A modified 6-form Tai Chi for patients with COPD

Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: A Network Meta-analysis

OBJECTIVE

A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare and rank the effectiveness of various breathing exercises for patients with chronic obstructive pulmonary disease (COPD).

DATA SOURCES

We searched PubMed, Web of Science, Embase, and the Cochrane Library databases to determine the articles.

STUDY SELECTION

Publications investigating the effect of breathing exercises on exercise capacity (six-minute walk test [6MWT]), pulmonary function (the ratio of the first second forced expiratory volume of forced vital capacity [FEV1/FVC]), quality of life (St George's Respiratory Questionnaire [SGRQ]), inspiratory muscle pressure (maximum inspiratory pressure [PImax]), and dyspnea (Borg scale) were searched.

DATA EXTRACTION

Data extracted by 2 researchers were entered into predesigned tables for data extraction. The quality of the literature was assessed using the Cochrane Collaboration's tool.

DATA SYNTHESIS

A total of 43 RCTs involving 1977 participants were analyzed. To boost exercise capacity, the top 2 exercises were inspiratory muscle training (75%), Chinese traditional fitness exercises (13%); To improve pulmonary function, the top 2 exercises were Chinese traditional fitness exercises (32%), diaphragm breathing (30%); To raise patients' quality of life, the top 2 exercises were yoga (52%), diaphragm breathing (28%); To increase inspiratory muscle pressure, the top 2 exercises were pursed-lip breathing (47%), Chinese traditional fitness exercises (25%); To improve dyspnea, the top 2 exercises were yoga (44%), inspiratory muscle training (22%).

CONCLUSIONS

Various breathing exercises for COPD patients confer benefits that manifest in diverse ways. Pulmonary rehabilitation specialists could administer personalized breathing exercises tailored to each patient's condition to attain optimal therapeutic outcomes.

Effect of different exercise programs on lung function in people with chronic obstructive pulmonary disease: A network meta-analysis of RCTs

BACKGROUND

Chronic obstructive pulmonary disease (COPD) has systemic consequences and causes structural abnormalities throughout the respiratory system. It is associated with a high clinical burden worldwide.

AIM

A network meta-analysis was performed to determine the effects of exercise programs on lung function measured by forced expiratory volume in the first second (FEV1), FEV1 as a percentage of the predicted value (FEV1%) and forced vital capacity in people with COPD.

METHODS

A literature search was performed to March 2023. Randomized controlled trials on the effectiveness of exercise programs on lung function in people with COPD were included. A standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups were carried out to calculate the standardized mean difference and 95 % CI. The risk of bias was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess the quality of the evidence.

RESULTS

35 studies with a total sample of 2909 participants were included in this network meta-analysis. The highest standardized mean difference was for active mind body movement therapy programs versus control for FEV1 and FEV1% (0.71; 95 % CI 0.32 to1.09; and 0.36; 95 % CI 0.15 to 0.58, respectively), and pulmonary rehabilitation+active mind body movements therapies versus control for forced vital capacity (0.45; 95 % CI 0.07 to 0.84).

CONCLUSIONS

active mind body movement therapy programs were the most effective type of exercise program to improve lung function measured by FEV1 and FEV1%; pulmonary rehabilitation+active mind body movements therapies had the greatest effects on FVC in people with COPD. Exercise programs in which the abdominal muscles are strengthened could improve lung emptying, helping to overcome airway resistance in people with COPD.

Effects of Tai Chi on Lung Function, Exercise Capacity and Psychosocial Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials

Objectives: To explore whether tai chi can improve lung function, exercise capacity, and health-related outcomes in patients with chronic obstructive pulmonary disease (COPD). Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and China Science and Technology Journal Database (VIP) databases were searched from inception to January 5, 2023. The methodological quality of the included studies was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions criteria. Results: A total of 1430 participants from 20 randomized controlled trials were included in this review. The results indicated significant effects of tai chi on FEV1, 6WMD, anxiety, and quality of life (p < 0.01), but not on FEV1%, FEVI/FVC, depression, and social support. Conclusions: Tai chi might be a potential alternative therapy to improve FEV1, 6WMD, anxiety, and quality of life for patients with COPD.

Meditative movement for breathlessness in advanced COPD or cancer: a systematic review and meta-analysis

The effect of meditative movement, which includes yoga, tai chi and qi gong, on breathlessness in advanced disease is unknown. This systematic review aims to comprehensively assess the evidence on the effect of meditative movement on breathlessness (primary outcome), health-related quality of life, exercise capacity, functional performance and psychological symptoms (secondary outcomes) in advanced disease. 11 English and Chinese language databases were searched for relevant trials. Risk of bias was assessed using the Cochrane tool. Standardised mean differences (SMDs) with 95% confidence intervals were computed. 17 trials with 1125 participants (n=815 COPD, n=310 cancer), all with unclear or high risk of bias, were included. Pooled estimates (14 studies, n=671) showed no statistically significant difference in breathlessness between meditative movement and control interventions (SMD (95% CI) 0.10 (-0.15-0.34); Chi2=30.11; I2=57%; p=0.45), irrespective of comparator, intervention or disease category. Similar results were observed for health-related quality of life and exercise capacity. It was not possible to perform a meta-analysis for functional performance and psychological symptoms. In conclusion, in people with advanced COPD or cancer, meditative movement does not improve breathlessness, health-related quality of life or exercise capacity. Methodological limitations lead to low levels of certainty in the results.

Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The present systematic review and meta-analysis of randomized clinical trials (RCTs) aimed to investigate the effects of pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease (COPD).

METHODS

The RCTs of pulmonary rehabilitation programs published between 1999 and 2021 were retrieved from electronic databases (PubMed, Cochrane Library, and Embase). Two reviewers independently assessed the topical relevance and trial quality and extracted data for meta-analysis using the Stata software version 14.0.

RESULTS

A total of 39 trials involving 2,397 participants with COPD were evaluated. We found that patients who received pulmonary rehabilitation program had significant improvement in the 6-min walk test (6MWT), St. George Respiratory Questionnaire score, and the modified British Medical Research Council score as compared to those who received usual care. Yoga and Tai Chi showed significant improvement in the forced expiratory volume (FEV1)% in 1 s predicted value. However, no significant difference was detected in the modified Borg score, forced vital capacity (FVC), and FEV1/FVC predicted value between the pulmonary rehabilitation and usual care groups.

CONCLUSION

Yoga and Tai Chi showed a significant improvement in the FEV1% predicted value. Also, pulmonary rehabilitation program improved the exercise capacity, the quality of life, and dyspnoea in patients with COPD.Key messagesA total of 39 trials involving 2,397 participants with COPD were evaluated.We found that patients who received pulmonary rehabilitation program had significant improvement in the 6MWT, St. George Respiratory Questionnaire score, and the modified British Medical Research Council score as compared to those who received usual care.Yoga and Tai Chi showed significant improvement in the FEV1% predicted value.No significant difference was detected in the modified Borg score, FVC, and FEV1/FVC predicted value between the pulmonary rehabilitation and usual care groups.

Effectiveness of pulmonary rehabilitation performed through exercise training for patients with stable COPD: A meta-analysis of randomized controlled trials

Background

The application of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) improves functional capacity and health-related quality of life (HRQoL) at all stages of disease severity. The aim of this study was to determine the effects of PR, performed through exercise training (PR-ET), on functional capacity and HRQoL in patients with stable COPD.

Methods

The meta-analysis was performed by including randomized controlled trials (RCTs) involving patients with stable COPD who participated in different types of PR-ET in which six-minute walk distance (6MWD) and/ or St. George’s Respiratory Questionnaire total scores (SGRQ) were measured. The data search was conducted in December 2020 and January 2021.

Results

The first meta-analysis showed a statistically significant positive effect (MD=31.73m; p<0.00001) of PR-ET on 6MWD. Similarly, the second meta-analysis found a statistically significant favourable effect of pulmonary rehabilitation through exercise training on SGRQ total scores (MD=-8.09; p=0.002).

Conclusions

PR, which includes several different types of exercise training, has a positive effect on the functional capacity and HRQoL of patients with stable COPD. Further studies should be conducted to determine the effects of home-based PR-ET and PR-ET >8 weeks on SGRQ total scores.

Tai Chi for Overweight/Obese Adolescents and Young Women with Polycystic Ovary Syndrome: A Randomized Controlled Pilot Trial

Background

Exercise is one of the recommended interventions for polycystic ovary syndrome (PCOS), and current evidence has shown that Tai chi may have favorable effects. The objective of this randomized controlled pilot trial was to study the feasibility and potential effects of Tai chi for overweight/obese adolescents and young women with PCOS, so a future definitive randomized controlled trial (RCT) can be well designed and implemented.

Materials and Methods

This study recruited 50 patients who were randomly assigned to two groups (Tai chi and self-monitored exercise) at a ratio of 3 : 2. The intervention lasted for 3 months, and the feasibility and effectiveness outcomes were measured.

Results

A total of 42 patients completed the study, including 24 in the Tai chi group and 18 in the control group. Compared with the self-monitored exercise group, there was a significantly decreased body mass index (BMI) in the Tai chi group adjusted for baseline BMI. The testosterone level and lipid profile were also decreased compared to controls; the same tendency was also observed for the homeostasis model assessment of insulin resistance (HOMA-IR), but the difference did not achieve statistical significance. Twenty-four (out of 30, 80%) patients in the Tai chi group and 18 (out of 20, 90%) patients in the self-monitored exercise group completed the data collection. A total of 36 exercise sessions were held in both groups. Patients in the Tai chi group took a mean of 34.0 ± 2.21 classes (93.06%), and those in the self-monitored exercise group engaged in 32 ± 3.06 exercise sessions (88.27%) out of the 36 required exercise sessions.

Conclusions

The present pilot study was feasible to deliver; there was a decrease in BMI, testosterone level, and lipid profile for PCOS patients in the Tai chi group at 3 months. In a future definitive trial, lower recruitment rate and outcome measurements lead to poor patient acceptance such as the 5-time point oral glucose tolerance test need to be considered and one fixed type of aerobic exercise and supervision from the investigator for the control group are also needed. Trial registration: ClinicalTrials.gov, NCT02608554.

Self-management interventions for people with chronic obstructive pulmonary disease

BACKGROUND

Self-management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. Since the 2014 update of this review, several studies have been published.

OBJECTIVES

Primary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of health-related quality of life (HRQoL) and respiratory-related hospital admissions. To evaluate the safety of COPD self-management interventions compared to usual care in terms of respiratory-related mortality and all-cause mortality. Secondary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of other health outcomes and healthcare utilisation. To evaluate effective characteristics of COPD self-management interventions.

SEARCH METHODS

We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, EMBASE, trials registries and the reference lists of included studies up until January 2020.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995. To be eligible for inclusion, self-management interventions had to include at least two intervention components and include an iterative process between participant and healthcare provider(s) in which goals were formulated and feedback was given on self-management actions by the participant.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. We contacted study authors to obtain additional information and missing outcome data where possible. Primary outcomes were health-related quality of life (HRQoL), number of respiratory-related hospital admissions, respiratory-related mortality, and all-cause mortality. When appropriate, we pooled study results using random-effects modelling meta-analyses.

MAIN RESULTS

We included 27 studies involving 6008 participants with COPD. The follow-up time ranged from two-and-a-half to 24 months and the content of the interventions was diverse. Participants' mean age ranged from 57 to 74 years, and the proportion of male participants ranged from 33% to 98%. The post-bronchodilator forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of participants ranged from 33.6% to 57.0%. The FEV1/FVC ratio is a measure used to diagnose COPD and to determine the severity of the disease. Studies were conducted on four different continents (Europe (n = 15), North America (n = 8), Asia (n = 1), and Oceania (n = 4); with one study conducted in both Europe and Oceania). Self-management interventions likely improve HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (lower score represents better HRQoL) with a mean difference (MD) from usual care of -2.86 points (95% confidence interval (CI) -4.87 to -0.85; 14 studies, 2778 participants; low-quality evidence). The pooled MD of -2.86 did not reach the SGRQ minimal clinically important difference (MCID) of four points. Self-management intervention participants were also at a slightly lower risk for at least one respiratory-related hospital admission (odds ratio (OR) 0.75, 95% CI 0.57 to 0.98; 15 studies, 3263 participants; very low-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over a mean of 9.75 months' follow-up was 15 (95% CI 8 to 399) for participants with high baseline risk and 26 (95% CI 15 to 677) for participants with low baseline risk. No differences were observed in respiratory-related mortality (risk difference (RD) 0.01, 95% CI -0.02 to 0.04; 8 studies, 1572 participants ; low-quality evidence) and all-cause mortality (RD -0.01, 95% CI -0.03 to 0.01; 24 studies, 5719 participants; low-quality evidence). We graded the evidence to be of 'moderate' to 'very low' quality according to GRADE. All studies had a substantial risk of bias, because of lack of blinding of participants and personnel to the interventions, which is inherently impossible in a self-management intervention. In addition, risk of bias was noticeably increased because of insufficient information regarding a) non-protocol interventions, and b) analyses to estimate the effect of adhering to interventions. Consequently, the highest GRADE evidence score that could be obtained by studies was 'moderate'.

AUTHORS' CONCLUSIONS

Self-management interventions for people with COPD are associated with improvements in HRQoL, as measured with the SGRQ, and a lower probability of respiratory-related hospital admissions. No excess respiratory-related and all-cause mortality risks were observed, which strengthens the view that COPD self-management interventions are unlikely to cause harm. By using stricter inclusion criteria, we decreased heterogeneity in studies, but also reduced the number of included studies and therefore our capacity to conduct subgroup analyses. Data were therefore still insufficient to reach clear conclusions about effective (intervention) characteristics of COPD self-management interventions. As tailoring of COPD self-management interventions to individuals is desirable, heterogeneity is and will likely remain present in self-management interventions. For future studies, we would urge using only COPD self-management interventions that include iterative interactions between participants and healthcare professionals who are competent using behavioural change techniques (BCTs) to elicit participants' motivation, confidence and competence to positively adapt their health behaviour(s) and develop skills to better manage their disease. In addition, to inform further subgroup and meta-regression analyses and to provide stronger conclusions regarding effective COPD self-management interventions, there is a need for more homogeneity in outcome measures. More attention should be paid to behavioural outcome measures and to providing more detailed, uniform and transparently reported data on self-management intervention components and BCTs. Assessment of outcomes over the long term is also recommended to capture changes in people's behaviour. Finally, information regarding non-protocol interventions as well as analyses to estimate the effect of adhering to interventions should be included to increase the quality of evidence.

Exercise as a multi-modal disease-modifying medicine in systemic sclerosis: An introduction by The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis (G-FoRSS)

Systemic sclerosis (SSc) is a heterogeneous multisystem autoimmune disease whereby its main pathological drivers of disability and damage are vascular injury, inflammatory cell infiltration, and fibrosis. These mechanisms result in diffuse and diverse impairments arising from ischemic circulatory dysfunction leading to painful skin ulceration and calcinosis, neurovascular aberrations hindering gastrointestinal (GI) motility, progressive painful, incapacitating or immobilizing effects of inflammatory and fibrotic effects on the lungs, skin, articular and periarticular structures, and muscle. SSc-related impairments impede routine activities of daily living (ADLs) and disrupt three critical life areas: work, family, social/leisure, and also impact on psychological well-being. Physical activity and exercise are globally recommended; however, for connective tissue diseases, this guidance carries greater impact on inflammatory disease manifestations, recovery, and cardiovascular health. Exercise, through myogenic and vascular phenomena, naturally targets key pathogenic drivers by downregulating multiple inflammatory and fibrotic pathways in serum and tissue, while increasing circulation and vascular repair. G-FoRSS, The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis recognizes the scientific basis of and advocates for education and research of exercise as a systemic and targeted SSc disease-modifying treatment. An overview of biophysiological mechanisms of physical activity and exercise are herein imparted for patients, clinicians, and researchers, and applied to SSc disease mechanisms, manifestations, and impairment. A preliminary guidance on exercise in SSc, a research agenda, and the current state of research and outcome measures are set forth.

Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes

Health-related quality of life (HRQoL), though rarely considered as a primary endpoint in clinical trials, may be the single outcome reflective of patient priorities when living with a health condition. HRQoL is a multi-dimensional concept that reflects the degree to which a health condition interferes with participation in and fulfillment of important life areas. HRQoL is intended to capture the composite degree of physical, physiologic, psychological, and social impairment resulting from symptom burden, patient-perceived disease severity, and treatment side effects. Diminished HRQoL expectedly correlates to worsening disability and death; but interventions addressing HRQoL are linked to increased survival. Sarcoidosis, being a multi-organ system disease, is associated with a diffuse array of manifestations resulting in multiple symptoms, complications, and medication-related side effects that are linked to reduced HRQoL. Diminished HRQoL in sarcoidosis is related to decreased physical function, pain, significant loss of income, absence from work, and strain on personal relationships. Symptom distress can result clearly from a sarcoidosis manifestation (e.g., ocular pain, breathlessness, cough) but may also be non-specific, such as pain or fatigue. More complex, a single non-specific symptom, e.g., fatigue may be directly sarcoidosis-derived (e.g., inflammatory state, neurologic, hormonal, cardiopulmonary), medication-related (e.g., anemia, sleeplessness, weight gain, sub-clinical infection), or an indirect complication (e.g., sleep apnea, physical deconditioning, depression). Identifying and distinguishing underlying causes of impaired HRQoL provides opportunity for treatment strategies that can greatly impact a patient's function, well-being, and disease outcomes. Herein, we present a reference manual that describes the current state of knowledge in sarcoidosis-related HRQoL and distinguish between diverse causes of symptom distress and other influences on sarcoidosis-related HRQoL. We provide tools to assess, investigate, and diagnose compromised HRQoL and its influencers. Strategies to address modifiable HRQoL factors through palliation of symptoms and methods to improve the sarcoidosis health profile are outlined; as well as a proposed research agenda in sarcoidosis-related HRQoL.

Clinical Evidence of Tai Chi Exercise Prescriptions: A Systematic Review

Objectives

This systematic review aims to summarize the existing literature on Tai Chi randomized controlled trials (RCTs) and recommend Tai Chi exercise prescriptions for different diseases and populations.

Methods

A systematic search for Tai Chi RCTs was conducted in five electronic databases (PubMed, Cochrane Library, EMBASE, EBSCO, and Web of Science) from their inception to December 2019. SPSS 20.0 software and Microsoft Excel 2019 were used to analyze the data, and the risk of bias tool in the RevMan 5.3.5 software was used to evaluate the methodological quality of RCTs.

Results

A total of 139 articles were identified, including diseased populations (95, 68.3%) and healthy populations (44, 31.7%). The diseased populations included the following 10 disease types: musculoskeletal system or connective tissue diseases (34.7%), circulatory system diseases (23.2%), mental and behavioral disorders (12.6%), nervous system diseases (11.6%), respiratory system diseases (6.3%), endocrine, nutritional or metabolic diseases (5.3%), neoplasms (3.2%), injury, poisoning and certain other consequences of external causes (1.1%), genitourinary system diseases (1.1%), and diseases of the eye and adnexa (1.1%). Tai Chi exercise prescription was generally classified as moderate intensity. The most commonly applied Tai Chi style was Yang style (92, 66.2%), and the most frequently specified Tai Chi form was simplified 24-form Tai Chi (43, 30.9%). 12 weeks and 24 weeks, 2-3 times a week, and 60 min each time was the most commonly used cycle, frequency, and time of exercise in Tai Chi exercise prescriptions.

Conclusions

We recommend the more commonly used Tai Chi exercise prescriptions for different diseases and populations based on clinical evidence of Tai Chi. Further clinical research on Tai Chi should be combined with principles of exercise prescription to conduct large-sample epidemiological studies and long-term prospective follow-up studies to provide more substantive clinical evidence for Tai Chi exercise prescriptions.

Effect of Psychological-Behavioral Intervention on the Depression and Anxiety of COVID-19 Patients

The COVID-19 epidemic has caused increasing public panic and mental health stress. In this study, we explore the prevalence and factors linked to anxiety and depression in hospitalized patients with COVID-19. A total of 144 patients diagnosed with COVID-19 underwent depression and anxiety assessment by using the Hospital Anxiety and Depression Scale (HADS). Social support level was also evaluated by the Perceived Social Support Scale (PSSS) at admission. Results showed that gender, age, oxygen saturation, and social support were associated with anxiety for COVID-19 patients. In addition, age, family infection with SARS-CoV-2, and social support were the risk factors associated with depression. Moreover, we designed a psychological-behavioral intervention (PBI) program that included psychological support and breathing exercises, and explored its effects on patients with COVID-19. Of the 144 participants, 26 patients with both anxiety and depression symptoms (cutoff score of ≥8 on HADS-A and HADS-D) were randomly assigned to the intervention group and the control group at a 1:1 ratio. After 10-day treatment, the HADS scores of depression and anxiety were significantly reduced in the intervention group, and PSSS scores were also significantly improved. However, no significant differences in HADS and PSSS scores between pre- and post-treatment were found in the control group. Our findings indicate that mental concern and appropriate intervention are essential parts of clinical care for COVID-19 patients.

Yoga and Tai Chi: a mind-body approach in managing respiratory symptoms in obstructive lung diseases

PURPOSE OF REVIEW

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation because of airway and/or alveolar abnormalities. Symptoms include dyspnea, cough, chronic sputum production. As the third-ranked cause of death as well as disability-adjusted life years (DALYs), it poses a significant burden on patients, families, healthcare system and society. Regular physical activity is linked to decrease in morbidity and mortality associated with COPD, but implementation remains challenging. There is a need for community-based interventions that promote physical activity. Yoga and Tai Chi are widely available in the community and have been shown to be beneficial in patients with COPD as well as many of the co-morbid conditions associated with COPD.

RECENT FINDINGS

Yoga and Tai Chi have been found to be more effective than usual care in COPD with clinically meaningful improvements in 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1), and health-related quality of life (HRQoL). They have also been found to be comparable to pulmonary rehabilitation interventions.

SUMMARY

Yoga and Tai Chi provide community-based options for patients with COPD to improve their physical activity, quality of life, and pulmonary function.

Effectiveness and Economic Evaluation of Hospital-Outreach Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease

Objective

Hospital-outreach pulmonary rehabilitation (PR) can improve health status and reduce health-care utilization by patients with chronic obstructive pulmonary disease (COPD). However, its long-term effects and costs versus benefits are still not clear. This study was conducted to develop, deliver, and evaluate the effects and monetary savings of a hospital-outreach PR program for patients with COPD.

Methods

A randomized controlled trial was conducted. Patients with COPD (n=208) were randomly assigned to the hospital-outreach PR program (treatment) or treatment as usual (control). The treatment group received a 3-month intensive intervention, including supervised physical exercise, smoking cessation, self-management education, and psychosocial support, followed by long-term access to a nurse through telephone follow-up and home visits up to 24 months. The control group received routine care, including discharge education and a self-management education brochure. Main outcomes were collected at 3, 6, 12, and 24 -months postrandomization. Primary outcomes included health-care utilization (ie, readmission rates, times, and days, and emergency department visits) and medical costs. Secondary outcomes included lung function (ie, FEV1, FEV1% predicted, FVC), dyspnea (mMCR), exercise capacity (6MWD), impact on quality of life (CAT), and self-management (CSMS).

Results

At the end of 24 months, 85 (81.7%) in the treatment group and 89 (85.6%) in the control group had completed the whole program. Compared with the control group, patients in the treatment group had lower readmission rates, times, and days at 6 and 12 months and during 12-24 months. Regarding costs during the 2 years, the program achieved CN¥3,655.94 medical  savings per patient per year, and every ¥1 spent on the program led to ¥3.29 insavings. Patients in the treatment group achieved improvements in FEV1, FEV1% predicted, exercise capacity, and self-management. It also achieved relief of dyspnea symptoms and improvement in COPD's impact on quality of life.

Conclusion

The hospital-outreach PR program for patients with COPD achieved reductions in health-care utilization, monetary savings, and improvements in patient health outcomes. The effects of the program were sustained for at least 2 years.

Trial Registration

This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-TRC-14005108).

Prevalence and Factors Associated with Depression and Anxiety of Hospitalized Patients with COVID-19.. [PMID: 0 DOI: 10.1101/2020.03.24.20043075]

Objective

The 2019 coronavirus disease (COVID-19) epidemic has raised international concern. Mental health is becoming an issue that cannot be ignored in our fight against it. This study aimed to explore the prevalence and factors linked to anxiety and depression in hospitalized patients with COVID-19.

Methods

A total of 144 patients diagnosed with COVID-19 were included in this study. We assessed depression and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS), and social support using the Perceived Social Support Scale (PSSS) among patients at admission. Multivariate linear regression analyses were performed to identify factors associated with symptoms of anxiety and depression.

Results

Of the 144 participants, 34.72% and 28.47% patients with COVID-19 had symptoms of anxiety or depression, respectively. The bivariate correlations showed that less social support was correlated with more anxious (r=-0.196, p<0.05) and depressive (r=-0.360,p<0.05) symptoms among patients with COVID-19. The multiple linear regression analysis showed that gender (β=1.446, p=0.034), age (β=0.074, p=0.003), oxygen saturation (β =-2.140, p=0.049), and social support (β =-1.545, p=0.017) were associated with anxiety for COVID-19 patients. Moreover, age (β=0.084, p=0.001), family infection with SARS-CoV-2 (β =1.515, p=0.027) and social support (β =-2.236, p<0.001) were the factors associated with depression.

Conclusion

Hospitalized patients with COVID-19 presented features of anxiety and depression. Mental concern and appropriate intervention are essential parts of clinical care for those who are at risk.

Effects of Tai Chi training on the physical and mental health status in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background

Tai Chi is a systematic whole body movement developed in ancient China. It plays an increasingly important role in the field of pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD). Our review aimed to explore the impact of Tai Chi on the physical and mental health of patients with COPD.

Methods

We searched several English and Chinese databases and used the combination of subject words and free words to search for available literature from the establishment of the library until August 28, 2018. Two researchers screened studies and collected the data independently. The study inclusion criteria included: (I) patients diagnosed with COPD; (II) Tai Chi or Tai Chi Qigong as an intervention in addition to routine treatment; (III) routine treatment with or without exercises as control group. The primary outcomes were lung function, exercise capacity and health status; (IV) randomized controlled trials.

Results

Sixteen articles were included from 2009 to 2018 (n=1,096). The average time duration of Tai Chi program was 53.4 minutes each session, 4.13 sessions a week for a total of 4.13 months. Comparing with control group, Tai Chi group improved some lung function (forced volume capacity: mean difference =0.12, 95% CI: 0.03–0.21), (forced expiratory volume in 1s: mean difference =0.15, 95% CI: 0.08–0.21), enhanced 6-minute walking distance score (mean difference =30.78, 95% CI: 15.15–46.42), decreased COPD Assessment Test score (mean difference =−5.00, 95% CI: −7.51 to −2.50), decreased St. George’s Respiratory Questionnaire score (mean difference =−8.66, 95% CI: −14.60 to −2.72), enhanced Chronic Respiratory Disease Questionnaire score (mean difference =2.16, 95% CI: 1.49–2.83), decreased Hospital Anxiety and Depression Scale score(anxiety: mean difference =−1.04, 95% CI: −1.58 to −0.51; depression: mean difference =−1.25, 95% CI: −1.77 to −0.73). Comparing with exercise group, Tai Chi group statistically enhanced 6-minute walking distance score (mean difference =7.77, 95% CI: 2.63–12.91).

Conclusions

Tai Chi may represent an appropriate alternative or complement to standard rehabilitation programs. However, whether Tai Chi is better than pulmonary rehabilitation exercise has not been determined.

Effect of simplified Tai Chi exercise on relieving symptoms of patients with mild to moderate Parkinson's disease

BACKGROUND

Tai Chi, a kind of physical exercise, may act as a non-pharmacologic approach to reducing the symptoms of Parkinson's disease. This study was conducted to investigate the effect of simplified Tai Chi training plus routine exercise on motor and non-motor symptoms in patients with mild to moderate Parkinson's disease in comparison with routine exercise regimen alone.

METHODS

Forty-one outpatients and inpatients with Parkinson's disease (PD) were randomized into Tai Chi group (N.=19) and routine exercise group as control group (N.=22) for 12 weeks. The Tai Chi group included both Tai Chi traning and routine exercise. Motor and non-motor functions were assessed. Motor function was evaluated by Unified Parkinson's Disease Rating Scale part III (UPDRS-III) and Berg Balance Scale (BBS). The non-motor symptoms like quality of life, sleep quality, depression and anxiety state, cognitive function were assessed by Parkinson's Disease Questionnaire-39 (PDQ-39), Parkinson's Disease Sleep Scale (PDSS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Montreal Cognitive Assessment (MOCA) respectively.

RESULTS

After 12 weeks of intervention, participants in both Tai Chi and routine exercise groups gained effects in UPDRS-III, BBS, PDQ-39, PDSS and HAMD compared to the baseline. However, significant improvements between Tai Chi group and routine exercise group were only found in PDSS (P=0.029) and MoCA (P=0.024).

CONCLUSIONS

Tai Chi training plus routine exercise might therefore be an ideal alternative non-pharmacological approach for the motor and non-motor symptoms of PD patients, and especially be more useful for the improvement of sleep quality and cognitive function in Parkinson's disease compared with routine exercise regimen alone.

Effectiveness of pulmonary rehabilitation in elderly patients with COPD: A systematic review and meta-analysis of randomized controlled trials

AIM

The review aimed to evaluate the effects of pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND

With an increase in published reports on pulmonary rehabilitation, there is a need for a meta-analysis to measure the effects of pulmonary rehabilitation in elderly COPD patients.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

The Cochrane library (Issue 4, 2018), Web of Science (1975 to April 2018), Embase (1974 to April 2018), Pubmed (1966 to April 2018), CINAHL (1982 to April 2018), JBI (The Joanna Briggs Institute) (1996 to April 2018), CNKI (China National Knowledge Infrastructure) (1979 to April 2018), CBM (SinoMed) (1982 to April 2018), and Wanfang Data (1900 to April 2018) were searched.

REVIEW METHODS

Six outcome indicators were utilized for the effects of pulmonary rehabilitation. Two reviewers selected trials, evaluated the quality, and extracted data. Meta-analysis was performed by using the RevMan 5.3 software.

RESULTS

Eight studies recruited 414 elderly patients. Pulmonary rehabilitation resulted in significantly improved exercise capacity and quality of life in elderly people but with no influence on oxygen saturation compared with the control group.

CONCLUSION

There is a need to provide more detailed pulmonary rehabilitation programs for elderly patients with COPD.

Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial

Although the beneficial effect of exercise on the health of Chronic Obstructive Pulmonary Disease (COPD) patients has been widely demonstrated, that of Tai Chi Qigong (TCQ), as an alternative exercise, has been inconclusive. Therefore, this study aimed to evaluate the effects of combined center-and home-based TCQ on functional capacity and lung function in patients with mildly and moderately severe COPD. A total of 50 patients, with a mild and moderate degree of COPD, were recruited and randomly assigned to either the TCQ (n = 25) or control group (n = 25). The TCQ group completed 12-week center-and 12-week home-based training. The control group attended a meeting class once a week for 12 weeks. Outcome measures were assessed at baseline, and the 6th, 12th and 24th week. The primary outcomes were functional capacity (6-min walk test; 6MWT) and lung function. The secondary outcomes were dyspnea score and quality of life. The TCQ group demonstrated significant improvement in functional capacity at week 12 and 24 (p < 0.05) and dyspnea score and quality of life at week 6, 12 and 24 (p < 0.05) when compared to baseline. Functional capacity, forced expiratory volume in 1st second (FEV₁), dyspnea score, and quality of life were significantly better in the TCQ group from week 6 to week 24 when compared to the control group (p < 0.05). Combined center-and home-based TCQ training for patients with mildly and moderately severe COPD is effective in improving functional capacity, dyspnea score, and quality of life.

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This intervention was combind center-and home-base TCQ long term training.

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The participants are included the more homogeneity of COPD participants (mild and moderate degree of COPD).

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TCQ practice could be applied at home in mild or moderate degree of COPD.

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The benefical effect of TCQ training was demonstrated on outcomes only after 6 weeks of training.