results enable the future identification of patients with COPD who will find it difficult to engage in long-term physical activity after rehabilitation. Based on this, intervention strategies to promote physical activity in the content of pulmonary rehabilitation can be optimized. Trial registration Clinicaltrials.gov, ID: NCT02966561. Registered retrospectively after the start of the recruitment in June 2016 on 22 November 2016. All protocol modifications will be registered in the trial registry. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2124-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wolfgang Geidl
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany.
| | - Jana Semrau
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - René Streber
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - Nicola Lehbert
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | - Silke Wingart
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | | | - Michael Wittmann
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | - Rupert Wagner
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | - Klaus Pfeifer
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
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142
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Lalmolda C, Coll-Fernández R, Martínez N, Baré M, Teixidó Colet M, Epelde F, Monsó E. Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns. Int J Chron Obstruct Pulmon Dis 2017; 12:2531-2538. [PMID: 28883720 PMCID: PMC5574698 DOI: 10.2147/copd.s138451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. Aims The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. Materials and methods COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. Results Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0–1] vs 1 [0–2.5]; P=0.022) and in days of admission (0 [0–7] vs 7 [0–12]; P=0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient −0.785, P=0.014, and R2=0.219). Conclusion A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.
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Affiliation(s)
- C Lalmolda
- Respiratory Diseases Department, Hospital Universitari Parc Tauli.,Ciber de Enfermedades Respiratorias - Ciberes.,Universitat Autònoma de Barcelona - UAB
| | | | - N Martínez
- Respiratory Diseases Department, Hospital Universitari Parc Tauli
| | - M Baré
- Primary Care Unit Vallés Occidental, Institut Català de la Salut
| | - M Teixidó Colet
- Primary Care Unit Vallés Occidental, Institut Català de la Salut
| | - F Epelde
- Short Stay Unit, Emergency Service, Hospital Universitari Parc Taulí, Barcelona, Spain
| | - E Monsó
- Respiratory Diseases Department, Hospital Universitari Parc Tauli.,Ciber de Enfermedades Respiratorias - Ciberes.,Universitat Autònoma de Barcelona - UAB
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143
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Abstract
Physical inactivity is an underrecognized and undertreated lifestyle behavior among patients with chronic obstructive pulmonary disease and is independently associated with a number of adverse health-related outcomes. Pulmonary rehabilitation with exercise training provides an efficacious intervention with short-term improvements, but it is an infrequently used modality and does not consistently result in longer term increases in physical activity. Similarly, pedometer self-monitoring with coaching has demonstrated short-term increases in physical activity. However, further research is needed to determine the optimal method to support long-term behavior change that will have the greatest benefit. While available evidence suggests that reversing physical inactivity is an essential component of self-management to optimize health, it is only one component of a complex set of interventions needed to support patients in adapting to their chronic condition. In the future, this support will ideally start with identification of specific patient phenotypes, which describes their adaptation to the condition based on patients' knowledge, skills, confidence, symptoms, and impairments. This information will then be used to tailor education and behavior change strategies over the long term to promote sustainable physical activity and other healthy lifestyles.
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Affiliation(s)
- David B. Coultas
- VA Portland Health Care System, Portland, Oregon, and Oregon Health & Science University, Portland, Oregon
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144
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Peng YH, Huang CW, Liao WC, Chen HJ, Yin MC, Huang YM, Wu TN, Ho WC. Association between chronic obstructive pulmonary disease and increased risk of benign prostatic hyperplasia: a retrospective nationwide cohort study. BMJ Open 2017; 7:e015581. [PMID: 28645971 PMCID: PMC5734354 DOI: 10.1136/bmjopen-2016-015581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) and benign prostatic hyperplasia (BPH) are common disorders in ageing male populations. Nevertheless, the relationship between the two diseases has rarely been explored. The objective of this study was to examine whether patients with COPD are at an increased risk of BPH. DESIGN Retrospective nationwide cohort study. SETTING Data retrieved from the Taiwan National Health Insurance Research Database. PARTICIPANTS Overall, 19 959 male patients aged 40 years and over with newly diagnosed COPD between 2000 and 2006 were included as the COPD group, and 19 959 sex-matched and age-matched enrollees without COPD were included as the non-COPD group. Both groups were followed-up until the end of 2011. OUTCOME MEASURES A Cox proportional hazards regression model was used to compute the risk of BPH in patients with COPD compared with enrollees without COPD. RESULTS The overall incidence rate of BPH was 1.53 times higher in the COPD group than that in the non-COPD group (44.7 vs 25.7 per 1000 person-years, 95% CI 1.46 to 1.60) after adjusting for covariates. An additional stratified analysis revealed that this increased risk of BPH in patients with COPD remained significantly higher than that in enrollees without COPD in all men aged 40 years and over. CONCLUSION After adjustment for covariates, male patients with COPD were found to be at a higher risk of BPH. We suggest that clinicians should be cautious about the increased risk of BPH in male patients with COPD.
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Affiliation(s)
- Yi-Hao Peng
- Department of Public Health, China Medical University, Taichung, Taiwan
- Division of Respiratory Therapy, Asia University Hospital, Asia University, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
| | - Chien-Wen Huang
- Division of Chest Medicine, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan
- Department of Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Institute of Molecular Biology, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Chien Yin
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Ming Huang
- Division of Respiratory Therapy, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Trong-Neng Wu
- Department of Health Care Administration, Asia University, Taichung, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
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145
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146
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Intervenciones no farmacológicas en pacientes con EPOC en fase estable. Arch Bronconeumol 2017. [DOI: 10.1016/s0300-2896(17)30363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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147
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Rabe KF, Watz H. Chronic obstructive pulmonary disease. Lancet 2017; 389:1931-1940. [PMID: 28513453 DOI: 10.1016/s0140-6736(17)31222-9] [Citation(s) in RCA: 602] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 02/07/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) kills more than 3 million people worldwide every year. Despite progress in the treatment of symptoms and prevention of acute exacerbations, few advances have been made to ameliorate disease progression or affect mortality. A better understanding of the complex disease mechanisms resulting in COPD is needed. Smoking cessation programmes, increasing physical activity, and early detection and treatment of comorbidities are further key components to reduce the burden of the disease. However, without a global political and economic effort to reduce tobacco use, to regulate environmental exposure, and to find alternatives to the massive use of biomass fuel, COPD will remain a major health-care problem for decades to come.
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Affiliation(s)
- Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany; Department of Medicine, Christian Albrechts University Kiel, Kiel, Germany.
| | - Henrik Watz
- Pulmonary Research Institute, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
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148
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Mesquita R, Nakken N, Janssen DJ, van den Bogaart EH, Delbressine JM, Essers JM, Meijer K, van Vliet M, de Vries GJ, Muris JW, Pitta F, Wouters EF, Spruit MA. Activity Levels and Exercise Motivation in Patients With COPD and Their Resident Loved Ones. Chest 2017; 151:1028-1038. [DOI: 10.1016/j.chest.2016.12.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/02/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022] Open
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149
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Mesquita R, Meijer K, Pitta F, Azcuna H, Goërtz YMJ, Essers JMN, Wouters EFM, Spruit MA. Changes in physical activity and sedentary behaviour following pulmonary rehabilitation in patients with COPD. Respir Med 2017; 126:122-129. [PMID: 28427543 DOI: 10.1016/j.rmed.2017.03.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
A more profound investigation about the responses in activity levels following pulmonary rehabilitation (PR) in patients with COPD is needed. We aimed to describe groups of patients with COPD according to patterns of change in physical activity and sedentary behaviour following PR. 90 patients with COPD (60% male; mean age 67 ± 8; median FEV1 47 (32-62) %pred) completed a comprehensive PR programme. A triaxial accelerometer was used to assess the time in sedentary behaviour, light activities and moderate-to-vigorous physical activity (MVPA). Additionally, exercise capacity, quality of life, and symptoms of anxiety and depression were assessed before and after PR. Six groups with different patterns of change in physical activity and sedentary behaviour were identified. The two most prevalent patterns were represented by good responders (increase in physical activity and reduction in sedentary behaviour, 34%) and poor responders (decrease in physical activity and increase in sedentary behaviour, 30%). Good responders had greater improvements in six-minute walk distance (6MWD) and symptoms of depression than poor responders (P < 0.05 for all). Strong correlation was found between changes in sedentary behaviour and changes in light activities (rs = -0.89; P < 0.0001). Changes in 6MWD correlated fairly with changes in sedentary behaviour (rs = -0.26), light activities (rs = 0.25), and MVPA (rs = 0.24); P < 0.05 for all. Different patterns of change in activity levels following PR can be found in patients with COPD. Focusing on light physical activities might be a potential strategy to make patients less sedentary, but for this to be achieved prior (or at least parallel) improvements in functional capacity seem to be necessary.
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Affiliation(s)
- Rafael Mesquita
- Department of Research & Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.
| | - Kenneth Meijer
- Department of Human Movement Science, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Helena Azcuna
- Respiratory Department of Hospital Universitario Araba, Alava, Spain
| | - Yvonne M J Goërtz
- Department of Research & Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Johannes M N Essers
- Department of Human Movement Science, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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150
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Baker EH, Burrage DR. 'I'm useless after a bad night's sleep, doctor': could sleep be the key to improving physical activity in people with COPD? Thorax 2017; 72:677-678. [PMID: 28302749 DOI: 10.1136/thoraxjnl-2016-209905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Emma H Baker
- Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Daniel R Burrage
- Institute of Infection and Immunity, St George's, University of London, London, UK
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