1
|
Vaes AW, Burtin C, Casaburi R, Celli BR, Evans RA, Lareau SC, Nici L, Rochester CL, Troosters T. Prevalence and prognostic importance of exercise limitation and physical inactivity in COPD. Breathe (Sheff) 2024; 20:230179. [PMID: 38873237 PMCID: PMC11167648 DOI: 10.1183/20734735.0179-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/08/2024] [Indexed: 06/15/2024] Open
Abstract
Exercise limitation and physical inactivity are separate, but related constructs. Both are commonly present in individuals with COPD, contribute to disease burden over and above the respiratory impairments, and are independently predictive of adverse outcomes. Because of this, clinicians should consider assessing these variables in their patients with COPD. Field tests of exercise performance such as the 6-min walk test and the incremental and endurance shuttle walk tests require limited additional resources, and results correlate with negative outcomes. Laboratory measures of exercise performance using a treadmill or cycle ergometer assess exercise capacity, provide prognostic information and have the advantage of explaining physiological mechanisms (and their interactions) underpinning exercise limitation. Limitations in exercise capacity (i.e. "cannot do") and physical inactivity (i.e. "do not do") are both associated with mortality; exercise limitation appears to be the more important driver of this outcome.
Collapse
Affiliation(s)
- Anouk W. Vaes
- Department of Research and Development, Ciro, Horn, The Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Bartolome R. Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachael A. Evans
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Suzanne C. Lareau
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Linda Nici
- Providence Veterans Affairs Medical Center, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Carolyn L. Rochester
- Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | | |
Collapse
|
2
|
Jakobsson J, Stoffels AAF, van Hees HWH, De Brandt J, Nyberg A, Klijn P. Quality of aerobic training description and its relation to intervention efficacy in chronic obstructive pulmonary disease trials: study protocol for a systematic review, meta-analysis and meta-regression. BMJ Open 2024; 14:e084296. [PMID: 38803267 PMCID: PMC11129019 DOI: 10.1136/bmjopen-2024-084296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a major global health concern, characterised by ventilatory constraints, decreased cardiovascular fitness and reduced limb muscle function, profoundly affecting patients' quality of life. Aerobic training plays a crucial role in the treatment of COPD, but the variability in methodologies and incomplete reporting of key components in aerobic training trials limits the assessment of their effectiveness. This systematic review aims to critically evaluate the application of training principles and reporting of key components in aerobic training trials in randomised controlled trials (RCTs) in the COPD literature. METHODS AND ANALYSIS The protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol guidelines. The review will include RCTs utilising aerobic training in individuals with COPD. A comprehensive search, following a predefined search strategy will identify studies published from 2007 to 2024 in English from MEDLINE, Embase, CINAHL, CENTRAL and PEDro. Studies including people with COPD and any aerobic training intervention will be included. Two reviewers will independently screen abstracts and titles for inclusion. Two reviewers will independently conduct the screening of full-text documents and data extraction. Study quality will be assessed using the Tool for the assESsment of sTudy quality and bias in Exercise, specifically developed for exercise training studies. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. A systematic synthesis will be provided, with meta-analyses and meta-regression when appropriate. ETHICS AND DISSEMINATION As this review will involve the analysis of published data, ethical approval is not required. The findings of this review will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021247343.
Collapse
Affiliation(s)
- Johan Jakobsson
- Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden
| | - Anouk A F Stoffels
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Hieronymus W H van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Jana De Brandt
- Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden
| | - André Nyberg
- Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden
| | - Peter Klijn
- Merem Pulmonary Rehabilitation Center, Hilversum, Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| |
Collapse
|
3
|
Kim T, Kim H, Kong S, Shin SH, Cho J, Kang D, Park HY. Association Between Regular Moderate to Vigorous Physical Activity Initiation Following COPD Diagnosis and Mortality: An Emulated Target Trial Using Nationwide Cohort Data. Chest 2024; 165:84-94. [PMID: 37494977 DOI: 10.1016/j.chest.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Moderate to vigorous physical activity (MVPA) in patients with COPD affects their overall health outcomes, including symptom relief and improved quality of life. However, the magnitude of the effect of MVPA initiation on real-world clinical outcomes has not been well investigated. RESEARCH QUESTION How does MVPA initiation affect mortality and severe exacerbation in patients who have not engaged in MVPA prior to COPD diagnosis? STUDY DESIGN AND METHODS This study included patients with COPD aged ≥ 40 years who were not performing MVPA prior to COPD diagnosis and who had at least one health screening visit prior to and following their COPD diagnosis between January 1, 2010, and December 31, 2018. The main exposure was MVPA, defined as vigorous aerobic exercise > 20 min per day on ≥ 3 days per week or moderate aerobic exercise > 30 min per day on ≥ 5 days per week. The primary end point was all-cause mortality, and the secondary end point was initial severe exacerbation as the time to event following COPD diagnosis. RESULTS In total, 110,097 person-trials were included (27,564 MVPA increases and 82,533 control groups). No differences were observed between the covariates following matching. The adjusted hazards ratio of all-cause mortality for the MVPA group compared with the control group was 0.84 (95% CI, 0.79-0.89). In the subgroup analysis, patients aged > 65 years, female patients, those who had never smoked, and patients with a higher Charlson Comorbidity Index score displayed a stronger effect of MVPA on reducing mortality than younger male patients, those who had ever smoked, and patients with a lower Charlson Comorbidity Index score (Pinteraction < .05). The fully adjusted hazards ratio for the risk of severe exacerbation (MVPA group vs control) was 0.90 (95% CI, 0.87-0.94). INTERPRETATION Initiation of MVPA can potentially reduce mortality and severe exacerbations in patients with COPD, although personalized interventions and further clinical trials are necessary.
Collapse
Affiliation(s)
- Taeyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Hyunsoo Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Sunga Kong
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, 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
| | - 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
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| |
Collapse
|
4
|
Miki K, Tsujino K, Fukui M, Miki M, Kitajima T, Sumitani H, Hashimoto K, Yokoyama M, Hashimoto H, Nii T, Matsuki T, Kida H. Laryngeal widening and adequate ventilation by expiratory pressure load training improve aerobic capacity in COPD: a randomised controlled trial. Thorax 2023; 79:23-34. [PMID: 37696622 PMCID: PMC10803957 DOI: 10.1136/thorax-2022-219755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/26/2023] [Indexed: 09/13/2023]
Abstract
RATIONALE Despite strategies acting on peripheral airway obstruction in chronic obstructive pulmonary disease (COPD), exercise intolerance remains inadequately improved. We hypothesised that laryngeal narrowing is a potential treatment target of expiratory pressure load training (EPT) to improve exercise intolerance in COPD. METHODS The effect of 3-month EPT was assessed in 47 patients with COPD divided into Global Initiative for Chronic Obstructive Lung Disease (GOLD) mild-to-moderate (I-II) and severe-to-very severe (III-IV), randomly allocating 1:1 to EPT or control groups. The primary outcome was endurance time in the constant work rate exercise test in GOLD III-IV patients. RESULTS Compared with controls, EPT increased: (1) endurance time, with estimated treatment effect: +703 (95% CI: 379 to 1031) s, p=0.0008 (GOLD I-II); +390 (95% CI: 205 to 574) s, p=0.0006 (GOLD III-IV); (2) peak oxygen uptake (p=0.0086 in GOLD I-II; p=0.0004 in GOLD III-IV); (3) glottic dilatation ratio at maximum collapse on laryngoscopy in the submaximal exercise (p=0.0062 in GOLD I-II; p=0.0001 in GOLD III-IV); and (4) the inflection point of expiratory tidal volume relative to minute ventilation during the incremental exercise (p=0.0015 in GOLD I-II; p=0.0075 in GOLD III-IV). Across GOLD grades, the responses of glottic dilatation ratio at maximum collapse and the expiratory tidal volume at the inflection point were selected as more influential variables correlating with the improvement in peak oxygen uptake and endurance time, respectively. CONCLUSION These results show that EPT improved aerobic capacity and endurance time with larger laryngeal widening and adequate ventilation despite advanced COPD. TRIAL REGISTRATION NUMBER UMIN000041250.
Collapse
Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Motonari Fukui
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Mari Miki
- Department of Internal Medicine, LIAA Tokushima Prefecture Naruto Hospital, Naruto, Japan
| | - Takamasa Kitajima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Hitoshi Sumitani
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Kazuki Hashimoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Masashi Yokoyama
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hisako Hashimoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Takuro Nii
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| |
Collapse
|
5
|
Bakali M, Ward TC, Daynes E, Jones AV, Hawthorne GM, Latimer L, Divall P, Graham-Brown M, McCann GP, Yates T, Steiner MC, Evans RA. Effect of aerobic exercise training on pulse wave velocity in adults with and without long-term conditions: a systematic review and meta-analysis. Open Heart 2023; 10:e002384. [PMID: 38101857 PMCID: PMC10729135 DOI: 10.1136/openhrt-2023-002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/11/2023] [Indexed: 12/17/2023] Open
Abstract
RATIONALE There is conflicting evidence whether aerobic exercise training (AET) reduces pulse wave velocity (PWV) in adults with and without long-term conditions (LTCs). OBJECTIVE To explore whether PWV improves with AET in adults with and without LTC, to quantify the magnitude of any effect and understand the influence of the exercise prescription. DATA SOURCES CENTRAL, MEDLINE and EMBASE were among the databases searched. ELIGIBILITY CRITERIA We included studies with a PWV measurement before and after supervised AET of at least 3 weeks duration. Exclusion criteria included resistance exercise and alternative measures of arterial stiffness. DESIGN Controlled trials were included in a random effects meta-analysis to explore the effect of AET on PWV. Uncontrolled studies were included in a secondary meta-analysis and meta-regression exploring the effect of patient and programme factors on change in PWV. The relevant risk of bias tool was used for each study design. RESULTS 79 studies (n=3729) were included: 35 controlled studies (21 randomised control trials (RCT) (n=1240) and 12 non-RCT (n=463)) and 44 uncontrolled (n=2026). In the controlled meta- analysis, PWV was significantly reduced following AET (mean (SD) 11 (7) weeks) in adults with and without LTC (mean difference -0.63; 95% CI -0.82 to -0.44; p<0.0001). PWV was similarly reduced between adults with and without LTC (p<0.001). Age, but not specific programme factors, was inversely associated with a reduction in PWV -0.010 (-0.020 to -0.010) m/s, p<0.001. DISCUSSION Short-term AET similarly reduces PWV in adults with and without LTC. Whether this effect is sustained and the clinical implications require further investigation.
Collapse
Affiliation(s)
- Majda Bakali
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Thomas Cj Ward
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Enya Daynes
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Amy V Jones
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Grace M Hawthorne
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Lorna Latimer
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Pip Divall
- Education Centre Library, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matt Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Michael C Steiner
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rachael Andrea Evans
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
6
|
Zeng Q, Liao W, Fang W, Liu S, Duan C, Dai Y, Wei C. Clinical effect of aerobic exercise training in chronic obstructive pulmonary disease: A retrospective study. Medicine (Baltimore) 2023; 102:e35573. [PMID: 37861566 PMCID: PMC10589605 DOI: 10.1097/md.0000000000035573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Aerobic exercise training is a kind of pulmonary rehabilitation for lung diseases. This was a retrospective study to assess the efficacy of aerobic exercise training in chronic obstructive pulmonary disease (COPD) at a stable stage. A total of one hundred and fifty-six stable COPD patients who had accepted self-education only or self-education combined with an aerobic exercise training between January 2017 to January 2019 were reviewed retrospectively. A total of 79 patients who had received self-education combined with an aerobic exercise training schedule comprised the aerobic exercise training group (AET group) and 77 patients who had received self-education only were regarded as the education group (EDU group). The acute incidence rate in AET group was 7.6% better than that in EDU group 20.7% (P < .05). The AET group patients expressed higher levels of 6 minutes walking distance (6MWD) (P < .05) and better evaluations of both lung function (P < .05) and T lymphocyte immune response (P < .05), as well as significantly decreased chronic obstructive pulmonary disease assessment test (CAT) scores and modified British medical research council (mMRC) grades (P < .05). Patients in EDU group did not report any changes in any of these characteristics. The aerobic exercise training intervention contributed to an increasing in 6MWD and decrease in CAT scores and mMRC grades, as well as improving the T lymphocyte immune response in stable COPD patients.
Collapse
Affiliation(s)
- Qigang Zeng
- Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Guangdong Province, China
| | - Wangwang Liao
- Guangzhou University of Chinese Medicine, Guangdong Province, China
- Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Guangdong Province, China
| | - Wentao Fang
- Guangzhou University of Chinese Medicine, Guangdong Province, China
- Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Guangdong Province, China
| | - Shuling Liu
- Guangzhou University of Chinese Medicine, Guangdong Province, China
- Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Guangdong Province, China
| | - Chenxia Duan
- Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Guangdong Province, China
| | - Yong Dai
- Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Guangdong Province, China
| | - Chenggong Wei
- Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Guangdong Province, China
| |
Collapse
|
7
|
Ward TJ, Plumptre CD, Fraser-Pye AV, Dolmage TE, Jones AV, Trethewey R, Latimer L, Singh SJ, Lindley MR, Steiner MC, Evans RA. Understanding the effectiveness of different exercise training programme designs on V̇O 2peak in COPD: a component network meta-analysis. Thorax 2023; 78:1035-1038. [PMID: 37263780 DOI: 10.1136/thorax-2023-220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pulmonary rehabilitation programmes including aerobic training improve cardiorespiratory fitness in patients with COPD, but the optimal programme design is unclear. We used random effects additive component network meta-analysis to investigate the relative effectiveness of different programme components on fitness measured by V̇O2peak in COPD. The included 59 studies involving 2191 participants demonstrated that V̇O2peak increased after aerobic training of at least moderate intensity with the greatest improvement seen following high intensity training. Lower limb aerobic training (SMD 0.56 95% CI 0.32;0.81, intervention arms=86) and the addition of non-invasive ventilation (SMD 0.55 95% CI 0.04;1.06, intervention arms=4) appeared to offer additional benefit but there was limited evidence for effectiveness of other exercise and non-exercise components.
Collapse
Affiliation(s)
- Thomas Jc Ward
- Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise & Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | | | | | | | - Amy V Jones
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
| | - Ruth Trethewey
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
| | - Lorna Latimer
- Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise & Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Sally J Singh
- Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise & Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Martin R Lindley
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Michael C Steiner
- Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise & Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Rachael A Evans
- Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise & Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
8
|
Buttery SC. Getting the best from pulmonary rehabilitation. Thorax 2023; 78:951-952. [PMID: 37380355 DOI: 10.1136/thorax-2023-220411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hopsitals, London, UK
| |
Collapse
|
9
|
Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
Collapse
Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
10
|
Liu P, Zhang M, Gao H, Han S, Liu J, Sun X, Zhao L. Regulation of whole-transcriptome sequencing expression in COPD after personalized precise exercise training: a pilot study. Respir Res 2023; 24:156. [PMID: 37312153 DOI: 10.1186/s12931-023-02461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the world's leading causes of death and a major chronic respiratory disease. Aerobic exercise, the cornerstone of pulmonary rehabilitation, improves prognosis of COPD patients; however, few studies have comprehensively examined the changes in RNA transcript levels and the crosstalk between various transcripts in this context. This study identified the expression of RNA transcripts in COPD patients who engaged in aerobic exercise training for 12 weeks, and further constructions of the possible RNAs networks were made. METHODS Peripheral blood samples for all four COPD patients who benefited from 12 weeks of PR were collected pre- and post-aerobic exercises and evaluated for the expression of mRNA, miRNA, lncRNA, and circRNA with high-throughput RNA sequencing followed by GEO date validation. In addition, enrichment analyses were conducted on different expressed mRNAs. LncRNA-mRNA and circRNA-mRNA coexpression networks, as well as lncRNA-miRNA-mRNA and circRNA-miRNA-mRNA competing expression networks (ceRNAs) in COPD were constructed. RESULTS We identified and analyzed the differentially expressed mRNAs and noncoding RNAs in the peripheral blood of COPD patients' post-exercise. Eighty-six mRNAs, 570 lncRNAs, 8 miRNAs, and 2087 circRNAs were differentially expressed. Direct function enrichment analysis and Gene Set Variation Analysis showed that differentially expressed RNAs(DE-RNAs) correlated with several critical biological processes such as chemotaxis, DNA replication, anti-infection humoral response, oxidative phosphorylation, and immunometabolism, which might affect the progression of COPD. Some DE-RNAs were validated by Geo databases and RT-PCR, and the results were highly correlated with RNA sequencing. We constructed ceRNA networks of DE-RNAs in COPD. CONCLUSIONS The systematic understanding of the impact of aerobic exercise on COPD was achieved using transcriptomic profiling. This research offers a number of potential candidates for clarifying the regulatory mechanisms that exercise has on COPD, which could ultimately help in understanding the pathophysiology of COPD.
Collapse
Affiliation(s)
- Panpan Liu
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, 219 MiaoPu Road, Shanghai, 200315, People's Republic of China
| | - Meilan Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, 219 MiaoPu Road, Shanghai, 200315, People's Republic of China
| | - Hongchang Gao
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, 219 MiaoPu Road, Shanghai, 200315, People's Republic of China
| | - Shaojun Han
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, 219 MiaoPu Road, Shanghai, 200315, People's Republic of China
| | - Jinming Liu
- Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital Affiliated to TongJi University, Shanghai, China
| | - Xingguo Sun
- Department of Physiology and Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences National Center of Cardiovascular Diseases, Beijing, People's Republic of China.
| | - Lei Zhao
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, 219 MiaoPu Road, Shanghai, 200315, People's Republic of China.
| |
Collapse
|
11
|
Moecke DP, Zhu K, Gill J, Brar S, Petlitsyna P, Kirkham A, Girt M, Chen J, Peters H, Denson-Camp H, Crosbie S, Camp PG. A systematic review of exercise studies for individuals hospitalized with an acute exacerbation of chronic obstructive pulmonary disease: Focus on the principles of exercise training. Chron Respir Dis 2023; 20:14799731231215363. [PMID: 37967847 PMCID: PMC10655651 DOI: 10.1177/14799731231215363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND For exercise interventions to be effectively reproduced or applied in a "real world" clinical setting, clinical trials must thoroughly document all components of the exercise prescription and ensure that participants adhere to each component. However, previous reviews have not critically examined the quality of exercise prescription of inpatient Pulmonary Rehabilitation (PR) programs. OBJECTIVE The objectives of this review were to evaluate the (a) application of the principles of exercise training, (b) reporting of the frequency, intensity, time and type (FITT) components of exercise prescription, and (c) reporting of patient's adherence to the FITT components in intervention studies for patients admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS Relevant scientific databases were searched for randomized controlled trials (RCTs) that compared in-hospital PR with usual care for people hospitalized with AECOPD. Title and abstract followed by full-text screening were conducted independently by two reviewers. Data were extracted and synthesized to evaluate the application of the principles of exercise training and the reporting/adherence of the FITT components. RESULTS Twenty-seven RCTs were included. Only two applied all principles of exercise training. Specificity was applied by 70%, progression by 48%, overload by 37%, initial values by 89% and diminishing returns and reversibility by 37% of trials. Ten trials adequately reported all FITT components. Frequency and type were the components most reported (85% and 81%, respectively), while intensity was less frequently reported (52%). Only three trials reported on the patient's adherence to all four components. CONCLUSIONS Studies have not adequately reported the exercise prescription in accordance with the principles of exercise training nor reported all the FITT components of the exercise prescription and patient's adherence to them. Therefore, interpretation of the current literature is limited and information for developing exercise prescriptions to individuals hospitalized with an AECOPD is lacking.
Collapse
Affiliation(s)
- Débora Petry Moecke
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kai Zhu
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jagdeep Gill
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shanjot Brar
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Mirha Girt
- University of Queensland, Brisbane, QLD, Australia
| | - Joel Chen
- University of Calgary, Calgary, AB, Canada
| | - Hannah Peters
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Pat G Camp
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
12
|
Alexiou C, Chambers F, Megaritis D, Wakenshaw L, Echevarria C, Vogiatzis I. Greater exercise tolerance in COPD during acute intermittent compared to continuous shuttle walking protocols: A proof-of-concept study. Chron Respir Dis 2022; 19:14799731221142023. [PMID: 36548147 PMCID: PMC9793067 DOI: 10.1177/14799731221142023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: Ground-based walking is a simple training modality which would suit pulmonary rehabilitation (PR) settings with limited access to specialist equipment. Patients with COPD are, however, unable to walk uninterruptedly at a relatively fast walking pace to optimise training benefits. We compared an intermittent (IntSW) to a continuous (CSW) shuttle walking protocol.Methods: In 14 COPD patients (mean ± SD. FEV1: 45 ± 21% predicted) we measured walking distance, cardiac output (CO), arterial oxygen saturation (SpO2), and symptoms during (a) an IntSW protocol, consisting of 1-min walking alternating with 1-min rest, and (b) a CSW protocol, both sustained at 85% of predicted VO2 peak to the limit of tolerance (Tlim).Results: Median (IQR) distance was greater (p = 0.001) during the IntSW protocol (735 (375-1107) m) than the CSW protocol (190 (117-360) m). At iso-distance (distance at Tlim during CSW) the IntSW compared to the CSW protocol was associated with lower CO (8.6 ± 2.6 vs 10.3 ± 3.7 L/min; p = 0.013), greater SpO2 (92 ± 6% versus 90 ± 7%; p = 0.002), and lower symptoms of dyspnoea (2.8 ± 1.3 vs 4.9 ± 1.4; p = 0.001) and leg discomfort (2.3 ± 1.7 vs 4.2 ± 2.2; p = 0.001). At Tlim symptoms of dyspnoea and leg discomfort did not differ between the IntSW (4.4 ± 1.9 and 3.6 ± 2.1, respectively) and the CSW protocol.Conclusions: The IntSW protocol may provide important clinical benefits during exercise training in the PR settings because it allows greater work outputs compared to the CSW.
Collapse
Affiliation(s)
- Charikleia Alexiou
- Faculty of Health and Life
Sciences, Department of Sport, Exercise and Rehabilitation, Northumbria University
Newcastle, Newcastle upon Tyne, UK,Charikleia Alexiou, Faculty of Health and
Life Sciences, Northumbria University Newcastle, Department of Sport, Exercise
and Rehabilitation, Northumberland Building, Newcastle upon Tyne NE1 8ST, UK.
| | - Francesca Chambers
- Pulmonary Rehabilitation Services, Newcastle upon Tyne Hospitals NHS
Foundation Trust, Newcastle upon Tyne, UK
| | - Dimitrios Megaritis
- Faculty of Health and Life
Sciences, Department of Sport, Exercise and Rehabilitation, Northumbria University
Newcastle, Newcastle upon Tyne, UK
| | - Lynsey Wakenshaw
- Pulmonary Rehabilitation Services, Newcastle upon Tyne Hospitals NHS
Foundation Trust, Newcastle upon Tyne, UK
| | - Carlos Echevarria
- Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS
Foundation Trust, Newcastle upon Tyne, UK
| | - Ioannis Vogiatzis
- Faculty of Health and Life
Sciences, Department of Sport, Exercise and Rehabilitation, Northumbria University
Newcastle, Newcastle upon Tyne, UK
| |
Collapse
|
13
|
Financial Burden and Shortage of Respiratory Rehabilitation for SARS-CoV-2 Survivors: The Next Step of the Pandemic? JOURNAL OF RISK AND FINANCIAL MANAGEMENT 2022. [DOI: 10.3390/jrfm15010020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We read with great enthusiasm the recent article by Daynes et al [...]
Collapse
|
14
|
Vonbank K, Lehmann A, Bernitzky D, Gysan MR, Simon S, Krotka P, Zwick RH, Idzko M, Burtscher M. Comparison of heart rates at fixed percentages and the ventilatory thresholds in patients with interstitial lung disease. Scand J Med Sci Sports 2021; 32:754-764. [PMID: 34923682 PMCID: PMC9304263 DOI: 10.1111/sms.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
Heart rate (HR) responses to maximal exercise are commonly used for the prescription of training intensities in pulmonary rehabilitation. Those intensities are usually based on fixed percentages of peak HR (HRpeak), heart rate reserve (HRR), or peak work load (Wpeak), and rarely on HRs at the individual ventilatory thresholds (VT1 and VT2) derived from cardiopulmonary exercise testing (CPET). For patients suffering from interstitial lung disease (ILD), data on cardiorespiratory responses to CPET are scarce. Thus, the aim of this study was to record cardiorespiratory responses to CPET and to compare fixed HR percentages with HRs at VT1 and VT2 in ILD patients. A total of 120 subjects, 80 ILD patients and 40 healthy controls, underwent a symptom‐limited CPET. From the ILD patient, 32 suffered from idiopathic pulmonary fibrosis (IPF), 37 from connective tissue disease (CTD), and 11 from sarcoidosis. HRs at fixed percentages, that is, at 70%HRpeak, at 70%Wpeak, and at 60%HRR were significantly lower in the ILD patients compared with the control group (p‐values: 0.001, 0.044, and 0.011). Large percentages of HR values at 70%Wpeak and 60%HRR ranged between the HRs at VT1 and VT2 in ILD subgroups and controls as well. HRs at 70%HRpeak were lower than HRs at VT1 in 66% of the IPF patients, 54% of the CTD patients, and 55% of patients with sarcoidosis compared with 18% in the control group. Our findings demonstrate a considerable scattering of fixed HR percentages compared with HRs at the individual VTs derived from CPET in ILD patients. These findings may provide valuable information for the prescription of exercise intensity in pulmonary rehabilitation of ILD patients.
Collapse
Affiliation(s)
- Karin Vonbank
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Antje Lehmann
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Bernitzky
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Simon
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Pavla Krotka
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ralf-Harun Zwick
- ThermeWienMed, Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Marco Idzko
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Burtscher
- Department of Sports Sciences, Medical Section, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
15
|
Aakerøy L, Nørstebø EA, Thomas KM, Holte E, Hegbom K, Brønstad E, Steinshamn S. High-intensity interval training and pulmonary hemodynamics in COPD with hypoxemia. Eur Clin Respir J 2021; 8:1984642. [PMID: 34804414 PMCID: PMC8603835 DOI: 10.1080/20018525.2021.1984642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Exercise is recommended for all patients with COPD. Evidence for its benefit is considerably weaker in the more severe stages of the disease. The aim of this study was to investigate whether high-intensity interval training could improve exercise capacity, pulmonary hemodynamics and cardiac function in patients with severe COPD and hypoxemia. Methods Stable patients with COPD GOLD stage III or IV and hypoxemia were included. They underwent extensive cardiopulmonary testing including right heart catheterization, lung function tests, echocardiography and 6-minute walk test before and after completion of 10 weeks of high-intensity interval training performed with supplemental oxygen. Primary endpoint was change in pulmonary artery pressure measured by right heart catheterization. Results Ten patients with very severe airflow obstruction, mean FEV1 28.7% predicted and mean FEV1/VC 0.39 completed the exercise programme. Pulmonary artery pressure remained unchanged following the intervention (26,3 mmHg vs. 25,8 mmHg at baseline, p 0.673). Six-minute walk distance improved by a mean of44.8 m (p 0.010), which is also clinically significant. We found marginally improved left ventricular ejection fraction on echocardiography (54.6% vs 59.5%, p 0.046). Conclusion High-intensity interval training significantly improved exercise capacity while pulmonary hemodynamics remained unchanged. The improvement may therefore be due to mechanisms other than altered pulmonary artery pressure. The increase in ejection fraction is of uncertain clinical significance. The low number of patients precludes firm conclusions.
Collapse
Affiliation(s)
- Lars Aakerøy
- Department of Thoracic Medicine, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ester Alfer Nørstebø
- Department of Clinical Services, St. Olavs University Hospital, Trondheim, Norway
| | - Karen Marie Thomas
- Department of Clinical Services, St. Olavs University Hospital, Trondheim, Norway
| | - Espen Holte
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Knut Hegbom
- Department of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Eivind Brønstad
- Department of Thoracic Medicine, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigurd Steinshamn
- Department of Thoracic Medicine, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
16
|
Rebelo P, Brooks D, Marques A. Measuring intensity during free-living physical activities in people with chronic obstructive pulmonary disease: a systematic literature review. Ann Phys Rehabil Med 2021; 65:101607. [PMID: 34818590 DOI: 10.1016/j.rehab.2021.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD). OBJECTIVE This systematic review identified which outcomes, outcome measures and instruments have been used to assess single free-living PA-related intensity in people with COPD and compared the intensity level (light, moderate, vigorous) obtained by different outcome measures. METHODS PubMed, Scopus, Web of Science, Cochrane Library and EBSCO were searched for original studies of COPD and assessing single free-living PA-related intensity were included. Agreement was calculated as the number of agreements between 2 measures [same intensity level]/ number of comparisons using both measures*100. RESULTS We included 43 studies (1282 people with COPD, mean age 66 years, 65% men, 49% FEV1%pred) and identified 13 outcomes, 46 outcome measures and 22 instruments. The most-reported outcomes, outcome measures and instruments were dyspnoea with the Borg scale 0-10; cardiac function, via heart rate (HR) using HR monitors; and pulmonary gas exchange, namely oxygen consumption (VO2), using portable gas analysers, respectively. The most frequently assessed PAs were walking and lifting, changing or moving weights/objects. Agreement between the outcome measures ranged from 0 (%VO2peak vs metabolic equivalent of task [MET]; %HRpeak vs Fatigue Borg; MET vs walking speed) to 100% (%HRreserve vs dyspnoea Borg; fatigue and exertion Borg vs walking speed). %VO2peak/reserve elicited the highest intensity. Hence, Borg scores, %HRreserve and MET may underestimate PA-related intensity. CONCLUSIONS Various methodologies are used to assess single free-living PA-related intensity and yield different intensity levels for the same PA. Future studies, further exploring the agreement between the different outcome measures of PA-related intensity and discussing their advantages, disadvantages and applicability in real-world settings, are urgent. These would guide future worldwide recommendations on how to assess single free-living PA-related intensity in COPD, which is essential to optimise PA interventions and ensure patient safety.
Collapse
Affiliation(s)
- Patrícia Rebelo
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; West Park Healthcare Centre, Toronto, ON, Canada
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| |
Collapse
|
17
|
Rausch Osthoff AK, Beyer S, Gisi D, Rezek S, Schwank A, Meichtry A, Sievi NA, Hess T, Wirz M. Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT. BMC Pulm Med 2021; 21:317. [PMID: 34641819 PMCID: PMC8506471 DOI: 10.1186/s12890-021-01685-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA. Methods A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants’ steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed. Results Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time. Conclusions In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed. Trial registration: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).
Collapse
Affiliation(s)
- Anne-Kathrin Rausch Osthoff
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland.
| | - Swantje Beyer
- Pneumology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - David Gisi
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Spencer Rezek
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Ariane Schwank
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - André Meichtry
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Hess
- Pneumology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
| |
Collapse
|
18
|
Gravier FE, Smondack P, Prieur G, Medrinal C, Combret Y, Muir JF, Baste JM, Cuvelier A, Boujibar F, Bonnevie T. Effects of exercise training in people with non-small cell lung cancer before lung resection: a systematic review and meta-analysis. Thorax 2021; 77:486-496. [PMID: 34429375 DOI: 10.1136/thoraxjnl-2021-217242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Exercise training before lung resection for non-small cell lung cancer is believed to decrease postoperative complications (POC) by improving cardiorespiratory fitness. However, this intervention lacks a strong evidence base. AIM To assess the effectiveness of preoperative exercise training compared with usual care on POC and other secondary outcomes in patients with scheduled lung resection. METHODS A systematic search of randomised trials was conducted by two authors. Meta-analysis was performed, and the effect of exercise training was estimated by risk ratios (RR) and mean differences, with their CIs. Clinical usefulness was estimated according to minimal important difference values (MID). RESULTS Fourteen studies involving 791 participants were included. Compared with usual care, exercise training reduced overall POC (10 studies, 617 participants, RR 0.58, 95% CI 0.45 to 0.75) and clinically relevant POC (4 studies, 302 participants, Clavien-Dindo score ≥2 RR 0.42, 95% CI 0.25 to 0.69). The estimate of the effect of exercise training on mortality was very imprecise (6 studies, 456 participants, RR 0.66, 95% CI 0.20 to 2.22). The main risks of bias were a lack of participant blinding and selective reporting. Exercise training appeared to improve exercise capacity, pulmonary function and also quality of life and depression, although the clinical usefulness of the changes was unclear. The quality of the evidence was graded for each outcome. CONCLUSION Preoperative exercise training leads to a worthwhile reduction in postoperative complications. These estimates were both accurate and large enough to make recommendations for clinical practice.
Collapse
Affiliation(s)
- Francis-Edouard Gravier
- ADIR Association, University Hospital Centre Rouen, Rouen, France .,UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| | - Pauline Smondack
- ADIR Association, University Hospital Centre Rouen, Rouen, France
| | - Guillaume Prieur
- UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France.,Intensive Care Unit Department, Groupe Hospitalier du Havre, Le Havre, France
| | - Clement Medrinal
- Intensive Care Unit Department, Groupe Hospitalier du Havre, Le Havre, France.,IFMK Saint-Michel, Paris, France.,Equipe de Recherche Paramédicale sur le HAndicap Neuromoteur (ERPHAN), Université Paris-Saclay, Versailles, France
| | - Yann Combret
- Intensive Care Unit Department, Groupe Hospitalier du Havre, Le Havre, France
| | - Jean-François Muir
- ADIR Association, University Hospital Centre Rouen, Rouen, France.,UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| | - Jean-Marc Baste
- Thoracic Surgery Department, University Hospital Centre Rouen, Rouen, France.,INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| | - Antoine Cuvelier
- UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, University Hospital Centre Rouen, Rouen, France
| | - Fairuz Boujibar
- Thoracic Surgery Department, University Hospital Centre Rouen, Rouen, France.,INSERM U1096, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, University Hospital Centre Rouen, Rouen, France.,UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen University, Rouen, France
| |
Collapse
|
19
|
Buttery SC, Lewis A, Kemp SV, Banya W, Quint JK, Steiner MC, Hopkinson NS. Lung volume reduction eligibility in patients with COPD completing pulmonary rehabilitation: results from the UK National Asthma and COPD Audit Programme. BMJ Open 2020; 10:e040942. [PMID: 33247022 PMCID: PMC7703433 DOI: 10.1136/bmjopen-2020-040942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To establish what proportion of patients completing a UK pulmonary rehabilitation (PR) programme meet the 2018 National Institute for Health and Care Excellence (NICE) chronic obstructive pulmonary disease (COPD) guideline (NG115) criteria to have a respiratory review to establish whether referral to a lung volume reduction multidisciplinary team would be appropriate. This respiratory review would include evaluation of the presence of hyperinflation and the presence of emphysema on CT scan. The NICE criteria include measures of breathlessness and exercise capacity but these parameters are not completely defined. DESIGN Observational study. SETTING PR programmes across the UK in 2015 (210 centres) and 2017 (184 centres) entering data into the Royal College of Physicians' National Asthma and COPD Audit Programme. PARTICIPANTS 8295 (55.7%) of 14 889 patients in programmes using incremental shuttle walk test (ISWT) or 6-minute walk test (6MWT) as an outcome measure completed PR, and 4856 (32.6%) had complete data recorded (6MWT/ISWT, baseline spirometry, Medical Research Council (MRC) dyspnoea score). RESULTS Depending on the walking test safety threshold adopted for the ISWT (≥140 m or ≥ 80 m) and the MRC dyspnoea score threshold used (MRC score ≥3 or ≥4 at the end of PR), between 4.9% and 18.1% of PR completers met the NICE criteria for a lung volume reduction-focused respiratory review. CONCLUSIONS Lung volume reduction therapies are beneficial in appropriately selected patients with COPD, but few procedures are performed, and treatment pathways are unclear. These data help to inform the feasibility of the approach recommended by NICE and highlight the need for future systematic pathways to reduce inequalities in patients being considered for effective treatments.
Collapse
Affiliation(s)
- Sara C Buttery
- National Heart and Lung Insititute, Imperial College London, London, UK
| | - Adam Lewis
- Department of Clinical Sciences, Brunel University London, Uxbridge, UK
| | - Samuel V Kemp
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Winston Banya
- National Heart and Lung Insititute, Imperial College London, London, UK
| | - Jennifer K Quint
- National Heart and Lung Insititute, Imperial College London, London, UK
| | - Michael C Steiner
- Department of Respiratory Sciences, Leicester Respiratory Biomedical Research Centre, University of Leicester, Leicester, UK
| | | |
Collapse
|
20
|
Patel S, Palmer MD, Nolan CM, Barker RE, Walsh JA, Wynne SC, Jones SE, Shannon H, Hopkinson NS, Kon SSC, Gao W, Maddocks M, Man WDC. Supervised pulmonary rehabilitation using minimal or specialist exercise equipment in COPD: a propensity-matched analysis. Thorax 2020; 76:264-271. [PMID: 33132208 PMCID: PMC7892370 DOI: 10.1136/thoraxjnl-2020-215281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/12/2020] [Accepted: 09/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Many trials supporting the benefits of pulmonary rehabilitation (PR) have used specialist exercise equipment, such as treadmills and cycle ergometers. However, access to specialist equipment may not be feasible in some settings. There is growing interest in delivering PR programmes with minimal, low-cost equipment, but uncertainty remains regarding their efficacy compared with programmes using specialist equipment. METHODS Using propensity score matching, 318 consecutive patients with COPD undergoing supervised PR using minimal equipment (PR-min) were compared 1:1 with a control group of 318 patients with COPD who underwent supervised PR using specialist equipment (PR-gym). A non-inferiority analysis was performed for the primary outcome (incremental shuttle walk (ISW)) and secondary outcomes (Chronic Respiratory Disease Questionnaire (CRQ)-domain and total scores). RESULTS Similar improvements in ISW and CRQ-domains were observed in PR-min and PR-gym groups (mean difference ISW: 3 m (95% CI -16 to 9); CRQ-total: 0.9 (95% CI -2.7 to 4.5)). The 95% CI between group differences for ISW and CRQ-total did not cross the predefined non-inferiority margins. However, completion rates were lower in PR-min compared with PR-gym (64% vs 73%; p=0.014). CONCLUSIONS In patients with COPD, PR delivered using minimal equipment produces clinically significant benefits in exercise capacity and health-related quality of life that are non-inferior to rehabilitation delivered using specialist equipment. This study provides support for the provision of PR using minimal exercise equipment, particularly in areas where access to specialist exercise equipment is limited.
Collapse
Affiliation(s)
- Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Melanie D Palmer
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Claire Marie Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ruth Emily Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jessica Anne Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stephanie C Wynne
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sarah Elizabeth Jones
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Harriet Shannon
- Faculty of Population Health Sciences, University College London, London, UK
| | | | - Samantha Swee Chin Kon
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - William D-C Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
21
|
Exercise Training in COPD: FITT for Purpose? Chest 2020; 158:9-10. [PMID: 32654732 DOI: 10.1016/j.chest.2020.02.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/27/2020] [Indexed: 11/22/2022] Open
|
22
|
Schneider LP, Machado FVC, Rodrigues A, Hirata RP, Pola DCD, Bertoche MP, Belo LF, Andrello ACDR, Fonseca J, Mantoani LC, Furlanetto KC, Pitta F. Total volume/week of physical activity: an underused variable of physical activity in daily life in patients with copd and its association with exercise capacity. Pulmonology 2020; 27:73-75. [PMID: 32546440 DOI: 10.1016/j.pulmoe.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lorena P Schneider
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil
| | - Felipe V C Machado
- Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Antenor Rodrigues
- Rehabilitation Aimed at Muscle Performance Laboratory - RAMP, Department of Physiotherapy, University of Toronto, Toronto, Canada
| | - Raquel P Hirata
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil
| | - Daniele C Dala Pola
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil
| | - Mariana P Bertoche
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil
| | - Letícia F Belo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil
| | - Ana Carolina Dos Reis Andrello
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil
| | - Jéssica Fonseca
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil
| | - Leandro C Mantoani
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil
| | - Karina C Furlanetto
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil; Biological and Health Sciences Research Center, University Pitágoras UNOPAR, Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL) - Londrina, Brazil.
| |
Collapse
|