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Karagiannis C, Savva C, Korakakis V, Adamide T, Georgiou A, Matheou I, Prodromou A, Xanthos T. Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev 2021; 41:426-431. [PMID: 34117184 DOI: 10.1097/hcr.0000000000000620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR. METHODS Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale. RESULTS Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group. CONCLUSIONS In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.
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Affiliation(s)
- Christos Karagiannis
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus (Drs Karagiannis and Savva and Ms Matheou); Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar (Dr Korakakis); Respiratory Clinic, Nicosia General Hospital, Nicosia, Cyprus (Dr Adamide); Private Doctor, Nicosia, Cyprus (Dr Georgiou); Physiotherapy Department, Nicosia General Hospital, and Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus (Ms Prodromou); and School of Medicine, European University Cyprus, Nicosia, Cyprus (Dr Xanthos)
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Kruapanich C, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Ubolnuar N, Chimpalee J, Mathiyakom W. The effect of unsupported arm elevations on regional chest wall volumes and thoracoabdominal asynchrony in patients with chronic obstructive pulmonary disease. Physiother Theory Pract 2021; 38:1602-1614. [PMID: 33555228 DOI: 10.1080/09593985.2021.1882018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To compare the effect of unsupported arm elevation (UAE) in different planes on chest wall volumes, thoracoabdominal asynchrony (TAA), ventilatory demands, dyspnea, and arm fatigue in patients with chronic obstructive pulmonary disease (COPD) and healthy subjects. Methods: Twenty-one patients with COPD and healthy-matched subjects performed UAE in shoulder flexion, scaption, abduction, and resting. Pulmonary total and regional chest wall volumes (VRCp), abdominal rib cage volume, abdominal volume, TAA, and ventilatory demands during arm positions were measured using optoelectronic plethysmography. Results: In both groups, VRCp and TAA were significantly affected during UAEs compared with the resting position. The healthy subjects had significantly decreased VRCp (L) (p < 0.05) during scaption (0.14 ± 0.07) and abduction (0.15 ± 0.06) than during flexion (0.18 ± 0.07) and no significantly different TAA between UAEs. The COPD group had no significantly different VRCp between UAEs, had significantly increased TAA (p < 0.05) during scaption (31.1°±9.5°) and abduction (32.3°±9.9°) than during flexion (29.7°±9.1°); and had significantly worse VRCp (p = 0.007), TAA (p = 0.0001), ventilatory demands (p < 0.05), dyspnea ((p = 0.03), and arm fatigue (p = 0.002). Conclusions: In patients with COPD, UAE in different planes similarly restricted the upper chest wall volume. Shoulder scaption and abduction significantly impaired TAA, ventilation, dyspnea, and arm fatigue compared with flexion. These results may help to select the appropriate UAE during physical activities.
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Affiliation(s)
- Chathipat Kruapanich
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Anong Tantisuwat
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Premtip Thaveeratitham
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Somrat Lertmaharit
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Nutsupa Ubolnuar
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Jaturong Chimpalee
- Department of Physical Therapy and Rehabilitation, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Witaya Mathiyakom
- Department of Physical Therapy, California State University, Northridge, Northridge, CA USA
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Kruapanich C, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Ubolnuar N, Mathiyakom W. Effects of Different Modes of Upper Limb Training in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Ann Rehabil Med 2019; 43:592-614. [PMID: 31693849 PMCID: PMC6835139 DOI: 10.5535/arm.2019.43.5.592] [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: 01/15/2019] [Accepted: 04/19/2019] [Indexed: 11/17/2022] Open
Abstract
Objective To determine effects of different modes of upper limb training on dyspnea and quality of life of individuals with chronic obstructive pulmonary disease (COPD) having different disease severity. Methods Randomized clinical trials were retrieved from five electronic databases. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration’s tool and the GRADE approach, respectively. Effects of upper limb training compared to control were identified using standardized mean difference and 95% confidence interval. Results Fifteen studies with 514 subjects were included. When compared to control, upper limb endurance and strength training with moderate quality of evidence resulted in significant improvement in dyspnea. However, quality of life was not significantly different between upper limb training of all modes of and the control. The upper limb training was more effective in reducing dyspnea in patients with severe COPD than in those with mild to moderate levels of COPD. Although quality of life was slightly improved by upper limb training for those with moderate or severe level of COPD, such improvement did not reach a significant level when compared to the control. Conclusion Upper limb endurance and strength training could significantly improve dyspnea in individuals with chronic obstructive pulmonary disease. Thus, incorporating the upper limb training into pulmonary rehabilitation is recommended to reduce dyspnea, especially for those with severe patients. Further studies with larger sample size and standardized training protocol are needed to confirm these finding (Registration No. CRD42018102805).
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Affiliation(s)
- Chathipat Kruapanich
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Anong Tantisuwat
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Premtip Thaveeratitham
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Somrat Lertmaharit
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nutsupa Ubolnuar
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Witaya Mathiyakom
- Department of Physical Therapy, California State University, Northridge, CA, USA
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Noninvasive ventilation and breathing-swallowing interplay in chronic obstructive pulmonary disease*. Crit Care Med 2014; 42:565-73. [PMID: 24145847 DOI: 10.1097/ccm.0b013e3182a66b4a] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate breathing-swallowing interactions in patients with chronic obstructive pulmonary disease requiring noninvasive mechanical ventilation and, if needed, to develop a technical modification of the ventilator designed to eliminate ventilator insufflations during swallowing. DESIGN We conducted a prospective, open-label, interventional study. PATIENTS Fifteen consecutive chronic obstructive pulmonary disease patients with exacerbations requiring ICU admission and NIV. INTERVENTIONS Swallowing performance and breathing-swallowing interactions were investigated noninvasively by chin electromyography, cervical piezoelectric sensor, and inductive respiratory plethysmography. Two water-bolus sizes (5 and 10 mL) were tested in random order. Swallowing was tested with and without noninvasive mechanical ventilation, in random order. First, a standard mechanical ventilator capable of delivering noninvasive mechanical ventilation was used. Second, a marketed device was equipped with an off-switch for use during swallowing. MEASUREMENTS AND MAIN RESULTS Swallowing performance and breathing-swallowing interactions were investigated noninvasively by chin electromyography, cervical piezoelectric sensor, and inductive respiratory plethysmography. Two water bolus sizes (5 and 10 mL) were tested in random order. Swallowing was tested with and without noninvasive mechanical ventilation in random order. First, a standard mechanical ventilator capable of delivering noninvasive mechanical ventilation was used. Swallowing efficiency, breathing-swallowing synchronization, and Borg Scale dyspnea scores improved significantly with noninvasive mechanical ventilation. However, swallowing induced ventilator triggering followed by autotriggering. To improve patient-ventilator synchrony, a marketed device was equipped with an off-switch for use during swallowing. This device completely eliminated swallowing-induced ventilator triggering and postswallow autotriggering. CONCLUSION Patients with chronic obstructive pulmonary disease admitted to the ICU for acute exacerbations had abnormal breathing-swallowing interactions and dyspnea, which improved with noninvasive mechanical ventilation. Furthermore, a ventilator device with a simple switch-off pushbutton to eliminate insufflations during swallows prevented swallowing-induced ventilator triggering and postswallow autotriggering.
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Abstract
Patients with lung cancer have high mortality and high morbidity. Lung cancer-related symptoms and problems such as dyspnea, fatigue, pain, and cachexia that begin in the early phase later result in poor physical functioning, psychosocial, and quality of life status. In addition, advancing age is associated with significant comorbidity. These patients may benefit from multidisciplinary therapy to reduce the perceived severity of dyspnea and fatigue and increase physical functioning and quality of life. Based on management of symptoms and problems such as dyspnea, physical inactivity, cancer-related fatigue, respiratory secretions, pain, and anxiety–depression of these patients, it is thought that physiotherapy techniques can be used on advanced lung cancer patients following a comprehensive evaluation. However, well-designed, prospective, and randomized-controlled trials are needed to prove the efficacy of physiotherapy and pulmonary rehabilitation in general for patients with advanced lung cancer.
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Affiliation(s)
- Sevgi Ozalevli
- Dokuz Eylul University, School of Physical Therapy and Re-habilitation, Izmir, Turkey
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Velloso M, do Nascimento NH, Gazzotti MR, Jardim JR. Evaluation of effects of shoulder girdle training on strength and performance of activities of daily living in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8:187-92. [PMID: 23589685 PMCID: PMC3624964 DOI: 10.2147/copd.s36606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have some limitations during activities of daily living that involve the arms. There is little information on the benefits of shoulder girdle training and its repercussions for activities of daily living in patients with COPD. The purpose of this study was to investigate whether shoulder girdle training with diagonal movements increases upper limb muscle strength and improves performance of activities of daily living in patients with COPD. METHODS Thirty-five patients with moderate to severe COPD (forced expiratory volume in one second 1.22 ± 0.49 L) and aged 36-80 years were recruited. Endurance time, maximal sustained weight, oxygen saturation, heart rate, respiratory rate, dyspnea, and arm fatigue were evaluated during an incremental upper limb test and eight simulated activities of daily living before and after an 8-week exercise training program. RESULTS A significant gain was observed for upper limb strength (P < 0.05). At the peak of the upper limb incremental test, the respiratory rate dropped from 33 to 27 breaths per minute, the Borg dyspnea score decreased from 2 to 0.5, and the upper limb fatigue score decreased from 3 to 2 (P < 0.05). No change was seen in any of these parameters during performance of activities of daily living. CONCLUSION Although shoulder girdle training increased upper limb strength, no improvement was detected in performance of activities of daily living.
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Affiliation(s)
- Marcelo Velloso
- Pulmonary Rehabilitation Center, Federal University of São Paulo/Associação de Assistência à Criança Deficiente (Unifesp/AACD), Brazil
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Jensen AL, Vedelø TW, Lomborg K. A patient-centred approach to assisted personal body care for patients hospitalised with chronic obstructive pulmonary disease. J Clin Nurs 2013; 22:1005-15. [PMID: 23331341 DOI: 10.1111/jocn.12050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the patients' experiences of receiving patient-centred personal body care and to document changes compared to the patients' experiences in previous hospital stays. BACKGROUND Patients with severe chronic obstructive pulmonary disease suffer from breathlessness. Personal body care is therefore often a major challenge, and during exacerbation these patients may need comprehensive assistance. The quality of assisted personal body care depends largely on the patients' and the nurses' symptom recognition, disease management and ability to achieve therapeutic clarity in the nurse-patient interaction. We developed, implemented and evaluated a patient-centred approach to assisted personal body care in which these characteristics were sought. DESIGN The study is a qualitative outcome analysis with an interpretive description methodology. METHODS Nine female and two male hospitalised patients with severe chronic obstructive pulmonary disease were selected for patient-centred care. Specially trained nurses and nursing assistants performed the patient-centred personal body care. Data material was obtained through participant observation of body care sessions with the patients, followed by individual in-depth interviews. The transcribed interviews were analysed and an interpretive description of the patients' experiences was established. RESULTS All patients experienced the patient-centred care to be different from what they had previously experienced. The most fundamental change was the experience of being an active part of a shared project. This experience encompassed three dimensions: clear signs of acknowledgement, attentive time and security. CONCLUSION Patient-centred assistance enables patients to take an active part in their personal body care activity. The intervention may be a method for nursing staff to secure patients-centred care. RELEVANCE TO CLINICAL PRACTICE Effective communication, tools for the assessment of breathlessness, clear and straight forward organisation of body care sessions, awareness of pauses and personal acknowledgment are important for the patients' ability to take part in personal body care activities.
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Affiliation(s)
- Annesofie L Jensen
- Department of Public Health, Section for Nursing Science, Faculty of Health Science, Aarhus University, Aarhus, Denmark.
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Covey MK, McAuley E, Kapella MC, Collins EG, Alex CG, Berbaum ML, Larson JL. Upper-Body Resistance Training and Self-Efficacy Enhancement in COPD. JOURNAL OF PULMONARY & RESPIRATORY MEDICINE 2012; Suppl 9:001. [PMID: 24707449 PMCID: PMC3975911 DOI: 10.4172/2161-105x.s9-001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Loss of skeletal muscle strength is commonly seen with chronic obstructive pulmonary disease (COPD). The study aim was to determine the effects of comprehensive upper-body resistance training (8 different lifts) and a self-efficacy enhancing intervention in COPD with respect to muscle strength, symptoms, functional status and exercise adherence. METHODS This randomized trial had 3 groups: upper-body resistance training with an intervention to enhance self-efficacy (UBR + SE), upper-body resistance training and health education (UBR + HE), gentle chair exercises and health education (CE + HE). Subjects performed 16 weeks of supervised training, then 12 months of long-term maintenance at home. Outcomes were: muscle strength, dyspnea, functional status, self-efficacy, and adherence. RESULTS Sixty-four subjects completed 16 wks of training: age 71 ± 8 yr, fat-free mass index 19 ± 3 kg/m2, forced expiratory volume in one second 58 ± 18 percent predicted. The UBR + SE intervention produced a 46% increase in strength compared to a 36% increase in the UBR + HE group (P = 0.054). The combined UBR + SE and UBR + HE groups produced a 41% increase in strength compared to an 11% increase in the CE+HE (P < 0.001). The combined UBR groups also demonstrated increases in lean arm mass (P = 0.003) and a trend toward decreased dyspnea (P = 0.053). There were no group differences in attrition, attendance and training progression. Fifty subjects completed long-term maintenance and the UBR + SE and UBR + HE groups retained some gains in muscle strength, 24% and 21% respectively, and the CE + HE group lost 3% of muscle strength from baseline. CONCLUSION The study provides strong evidence that comprehensive resistance training increased strength and lean arm mass and that strength can be partially maintained through a simple home program using hand weights. It provides limited evidence that upper-body resistance training improved dyspnea and that the exercise-specific self-efficacy enhancing intervention was beneficial.
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Affiliation(s)
- Margaret K. Covey
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, USA
| | - Mary C. Kapella
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, USA
| | - Eileen G. Collins
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, USA
- Department of Research and Development, Edward Hines Jr Veterans Administration Hospital, Chicago, USA
| | - Charles G. Alex
- Department of Research and Development, Edward Hines Jr Veterans Administration Hospital, Chicago, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stritch School of Medicine, Loyola University, Chicago, USA
| | - Michael L. Berbaum
- Institute for Health Research and Policy, University of Illinois at Chicago, USA
| | - Janet L. Larson
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, USA
- Acute, Critical and Long-Term Care Programs, School of Nursing, University of Michigan, USA
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Miranda EF, Malaguti C, Corso SD. Peripheral muscle dysfunction in COPD: lower limbs versus upper limbs. J Bras Pneumol 2012; 37:380-8. [PMID: 21755195 DOI: 10.1590/s1806-37132011000300016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 03/10/2011] [Indexed: 11/22/2022] Open
Abstract
In patients with COPD, the degree of functional impairment appears to differ between the upper and lower limbs. Significant dyspnea and fatigue have been reported by these patients when performing tasks with unsupported upper limbs and two mechanisms have been proposed to explain this fact: neuromechanical dysfunction of respiratory muscles; and changes in lung volume during such activities. The neuromechanical dysfunction seen in COPD patients during this type of exercise is related to changes in the breathing pattern, as well as to the simultaneity of afferent and efferent muscle stimuli, resulting in respiratory muscle asynchrony. In addition, the increased ventilation during upper limb exercise in patients with COPD leads to dynamic hyperinflation at different workloads. During lower limb exercises, the strength and endurance of the quadriceps muscle is lower in COPD patients than in healthy subjects. This could by explained by abnormal muscle metabolism (decreased aerobic capacity), dependence on glycolytic metabolism, and rapid accumulation of lactate during exercise. In comparison with lower limb exercises, upper limb exercises result in higher metabolic and ventilatory demands, as well as in a more intense sensation of dyspnea and greater fatigue. Because there are differences between the upper and lower limb muscles in terms of the morphological and functional adaptations in COPD patients, specific protocols for strength training and endurance should be developed and tested for the corresponding muscle groups.
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Bailey PH. Commentary on Barnett M (2005) Chronic obstructive pulmonary disease: a phenomenological study of patients’ experiences. Journal of Clinical Nursing. J Clin Nurs 2008; 17:838-9. [DOI: 10.1111/j.1365-2702.2006.01685.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhan S, Cerny FJ, Gibbons WJ, Mador MJ, Wu YW. Development of an Unsupported Arm Exercise Test in Patients With Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2006; 26:180-7; discussion 188-90. [PMID: 16738459 DOI: 10.1097/00008483-200605000-00013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Unsupported arm exercise tests have been used to evaluate the effects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), but the reliability and validity of these tests are not established. OBJECTIVE We evaluated the test-retest reliability and validity of a 6-minute pegboard and ring test (PBRT) in 27 outpatients with COPD and 30 age-matched controls. METHODS We evaluated a 6-minute PBRT, subject demographics, pulmonary function and disease-specific quality of life questionnaire, and the Pulmonary Functional Status Dyspnea Questionnaire-Modified version in 27 patients with COPD. RESULTS Highly significant correlation coefficients (r = .91, P < .001) were found between test and retest of PBRT scores. Statistically significant correlation coefficients were found between PBRT scores and pulmonary function tests such as FEV1% pred and FVC% pred, and activity domain and subdomain of Pulmonary Functional Status Dyspnea Questionnaire-Modified (P <or= .045). In addition, PBRT scores of healthy subjects were significantly higher than those of COPD subjects (P < .001), and were inversely related to age (P = .031). The FEV1% predicted and gender together accounted for 50% of the variance in the PBRT scores of patients with COPD. CONCLUSION PBRT is a reliable and valid method to assess unsupported arm exercise endurance in patients with COPD.
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Pinet C. Prise en charge thérapeutique des BPCO. Rev Mal Respir 2005. [DOI: 10.1016/s0761-8425(05)85654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wilcock A, Walker G, Manderson C, Carr D, Broadhurst D, Crosby V, Pavis H, Edgecombe J, Tattersfield AE. Use of upper limb exercise to assess breathlessness in patients with cancer: tolerability, repeatability, and sensitivity. J Pain Symptom Manage 2005; 29:559-64. [PMID: 15963864 DOI: 10.1016/j.jpainsymman.2004.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2004] [Indexed: 11/29/2022]
Abstract
We report the development of an arm exercise test to assess breathlessness in patients with lung cancer who are breathless at low levels of exertion. Exercise consisted of raising the arm over 40 cm, either the dominant arm only (n=10) or both arms alternating at minute intervals (n=12). Subjects breathed through a mouthpiece, and ventilation (VE) and oxygen uptake (VO(2)) were measured. Following familiarization, three tests were performed over one week to explore repeatability, and sensitivity was assessed in a fourth test. Arm exercise was generally well tolerated and increased breathlessness, VE, and VO(2). The commonest factor limiting exercise was arm fatigue, although four patients in the two-arm test also reported breathlessness. Repeatability for breathlessness score and VE was best in the two-arm test. The added resistance used to assess sensitivity could not be detected. The two-arm test offers a potential means of assessing the effects of an intervention on breathlessness and E in patients for whom a cycle or treadmill exercise test is unsuitable.
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Affiliation(s)
- Andrew Wilcock
- Department of Palliative Medicine, Hayward House Macmillan Specialist Palliative Care Cancer Unit, University of Nottingham, Nottingham City Hospital NHS Trust, Nottingham NG5 1PB, UK
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Bauldoff GS, Rittinger M, Nelson T, Doehrel J, Diaz PT. Feasibility of Distractive Auditory Stimuli on Upper Extremity Training in Persons With Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2005; 25:50-5. [PMID: 15714113 DOI: 10.1097/00008483-200501000-00011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the feasibility of distractive auditory stimuli (DAS) used during an upper extremity training (UET) program on perceived dyspnea, functional performance, and health-related quality of life. In addition, to determine the appropriate music tempo used during the UET. DESIGN Experimental, randomized, 3-group design with testing at baseline and 4 weeks. SETTING Outpatient. PATIENTS Thirty patients (13 male and 17 female) with moderate to severe chronic obstructive pulmonary disease (FEV1 41.27% +/- 18% predicted). INTERVENTION Moderate DAS group (n = 10) and slow DAS group (n = 10) subjects were instructed to perform UET for up to 15 minutes 3 to 5 times a week using DAS (walkman, audiocassettes). The control group (n = 10) received the same instructions, but no DAS. MEASURES AND RESULTS Primary outcome measures were perceived dyspnea, functional performance using the 6-minute peg and ring board (6MRPB) count and health-related quality of life. In addition, all subjects recorded the time of UET performance using self-report (daily logs). A significant increase was seen in 6MRPB count (P = .002) between groups. Moderate DAS subjects increased 6MPRB count 46 +/- 21 rings and slow DAS subjects increased 46 +/- 20 rings from baseline to 4 weeks whereas control subjects increased only 5 +/- 4 rings. No significant differences were noted for the remaining variables. CONCLUSION Subjects who used DAS (music) while performing UET improved functional performance whereas controls failed to continue improvement. The DAS is a feasible adjunct to UET that may have the potential to augment the effectiveness of pulmonary rehabilitation training.
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Bailey PH, Colella T, Mossey S. COPD-intuition or template: nurses' stories of acute exacerbations of chronic obstructive pulmonary disease. J Clin Nurs 2004; 13:756-64. [PMID: 15317516 DOI: 10.1111/j.1365-2702.2004.00927.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED STUDY RATIONAL: A number of nurse-researchers have examined the experience of dyspnoea reduction during non-acute phases of the chronic obstructive pulmonary disease (COPD). However, nurses working on in-patient hospital units are frequently required to care for individuals suffering from acute exacerbations of their disease (AECOPD). These critically ill individuals present at health care institutions incapacitated by severe shortness of breath/dyspnoea that is frequently refractory to treatment. To date, little is known about the nurses' understanding of the care they provide for individuals hospitalized because of these acute episodes of their chronic illness. STUDY OBJECTIVES The research project was undertaken, in part, to develop an understanding of nurses' experience of caregiving for individuals hospitalized for in-patient care during an AECOPD. METHODOLOGICAL DESIGN This focused ethnographic narrative examined the caregiving stories of 10 nurse caregivers. The 10 nurse caregivers were interviewed while caring for a patient and their family during an experience of an AECOPD characterized by incapacitating breathlessness. RESULTS The nurse caregivers told a number of caregiving stories that illustrated a common care template that appears to be based on intuition or pattern recognition focusing on anxiety sometimes to the exclusion of dyspnoea. CONCLUSIONS Analysis of these stories emphasized the need to facilitate nurses individualization of standard templates. More importantly, this analysis illustrated the critical need to develop strategies to facilitate the reshaping of inaccurate templates in the presence of new knowledge.
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McKeough ZJ, Alison JA, Bye PTP. Arm exercise capacity and dyspnea ratings in subjects with chronic obstructive pulmonary disease. JOURNAL OF CARDIOPULMONARY REHABILITATION 2003; 23:218-25. [PMID: 12782907 DOI: 10.1097/00008483-200305000-00010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to compare the metabolic, ventilatory, and dyspnea responses to unsupported arm exercise, supported arm exercise and leg exercise between subjects with chronic obstructive pulmonary disease (COPD) and healthy age-matched controls. METHODS For this study, 21 subjects with COPD (mean age, 62 +/- 2 years; predicted forced expiratory volume in 1 second [FEV(1)], 37 +/- 3%) and 7 healthy age-matched control subjects (% pred FEV(1) = 109 +/- 5%) were included in the analyses of three incremental exercise tests to peak work capacity: unsupported arm exercise, supported arm exercise (arm ergometry), and leg exercise (cycle ergometry). Work level, oxygen consumption (VO(2)), minute ventilation (V(E)), dyspnea, and rate of perceived exertion were measured each minute. RESULTS Peak work level and peak VO(2) were significantly reduced in the subjects with COPD for all exercise tests (P <.01 for all), as compared with the control subjects. Within the COPD group, the VO(2) and V(E) at peak exercise were significantly lower for unsupported arm exercise than for both the leg and supported arm exercises (both P <.001). The ratio of V(E) to maximal voluntary ventilation was high for leg exercise (96%), supported arm exercise (91%), and unsupported arm exercise (77%) among the subjects with COPD. At a given percentage of VO(2) peak, dyspnea scores were similar for all the exercise tests. CONCLUSIONS Ventilatory constraints limit exercise performance in COPD. The lowest amount of work, in terms of VO(2,), was during unsupported arm exercise. Because the subjects with COPD had scores showing similar levels of dyspnea at the same percentage of VO(2) peak, it is suggested that patients be encouraged to reach equivalent dyspnea levels when performing unsupported and supported arm exercise training and leg training.
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Affiliation(s)
- Zoe J McKeough
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
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Lareau SC, Meek PM, Press D, Anholm JD, Roos PJ. Dyspnea in patients with chronic obstructive pulmonary disease: does dyspnea worsen longitudinally in the presence of declining lung function? Heart Lung 1999; 28:65-73. [PMID: 9915932 DOI: 10.1016/s0147-9563(99)70044-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the direction and rate of change in the symptom of dyspnea in patients with chronic obstructive pulmonary disease (COPD) whose lung function has worsened over time. DESIGN Secondary analysis of a longitudinal data set. SETTING Outpatient clinic. PATIENTS Thirty-four medically stable male subjects with chronic obstructive pulmonary disease studied for 5.3 +/- 3.5 years, with a mean reduction in FEV1 over the period studied of 330.9 +/- 288.0 mL. Subjects were 63.3 +/- 5.5 years of age at entry into the study. OUTCOME MEASURES Dyspnea and functional status scores were obtained using the Pulmonary Functional Status and Dyspnea Questionnaire. RESULTS There was no significant difference in reports of dyspnea from the beginning to the end of the study, despite significant reductions in lung function. Of all activities studied, dyspnea when raising arms overhead was the only activity showing a relationship to the slope of change in FEV1 %. CONCLUSION These findings suggest that, although patients with chronic lung disease experience varying degrees of deterioration in lung function longitudinally, there is no evidence that they report worsening of dyspnea in tandem with these physiologic changes. In this study, patient ratings of dyspnea longitudinally were not directly linked to changes in lung impairment.
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Affiliation(s)
- S C Lareau
- Pulmonary Section and the Department of Diagnostic Services, Jerry L. Pettis Veterans Administration Medical Center, Loma Linda, California 92357, USA
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Bauldoff GS, Hoffman LA, Sciurba F, Zullo TG. Home-based, upper-arm exercise training for patients with chronic obstructive pulmonary disease. Heart Lung 1996; 25:288-94. [PMID: 8836744 DOI: 10.1016/s0147-9563(96)80064-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Prior studies demonstrate the ability of upper extremity training to increase arm strength and endurance when incorporated into a pulmonary rehabilitation program. However, patients with severe chronic obstructive pulmonary disease (COPD) may have transportation or mobility problems that make it difficult to travel to a rehabilitation site to obtain this training. This pilot study was designed to determine whether a home-based, upper-arm exercise program could increase arm strength and endurance, and decrease perceptions of breathlessness and fatigue during five activities of daily living. Twenty patients with severe COPD (FEV1 0.80 +/- 0.42) were randomized to an experimental (n = 10) or control group (n = 10). The experimental-group training included three upper arm exercises five times a week for 8 weeks, with training level incremented during weekly home visits. Control-group subjects were contacted weekly to equalize attention from health care providers. During the upper-extremity endurance test for number of rings moved, no significant differences between groups were seen for interaction or treatment. However, there was a significant interaction between treatment and time for perceived fatigue (p = 0.0012), with the experimental group perceiving less fatigue during upper arm work than did the control group. No change was seen in perceived breathlessness. Findings of this study suggest that a home-based, upper-arm exercise program can reduce perceptions of fatigue for patients with severe COPD during activities involving upper arm work. Testing in a larger sample is indicated to determine whether this training can also improve ability to perform unsupported arm work.
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Affiliation(s)
- G S Bauldoff
- Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, PA 15213, USA
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Breslin EH, Garoutte BC. Respiratory responses to unsupported arm lifts paced during expiration. West J Nurs Res 1995; 17:91-100; discussion 101-11. [PMID: 7863651 DOI: 10.1177/019394599501700108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Unsupported arm exercise endurance is reduced in both normal subjects and patients with chronic obstructive pulmonary disease in association with an increase in dyspnea and alterations in the pattern of respiratory muscle recruitment. Some report greater difficulty carrying out arm activity paced during the expiratory phase of respiration rather than during inspiration. The purpose of this study was to determine the effect of unsupported arm exercise lifts paced in phase with expiration (EUAL) on (a) diaphragm recruitment measured as the electromyographic amplitude (EMG-DI), (b) the pattern of thoracoabdominal motion measured with inductive plethysmography, and (c) the sensation of dyspnea measured with a 100 mm visual analog scale. Data were collected from 18 normal adult subjects at baseline and during EUAL. When compared with rest, EUAL resulted in significant increases in mean inspiratory and expiratory diaphragm EMG amplitudes, dyssynchronous thoracoabdominal motion, and dyspnea intensity. These changes in diaphragm recruitment and thoracoabdominal motion may in part explain reports of increased dyspnea intensity with unsupported arm exercise.
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Affiliation(s)
- E H Breslin
- Center for Nursing Research, School of Medicine, University of California, Davis Medical Center
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Breslin EH, Adams E, Lutz A, Roy C. Instrument development in the measurement of unsupported arm exercise endurance in normal adult subjects. Arch Phys Med Rehabil 1993; 74:649-52. [PMID: 8503757 DOI: 10.1016/0003-9993(93)90165-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Many daily activities, from basic grooming to employment tasks, require adequate unsupported arm endurance (UAE). We developed an electromechanical device to measure UAE endurance. The purpose of this study was to standardize the instrument for two rates of arm motion, moderate and slow, in 18 normal adult subjects (FEVI = 3.7L +/- .78, FVC = 4.2L +/- .74, FEV1/FVC = 1.1 +/- .08). Exercise endurance limits, and the following metabolic, ventilatory, and sensation responses were determined at rest prior to exercise and at end-exercise limits for both rates of UAE:minute ventilation (Ve), tidal volume (VT), respiratory rate (RR), duty cycle (Ti/Ttot), oxygen uptake (VO2), carbon dioxide production (VCO2), inspiratory flow (VT/Ti), heart rate (HR), and visual analog scale measurements (VAS) of dyspnea (D), respiratory effort (RE), and arm fatigue (AF). Significance increases from baseline rest were shown at the endurance limits for both rates of UAE in: VO2, VCO2, Ve, VT, RR, VT/Ti, HR, VAS-D, VAS-RE, and VAS-AF. There were no changes in Ti/Ttot and SaO2 with UAE. Peak VO2, RR, Ve, VT/Ti, and VAS-D with moderate exercise were significantly greater than slow UAE; and there was a trend increase in peak HR for moderate as opposed to slow rate UAE. Despite these differences, the endurance time between the two rates of UAE were similar. These data provide standards against which UAE in COPD can be evaluated.
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Affiliation(s)
- E H Breslin
- University of California Davis, Medical Center, Center for Nursing Research
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