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Chen LX, Peng SL, Mao LP, Luo XW, He Q, Xiang JH, Long FJ, Jiao Y. The Application of Self-Made Disseminating and Descending Breathing Exercises in Home Rehabilitation of Stable COPD. COPD 2024; 21:2369541. [PMID: 39087240 DOI: 10.1080/15412555.2024.2369541] [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: 07/12/2023] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 08/02/2024]
Abstract
To investigate the clinical effects and application value of self-made disseminating and descending breathing exercises on home rehabilitation of patients with stable chronic obstructive pulmonary disease (COPD). Seeking to generate concepts for creating novel, convenient, and efficient COPD prognosis rehabilitation exercises aimed at enhancing the well-being and rehabilitation confidence of both COPD patients and their families. A total of 70 COPD patients admitted to our outpatient department from July 2019 to September 2021 were randomly divided into the exercise group (n = 35) and the control group (n = 35). The control group received routine breathing training, while the exercise group was treated with self-made disseminating and descending breathing exercises. The respiratory function, including pulmonary function (FVC, FEV1, FEV1/FVC) and respiratory muscle strength (MIP, MEP), exercise tolerance (6-min walking distance, 6MWT), Modified Medical Research Council Dyspnea Scale (mMRC, Borg), COPD quality of life score (CAT, SGRQ), anxiety and depression scores (HAMA, HAMD) were compared between the two groups after 12-week exercise. After 12-week training, the FEV1, MIP, and MEP in the exercise group were significantly higher than those in the control group (p < 0.001), and the 6MWT was significantly increased in the exercise group compared to the control group (p < 0.001); while the mMRC, Borg score, the scores of CAT, SGRQ, HAMA, and HAMD were found significantly lower than those in the control group (p < 0.001). The self-made disseminating and descending breathing exercises can improve respiratory function and reduce symptoms of dyspnea in COPD patients, while enhancing exercise tolerance and relieving anxiety and depression, and are worthy of clinical application.
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Affiliation(s)
- Ling-Xiu Chen
- Department of Respiratory and Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Shu-Lei Peng
- Department of Sleep Medical Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Liang-Ping Mao
- Department of Respiratory and Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Xin-Wei Luo
- Department of Respiratory and Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Qian He
- Department of Respiratory and Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Jian-Hua Xiang
- Department of Respiratory and Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Fu-Juan Long
- Department of Pediatrics, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Yan Jiao
- Department of Respiratory and Critical Care Medicine, Chongqing University Three Gorges Hospital, Chongqing, China
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Pehlivan E, Çetinkaya E, Özcan ZB, Karaahmetoğlu FS, Çörtük M, Ataç A, Çınarka H. Investigation of Inspiratory Muscle Training Efficiency Before Bronchoscopic Lung Volume Reduction: A Randomized Controlled Trial. Arch Bronconeumol 2024:S0300-2896(24)00226-6. [PMID: 39025760 DOI: 10.1016/j.arbres.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is recommended prior to bronchoscopic lung volume reduction (BLVR) procedures to optimize patient outcomes. However, there's a lack of clear guidance on PR content. The aim of our study is to examine the effect of adding inspiratory muscle training (IMT) to standard PR before BLVR on exercise capacity, dyspnea, fatigue level and quality of life. METHODS Sixty-four patients were randomly assigned to either the PR Group (PRGr) or the PR with IMT group (IMTGr). Both groups underwent an 8-week standard PR program, including breathing exercises, muscle strengthening, and walking. Additionally, IMTGr received IMT sessions. Outcome measures comprised six-minute walking distance (6MWD), maximal inspiratory and expiratory pressures (MIP, MEP), peripheral muscle strength, modified Medical Research Council dyspnea score, fatigue symptom scale, spirometric parameters, Saint George Quality of Life Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form (IPAQ-SF), and Hospital Anxiety and Depression Scale. RESULTS Our study found no significant difference in exercise capacity improvement between IMTGr and PRGr. However, IMTGr showed significant improvement in MIP compared to PRGr. Both groups experienced improvements in dyspnea, fatigue, and depression scores, as well as enhancements in 6MWD, MEP, peripheral muscle strength, IPAQ-SF and SGRQ scores. CONCLUSION Adding IMT to PR did not show a significant difference between groups among BLVR-eligible patients. However, improved respiratory muscle strength may have positive clinical implications. Further research is needed to explore short and long-term effects.
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Affiliation(s)
- Esra Pehlivan
- University of Health Sciences, Faculty of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Erdoğan Çetinkaya
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Betül Özcan
- University of Health Sciences, Enstitute of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Fulya Senem Karaahmetoğlu
- University of Health Sciences, Enstitute of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Mustafa Çörtük
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Amine Ataç
- Istanbul Gedik University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Halit Çınarka
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Barbosa M, de Melo CA, Torres R. The effects of adding a six-month Pilates exercise program to three months of traditional community-based pulmonary rehabilitation in individuals with COPD: a prospective cohort study. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2024; 60:68-85. [PMID: 38828206 PMCID: PMC11144029 DOI: 10.29390/001c.117966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
Introduction Pilates exercise may complement traditional pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease (COPD). The objective was to analyze the effects of adding a six-month Pilates exercise program to a three-month pulmonary rehabilitation for individuals with COPD. Methods Thirty-five participants with COPD (GOLD B) were assigned to the intervention (n=14) or control (n=21) group. Both groups received an initial three months of a pulmonary rehabilitation program. The intervention group further underwent six months of pilates. Participants were evaluated at baseline and at three, six, and nine months. Lung function and strength of respiratory muscles were defined as primary outcomes. Secondary outcomes included cardiac, physical function, and exacerbation episodes. Results There were no consistent statistically significant differences between groups for the lung function outcomes (p\<0.05). Maximal inspiratory and expiratory pressure increased significantly at three months in both groups (p\<0.05). It was significantly superior in the intervention group at nine months for maximal inspiratory pressure (p=0.005) and six and nine months for maximal expiratory pressure (p=0.027 and p\<0.001, respectively). Changes in muscle strength (knee extension and handgrip) were comparable between groups (p>0.05), but exercise-induced fatigue and balance were significantly superior in the intervention group at the six- and nine-month follow-ups (p\<0.05). Discussion Pilates exercise programs may be implemented to augment traditional pulmonary rehabilitation with the goal of improving the strength of respiratory muscles. Conclusion Adding a Pilates exercise program to pulmonary rehabilitation resulted in superior strength of respiratory muscles, higher resistance to exercise-induced fatigue, and improved balance.
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Affiliation(s)
- Marisela Barbosa
- PhysiotherapyCentro Hospitalar do Baixo Vouga Aveiro - Unidade Local de Saúde da Região de Aveiro, Aveiro, Portugal
- PhysiotherapyEscola Superior de Saúde Norte da Cruz Vermelha Portuguesa, Oliveira de Azeméis, Portugal
| | - Cristina A. de Melo
- PhysiotherapySchool of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal (retired)
| | - Rui Torres
- PhysiotherapyCESPU, North Polytechnic Institute of Health, Paredes, Portugal
- PhysiotherapyCIR, Center for Rehabilitation Research, Polytechnic Institute of Porto, Porto, Portugal
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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.
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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
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Cui S, Ji H, Li L, Zhu H, Li X, Gong Y, Song Y, Hu L, Wu X. Effects and long-term outcomes of endurance versus resistance training as an adjunct to standard medication in patients with stable COPD: a multicenter randomized trial. BMC Pulm Med 2024; 24:196. [PMID: 38649893 PMCID: PMC11036716 DOI: 10.1186/s12890-024-03010-z] [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: 07/20/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Comparisons between endurance training (ET) and resistance training (RT) have produced equivocal findings in chronic obstructive pulmonary disease (COPD) patients. The purpose of our study is to investigate the effectiveness and long-term outcomes of adding ET and RT to conventional medical treatment in patients with COPD. A secondary objective is to investigate the clinical improvements resulting from exercise training in patients with different disease severities. METHODS The study was a multicenter, prospective trial in people with stable COPD. The cohort was randomized to three groups: individualized medical treatment group (MT), MT + endurance training group (MT + ET) and MT + resistance training group (MT + RT). Exercise was performed 3 times weekly over a 12-week period. The endpoints of exercise capacity, health-related quality of life, COPD symptoms, lung function, and anxiety and depression questionnaires were re-evaluated at baseline, at the completion of the intervention and at 6 and 12-month follow-up. According to the COPD assessment tool offered by GOLD guidelines, patients were stratified into GOLD A and B groups and GOLD C and D groups for further subgroup analysis. RESULTS The intention-to-treat (ITT) population included 366 patients, 328 of them completed the study protocol over 12 months (the PP-population). There were no significant differences in the primary outcome, quality of life, between patients who underwent medical treatment (MT) alone, MT + endurance training (MT + ET), or MT + resistance training (MT + RT) at the completion of the intervention, 6-, or 12-month follow-up. Additionally, no significant differences were observed between MT, MT + RT, or MT + ET groups concerning the primary outcome, exercise capacity (3MWD), after initial 3 months of intervention. However, a small statistically significant difference was noted in favor of MT + ET compared to MT + RT at 12 months (ITT: Δ3MWD in ET vs RT = 5.53 m, 95% confidence interval: 0.87 to 13.84 m, P = 0.03) (PP: Δ3MWD in ET vs RT = 7.67 m, 95% confidence interval: 0.93 to 16.27 m, P = 0.04). For patients in the GOLD C and D groups, improvement in quality of life following ET or RT was significantly superior to medical intervention alone. Furthermore, upon completion of the exercise regimen, RT exhibited a greater improvement in anxiety compared to ET in these patients (ITT: ΔHAD-A at 3-month: RT = -1.63 ± 0.31 vs ET = -0.61 ± 0.33, p < 0.01) (PP: ΔHAD-A at 3-month: RT = -1.80 ± 0.36 vs ET = -0.75 ± 0.37, p < 0.01). CONCLUSIONS Our study presents evidence of the beneficial effects of ET and RT in combination with standard medical treatment, as well as the long-term effects over time after the intervention. While the statistically significant effect favoring ET over RT in terms of exercise capacity was observed, it should be interpreted cautiously. Patients in severe stages of COPD may derive greater benefits from either ET or RT and should be encouraged accordingly. These findings have implications for exercise prescription in patients with COPD. TRIAL REGISTRATION ChiCTR-INR-16009892 (17, Nov, 2016).
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Affiliation(s)
- Shilei Cui
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China
- Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Haiying Ji
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Li Li
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Huili Zhu
- Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Xiangyang Li
- Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Ying Gong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China.
- Shanghai Respiratory Research Institute, Shanghai, 200032, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200032, China.
| | - Lijuan Hu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China.
- Shanghai Respiratory Research Institute, Shanghai, 200032, China.
| | - Xu Wu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China.
- Shanghai Respiratory Research Institute, Shanghai, 200032, China.
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Xin W, Xu D, Dou Z, Jacques A, Umbella J, Hill AM. Effectiveness of Community-Based Rehabilitation (CBR) Centers for Improving Physical Fitness for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Ann Rehabil Med 2024; 48:5-21. [PMID: 38433005 PMCID: PMC10915308 DOI: 10.5535/arm.23148] [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: 10/12/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024] Open
Abstract
To synthesise the best available evidence for the effectiveness of interventions delivered in community-based rehabilitation (CBR) centers on physical fitness, for community-dwelling older adults living in Asian countries. This study is a systematic review and meta-analysis. Seven English and two Chinese electronic databases were searched for randomised controlled trials (RCTs) and quasi-experimental studies that were conducted by centers providing CBR. Independent reviewers screened, quality-appraised and extracted data. The primary outcome was physical fitness measured by validated assessment tools, including the Timed Up and Go Test (TUG), gait speed, hand grip strength, Functional Reach Test (FRT), and one-leg standing test. Assessments of activity of daily living and quality of life using tools including the Barthel Index, Short Form (SF)-12, and SF-36 were secondary outcomes. After screening 5,272 studies, 29 studies were included (16 RCTs, 13 quasi-experimental studies) from four countries. Meta-analyses found that CBR programs significantly decreased TUG time (mean difference [MD], -1.89 seconds; 95% confidence interval [95% CI], -2.84 to -0.94; I2=0%; Z=3.90, p<0.0001), improved gait speed (MD, 0.10 m/s; 95% CI, 0.01-0.18; I2=0%; Z=2.26, p=0.02), and increased one-leg standing time (MD, 2.81 seconds; 95% CI, 0.41-5.22; I2=0%; Z=2.29, p=0.02). Handgrip strength and FRT showed no statistically significant improvement in the meta-analyses. CBR may improve aspects of physical fitness for older adults in Asian countries. However, variability in intervention components and measurement tools reduced the ability to pool individual studies. Further trials are required with robust designs including standardised measures of physical fitness.
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Affiliation(s)
- Wei Xin
- Curtin Medical School, Curtin University, Perth, Australia
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dan Xu
- Curtin Medical School, Curtin University, Perth, Australia
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of General Family Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, Perth, Australia
| | - Josephine Umbella
- School of Allied Health, The University of Western Australia, Perth, Australia
| | - Anne-Marie Hill
- School of Allied Health, The University of Western Australia, Perth, Australia
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Chung AC, Chang CJ, Liu JF, Hung MS, Fang TP, Lin HL. The short- and long-term effects of lower limb endurance training on outpatients with chronic obstructive pulmonary disease. Clin Rehabil 2024; 38:85-97. [PMID: 37574917 DOI: 10.1177/02692155231192453] [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] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To explore the short- and long-term effects of lower-limb endurance training on chronic obstructive pulmonary disease outpatients. DESIGN Prospective quasi-experimental study. SETTING 1383-bed teaching hospital in Taiwan. PARTICIPANTS Overall, 69 outpatients diagnosed with chronic obstructive pulmonary disease were enrolled. A total of 60 patients completed the study. INTERVENTION Training group: Lower-limb endurance training; control group: Education only. MAIN MEASURES The modified medical research council score, chronic obstructive pulmonary disease assessment test score, pulmonary function test, and number of acute exacerbation within a year. RESULTS The training group showed significant improvement in the chronic obstructive pulmonary disease assessment test total score, modified medical research council score (both P < 0.001) at third month sustaining to 12th month (P < 0.001) and presented less events of acute exacerbation (P = 0.011) at 12th month. The chronic obstructive pulmonary disease assessment test decreased by 8 points sustaining to 12th month. The training group presented significant post-training functional capacity improvements in 6-min walking distance, lowest oxygen saturation during 6-min walking test, peak workload, maximum inspiratory/ expiratory pressures, and calf circumference. CONCLUSIONS The lower-limb endurance training improved perceived dyspnea in daily activity and health status after completion of training and sustaining for a year. The lower-limb endurance training alleviated disease impacted on reduced acute exacerbations.
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Affiliation(s)
- An-Chi Chung
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Physical Education, Health & Recreation, National Chiayi University-Minhsiung Campus, Chiayi, Taiwan
| | - Chun-Jung Chang
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jui-Fang Liu
- Department of Respiratory Care, Chang Gung University and Technology, Chiayi, Taiwan
- Chronic Diseases and Health Promotion Research Centre, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Ming-Szu Hung
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Pei Fang
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Respiratory Care, Chang Gung University and Technology, Chiayi, Taiwan
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
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Molinier V, Moine E, Caille P, Fernandes N, Alexandre F, Heraud N. Relevance of multidimensional dyspnea assessment in the context of pulmonary rehabilitation. Chron Respir Dis 2024; 21:14799731241255135. [PMID: 39046275 PMCID: PMC11271156 DOI: 10.1177/14799731241255135] [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: 01/09/2024] [Accepted: 04/07/2024] [Indexed: 07/25/2024] Open
Abstract
Objectives: While dyspnea is the main symptom in chronic obstructive pulmonary disease (COPD), it is often inadequately evaluated in pulmonary rehabilitation (PR), as it is typically measured using only the impact dimension (ID). However, dyspnea is a multidimensional construct including perception (PD) and emotional (ED) domains. Our work aimed to study the complementarity of dyspnea dimensions and their respective ability to identify different evolutions during PR. Methods: 145 people with COPD attending PR were included in this retrospective study. Dyspnea scores from the modified Medical Research Council scale (ID) and the Multidimensional Dyspnea Profile questionnaire (PD/ED), exercise capacity, quality of life at the start (T1) and the end of PR (T2) were collected from existing databases/medical files. The evolution of each dyspnea dimension was evaluated using the delta score between T2-T1. PR response was defined using the minimal clinically important difference. Results: Our results show that each dyspnea dimension was associated with different health-outcomes. Positive correlations were found between PD-ED at baseline and between their T2-T1 delta score (ρ = 0.51; ρ = 0.41 respectively, p < .01), but there was no significant correlation between ID-PD or -ED (p > .05). 51% of the patients did not respond on ID, but 85% of them nonetheless responded on either PD or ED. Finally, 92% of patients responded on at least one dimension after PR. Discussion: Our study emphasizes the significance of assessing each dimension of dyspnea independently and complementary, as dimensions are associated with different elements and evolve differently under PR effects. This approach is crucial to identifying weak points and allows professionals to focus on program elements that most effectively address the specific dimension causing problems.
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Affiliation(s)
- Virginie Molinier
- Direction de la Recherche clinique et de l’Innovation en Santé, Clariane, Lodève, France
| | - Espérance Moine
- Direction de la Recherche clinique et de l’Innovation en Santé, Clariane, Lodève, France
| | - Pauline Caille
- Direction de la Recherche clinique et de l’Innovation en Santé, Clariane, Lodève, France
- Department of Sports Sciences, University of Rennes, Rennes, France
| | | | - François Alexandre
- Direction de la Recherche clinique et de l’Innovation en Santé, Clariane, Lodève, France
| | - Nelly Heraud
- Direction de la Recherche clinique et de l’Innovation en Santé, Clariane, Lodève, France
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Kuz U, Maliuvanchuk S, Herych R, Herych P. Efficacy and safety of physical therapy in patients with stage III COPD during ambulatory rehabilitation. J Med Life 2023; 16:1769-1775. [PMID: 38585540 PMCID: PMC10994626 DOI: 10.25122/jml-2023-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/20/2023] [Indexed: 04/09/2024] Open
Abstract
This study aimed to determine the efficacy of a combined physical therapy and pharmacological treatment for patients recovering from stage III COPD exacerbation. The efficacy of the rehabilitation program was assessed using anthropological parameters, physical condition, respiratory system function, and functional endurance capacity. Data were collected from 39 patients with stage III COPD who underwent the rehabilitation program. Physical and anthropometric assessments were conducted using the Quetelet Body Mass Index, the Pignet Index, and the Vital Capacity Index (VCI). The functional capacities of the cardiorespiratory system were measured before and after the rehabilitation program using the Ruffier and Ruffier-Dickson tests and the hypoxic Shtange and Genchi tests. Exercise tolerance was evaluated using the Harvard Step Test and the Six-Minute Walk Distance Test (6MWD). Statistical analysis was conducted using the non-parametric Mann-Whitney U test for independent and dependent groups. Participants were randomly divided into two groups for rehabilitation: Group I received standard therapy and a routine physical therapy program, while Group II was given standard therapy along with a modified physical therapy regimen. There was a slight improvement in patient condition during the rehabilitation period for both groups. However, there was a low compliance rate for smoking cessation among the majority of patients, with some reducing their daily cigarette intake. Further long-time research is required to determine the efficacy of the proposed physical therapy program in combination with basic pharmacological therapy. The study suggests incorporating psychotherapeutic sessions and occupational therapy into future rehabilitation programs.
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Affiliation(s)
- Ulyana Kuz
- Department of Traumatology, Orthopedics and Emergency War Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Svitlana Maliuvanchuk
- Department of Pharmaceutical Management, Drug Technology and Pharmacognosy, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Roman Herych
- Department of Internal Medicine №1, Clinical Immunology and Allergology, named after Academician Neyko EM, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Petro Herych
- Department of Physical Therapy and Occupational Therapy, Vasyl Stefanyk Precarpathian National University, Ivano-Frankivsk, Ukraine
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Viana SMDNR, de Bruin VMS, Vasconcelos RS, Nogueira ANC, Mesquita R, de Bruin PFC. Melatonin supplementation enhances pulmonary rehabilitation outcomes in COPD: a randomized, double-blind, placebo-controlled study. Respir Med 2023; 220:107441. [PMID: 37944829 DOI: 10.1016/j.rmed.2023.107441] [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: 07/19/2023] [Revised: 10/08/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Melatonin (MLT), the main product of the pineal gland, is involved in muscle tissue repair and regeneration, besides several other important physiologic functions. In COPD, MLT administration can improve lung oxidative stress and sleep quality, but its potential effects on the outcomes of pulmonary rehabilitation (PR) have not been previously investigated. A randomized controlled trial was undertaken to test the hypothesis that a combined approach of rehabilitative exercise training and MLT supplementation could maximize functional performance, health status and quality of life in patients with COPD. Thirty-nine individuals with COPD referred to a supervised PR program at the Federal University of Ceara, Brazil, were randomized to receive MLT (3 mg/day; n = 18) or placebo (n = 21). Exercise capacity (6-min walk test - 6MWT), health status (COPD assessment test), and quality of life (airways questionnaire 20) were investigated as primary outcomes. No differences were observed at baseline in demographic, anthropometric and clinical characteristics between MLT and placebo groups. At the end of PR, superiority of the MLT group was demonstrated in improvement in the distance covered in the 6MWT (71 ± 26 vs. 25 ± 36 m; p < 0.01), health status (-11 ± 6 vs. -3 ± 5; p < 0.01), and quality of life (-6.9 ± 3.0 vs. -1.9 ± 2.4; p < 0.01), compared to the placebo group. In conclusion, MLT supplementation during the course of 12 weeks of PR can improve functional capacity, health status and quality of life in patients with COPD. These findings may have significant implications for the management of this condition.
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Affiliation(s)
| | | | | | | | - Rafael Mesquita
- Federal University of Ceara, Fortaleza, Brazil; Masters Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, CE, Brazil
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11
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Alsina-Restoy X, Torres-Castro R, Caballería E, Gimeno-Santos E, Solis-Navarro L, Francesqui J, Hernández-Gonzalez F, Ramos-Casals M, Blanco I, Sellarés J. Pulmonary rehabilitation in sarcoidosis: A systematic review and meta-analysis. Respir Med 2023; 219:107432. [PMID: 37858728 DOI: 10.1016/j.rmed.2023.107432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Exercise intolerance, muscle weakness, dyspnoea, and fatigue are frequent complications in symptomatic sarcoidosis patients. Pulmonary rehabilitation improves exercise capacity, symptoms, and quality of life in patients with chronic respiratory diseases. Our objective was to systematically determine the effects of pulmonary rehabilitation in patients with sarcoidosis. METHODS A systematic review was conducted in seven databases. Studies that applied pulmonary rehabilitation in patients with sarcoidosis were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. RESULTS Of the 406 reports returned by the initial search, five articles reporting on 184 patients were included in the data synthesis. Two studies included multi-component exercise, one inspiratory muscle training, one a physical activity incentivisation programme, and one a telerehabilitation program. In the intervention group (IG), we found significant improvement in exercise capacity (SMD 1.65, 95%CI 0.45, 2.86 points, p = 0.006). If we only analyse the studies that performed the 6-min walking test, the IG walked 40.3 (CI95% 20.3, 60.2) m higher than the control group (CG) (p < 0.001). Additionally, dyspnoea score was reduced (MD -0.42 95%CI -0.75, -0.10, p = 0.002). However, fatigue, quality of life and pulmonary function did not show any change. CONCLUSION Pulmonary rehabilitation could improve exercise capacity and dyspnoea perception in patients with sarcoidosis.
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Affiliation(s)
- Xavier Alsina-Restoy
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Estrella Caballería
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Elena Gimeno-Santos
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Instituto de Salud Global (ISGlobal), Barcelona, Spain
| | - Lilian Solis-Navarro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Joel Francesqui
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Fernanda Hernández-Gonzalez
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Isabel Blanco
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Spain
| | - Jacobo Sellarés
- Department of Pulmonary Medicine, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Spain.
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12
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Shibata Y, Kawayama T, Muro S, Sugiura H. Management goals and stable phase management of patients with chronic obstructive pulmonary disease in the Japanese respiratory society guideline for the management of chronic obstructive pulmonary disease 2022 (6th edition). Respir Investig 2023; 61:773-780. [PMID: 37741092 DOI: 10.1016/j.resinv.2023.08.007] [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: 06/05/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 09/25/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by airflow obstruction on spirometry and symptoms such as dyspnea on exertion and chronic cough with sputum production, thus making it a significant healthcare issue worldwide. Japanese patients with COPD have unique characteristics compared to patients in Western countries, including older age and lower exacerbation frequency. The Japanese Respiratory Society (JRS) published the 6th edition of the COPD guideline in June 2022. This article introduces the management goals of COPD and describes its management during the stable phase, as outlined in the guideline. Management goals include improving the current status, such as the symptoms, quality of life (QOL), exercise tolerance, and physical activity, and reducing future risks through prevention of exacerbation and suppression of disease progression to prevent shortening of healthy life expectancy. Management plans should include avoidance of causative substances, assessment of disease severity, and personalized treatment plans. Pharmacotherapy using inhalation bronchodilators is a key component of the treatment of stable COPD. Bronchodilators, including short- and long-acting dilators, are commonly used to relieve symptoms and improve QOL. Inhaled corticosteroids (ICSs) are used in combination with long-acting bronchodilators, especially in patients with asthma and COPD overlap, or those experiencing frequent exacerbation of eosinophilia. Combination therapy with a long-acting muscarinic antagonist (LAMA), a long-acting beta 2 agonist (LABA), and ICS is expected to improve QOL and respiratory function and reduce mortality and exacerbation compared to the LAMA + LABA combination. Non-pharmacological therapies, including smoking cessation and pulmonary rehabilitation, should also be considered.
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Affiliation(s)
- Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, 830-0011, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University School of Medicine, Nara, 634-8521, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
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13
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Rochester CL, Alison JA, Carlin B, Jenkins AR, Cox NS, Bauldoff G, Bhatt SP, Bourbeau J, Burtin C, Camp PG, Cascino TM, Dorney Koppel GA, Garvey C, Goldstein R, Harris D, Houchen-Wolloff L, Limberg T, Lindenauer PK, Moy ML, Ryerson CJ, Singh SJ, Steiner M, Tappan RS, Yohannes AM, Holland AE. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2023; 208:e7-e26. [PMID: 37581410 PMCID: PMC10449064 DOI: 10.1164/rccm.202306-1066st] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Background: Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods: The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions: These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.
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14
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Romanet C, Wormser J, Fels A, Lucas P, Prudat C, Sacco E, Bruel C, Plantefève G, Pene F, Chatellier G, Philippart F. Effectiveness of exercise training on the dyspnoea of individuals with long COVID: A randomised controlled multicentre trial. Ann Phys Rehabil Med 2023; 66:101765. [PMID: 37271020 PMCID: PMC10237688 DOI: 10.1016/j.rehab.2023.101765] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently be associated with long COVID, whose symptoms can include persistent respiratory symptoms up to 1 year later. Rehabilitation is currently recommended by most guidelines for people with this condition. OBJECTIVES To evaluate the effects of exercise training rehabilitation (ETR) on dyspnoea and health-related quality of life measures in people with continuing respiratory discomfort following CARDS. METHODS In this multicentre, two-arm, parallel, open, assessor-blinded, randomised controlled trial, we enroled adults previously admitted with CARDS to 3 French intensive care units who had been discharged at least 3 months earlier and who presented with an mMRC dyspnoea scale score > 1. Participants received either ETR or standard physiotherapy (SP) for 90 days. The primary outcome was dyspnoea, as measured by the Multidimensional Dyspnoea Profile (MDP), at day 0 (inclusion) and after 90 days of physiotherapy. Secondary outcomes were the mMRC and 12-item Short-Form Survey scores. RESULTS Between August 7, 2020, and January 26, 2022, 487 participants with CARDS were screened for inclusion, of whom 60 were randomly assigned to receive either ETR (n = 27) or SP (n = 33). Mean MDP following ETR was 42% lower than after SP (26.15 vs. 44.76); a difference of -18.61 (95% CI -27.78 to -9.44; p<10-4). CONCLUSION People who were still suffering from breathlessness three months after being discharged from hospital with CARDS had significantly improved dyspnoea scores when treated with ETR therapy for 90 days unlike those who only received SP. Study registered 29/09/2020 on Clinicaltrials.gov (NCT04569266).
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Affiliation(s)
- Christophe Romanet
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Johan Wormser
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Pauline Lucas
- Department of Intensive Care, Hopital Cochin - Port Royal, Paris, France
| | - Camille Prudat
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Emmanuelle Sacco
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Cédric Bruel
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Gaëtan Plantefève
- Department of Intensive Care, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Frédéric Pene
- Department of Intensive Care, Hopital Cochin - Port Royal, Paris, France
| | - Gilles Chatellier
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - François Philippart
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
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15
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Wang H, Liu Q, Liu L, Cao J, Liang Q, Zhang X. High-intensity interval training improves the outcomes of patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. Respir Med 2023; 208:107128. [PMID: 36717003 DOI: 10.1016/j.rmed.2023.107128] [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: 10/07/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pulmonary exercise is an important part in the treatment of chronic obstructive pulmonary disease (COPD). We aimed to evaluate the effects and safety of high-intensity interval training (HIIT) in patients with COPD, to provide insights to the COPD treatment and care. METHODS Two investigators searched PubMed, Medline, Embase, web of Science, Cochrane library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases up to Sept 15, 2022 for randomized controlled trials (RCTs) on the effects and safety of HIIT for COPD patients. RevMan5.3 software was used for statistical analysis. RESULTS A total of 20 RCTs involving 962 COPD patients were finally included. 514 patients underwent HIIT interventions. Meta-analysis showed that HIIT increased the peak oxygen consumption (SMD = 0.30, 95%CI:0.14-0.46), peak minute ventilation (SMD = 0.26, 95%CI: 0.05-0.47), peak work rate (SMD = 0.34, 95%CI: 0.17-0.51), 6-min walking distance (SMD = 0.39, 95%CI: 0.23-0.55) in COPD patients (all P < 0.05). HIIT improved the quality of life (SMD = 0.30, 95%CI: 0.06-0.54) and reduced the dyspnea (SMD = -0.27, 95%CI: -0.51∼-0.03) in COPD patients (all P < 0.05). There were no significant differences in the forced expiratory volume in 1 s/forced vital capacity (SMD = 0.28, 95%CI: -0.01-0.56) and St. George's Respiratory Questionnaire score (SMD = -0.35, 95%CI: -0.73-0.03) between HIIT and control group (all P > 0.05). There was no publication bias analyzed by the Egger test and funnel plots (all P > 0.05). CONCLUSIONS HIIT may be beneficial to improve the pulmonary function, exercise capacity and quality of life of patients with COPD, which is worthy of clinical promotion for COPD treatment and care.
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Affiliation(s)
- Hongyan Wang
- School of Nursing, Sichuan Nursing Vocational College, China
| | - Qin Liu
- School of Nursing, Chengdu University of TCM, China
| | - Linfeng Liu
- School of Nursing, Sichuan Nursing Vocational College, China
| | - Jun Cao
- School of Nursing, Sichuan Nursing Vocational College, China
| | | | - Xiangeng Zhang
- School of Nursing, Sichuan Nursing Vocational College, China.
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16
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Medeiros VMGD, Gonçalves de Lima J, Rosa C, Rega J, Mediano MFF, Rodrigues Junior LF. Physiotherapy in lymphangioleiomyomatosis: a systematic review. Ann Med 2022; 54:2744-2751. [PMID: 36217116 PMCID: PMC9559050 DOI: 10.1080/07853890.2022.2128401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Lymphangioleiomyomatosis (LAM) is associated with progressive dyspnoea and exercise intolerance, but despite the central role of physiotherapy on pulmonary rehabilitation, there is a huge lack of physiotherapy approaches used specifically for LAM patients. OBJECTIVE to identify the physiotherapeutic strategies used in the treatment of patients with LAM. MATERIALS AND METHODS This is a systematic review of literature. Searches were performed (in PubMed, Lilacs, Embase and PEDro databases) with the keywords "Lymphangioleiomyomatosis" and "Physiotherapy," and its variations. Articles describing physiotherapy interventions were included in the study. Data extracted from the studies were authors, year, country of publication, sample size, physiotherapy intervention, time/frequency/duration of intervention protocols, instruments used to measure results and main findings. Methodological quality of studies was evaluated by PEDro Scale (clinical trials), Newcastle-Ottawa Scale (NOS; observational studies) and CARE checklist (case reports), respectively. RESULTS A total of 82 articles identified, three duplicates were removed, 71 studies were excluded after title and abstract reading and four after full-text reading, all due to absence of association with the study topic. Four studies were included in the present review. Cardiorespiratory physiotherapy with endurance and resistance training were identified as physiotherapeutic strategies to improve lung function, functional capacity, depression symptoms and quality of life in LAM. CONCLUSIONS Endurance and resistance training is the keystone for physiotherapy in patients with LAM, but despite the reported benefits, there is a huge lack of studies related to the modalities, safety and dosage of physiotherapy prescription for patients with LAM.KEY MESSAGESLymphangioleiomyomatosis (LAM), a rare disease, leads to progressive dyspnoea and exercise intolerance;Physiotherapy can improve dyspnoea and exercise intolerance in LAM through endurance and resistance exercises.
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Affiliation(s)
| | | | - Claudia Rosa
- Physiotherapy Service, National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Juliana Rega
- Physiotherapy Service, National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Mauro Felippe Felix Mediano
- Education and Research Department, National Institute of Cardiology, Rio de Janeiro, Brazil.,Laboratory of Clinical Research on Chagas Disease, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Luiz Fernando Rodrigues Junior
- Education and Research Department, National Institute of Cardiology, Rio de Janeiro, Brazil.,Department of Physiological Sciences, Biomedical Institute, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Performance Score (T2D)-A New Perspective in the Assessment of Six-Minute Walking Tests in Pulmonary Rehabilitation. Diagnostics (Basel) 2022; 12:diagnostics12102402. [PMID: 36292092 PMCID: PMC9601141 DOI: 10.3390/diagnostics12102402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Because absolute changes in outcomes are difficult to interpret and the minimal clinically important difference (MCID) is not suitable to address this challenge, a novel method of classifying outcomes by relating changes to baseline values is warranted. We used the "performance score" (T2D), which reflects individual performance, enabling us to consider the functional status at the beginning of rehabilitation without dealing with the problems of mathematical coupling or regression effects, as encountered in ANCOVA. To illustrate the T2D, we retrospectively analyzed changes in the six-minute walking test (6MWT) in COPD patients undergoing outpatient pulmonary rehabilitation and compared the results with absolute differences related to a predetermined MCID. We evaluated a total of 575 COPD patients with a mean age of 61.4 ± 9.2 years. 6MWT improved significantly, with a mean change of 32.3 ± 71.2. A total of 105/311 participants who had reached the MCID were still classified as "below average" by the T2D. Conversely, 76/264 patients who had not reached the MCID were classified as "above average". This new performance measure accounts for the patient's current status and for changes over time, potentially representing a simple and user-friendly tool that can be used to quantify a patient's performance and response to rehabilitation.
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18
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Xu H, Guo R, Yang Y. Effects of Osimertinib Combined With Pulmonary Rehabilitation and Health Care Training on Pulmonary Function, Complications, and Quality of Life in Patients After Radical Resection of Lung Cancer. Front Public Health 2022; 10:911377. [PMID: 35757653 PMCID: PMC9226408 DOI: 10.3389/fpubh.2022.911377] [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: 04/02/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To explore the effects of osimertinib combined with pulmonary rehabilitation and health care training on pulmonary function, complications, and the quality of life (QOL) in patients after radical resection of lung cancer. Methods The data of 120 patients with radical resection of lung cancer admitted to The First Affiliated Hospital of Zhengzhou University from February 2020 to February 2021 were retrospectively analyzed. According to the order of admission, they were equally divided into group p and group q. All patients were given pulmonary rehabilitation and health care training, and group p was treated with osimertinib, while group q received the treatment of pemetrexed combined with cisplatin. The pulmonary function, the incidence of complications, and QOL between the two groups were compared. Results Compared with group q, the pulmonary function was higher (P < 0.001), the incidence of complications was significantly lower (P < 0.05), and QOL scores were markedly higher in group p after treatment (P < 0.001). Conclusion The combination of osimertinib and pulmonary rehabilitation and health care training can improve the pulmonary function of patients with non-small cell lung cancer (NSCLC) with radical resection of lung cancer, and reduce their postoperative morbidity, thereby improving their QOL, which is conducive to reducing the patient's and society's medical burden.
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Affiliation(s)
- Haijiang Xu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yantao Yang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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19
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Effect of Respiration Training-Assisted Western Medicine Therapy on Activity Tolerance, Pulmonary Function, and Quality of Life of Chronic Obstructive Pulmonary Disease Patients in the Stable Phase. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9427602. [PMID: 35399844 PMCID: PMC8986397 DOI: 10.1155/2022/9427602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023]
Abstract
Objective To explore the effect of respiration training-assisted western medicine therapy on activity tolerance, pulmonary function, and quality of life (QOL) of chronic obstructive pulmonary disease (COPD) patients in the stable phase. Methods The medical data of 90 COPD patients in the stable phase treated in the respiratory medicine of our hospital (November 2020-November 2021) were chosen for the retrospective analysis, and the patients were split into group A (n = 45, respiration training-assisted western medicine therapy) and group B (n = 45, western medicine therapy) according to the clinical reception order, so as to record and compare the activity tolerance, lung function, and QOL between the groups after intervention. Results Compared with group B after intervention, group A showed greatly longer mean 6-min walking distance, significantly lower St. George's Respiratory Questionnaire (SGRQ) score, significantly higher specific airway conductance (sGAW) and level values of various lung function indicators, and significantly lower level values of airway resistance (RAW) and specific airway resistance (sRAW) (p all<0.001); the total effective rate was significantly higher in group A (p < 0.05). Conclusion Respiration training-assisted western medicine therapy is a dependable way to improve the activity tolerance of COPD patients in the stable phase, and such strategy largely improves patients' lung function and QOL. Deeper studies will be helpful to establish a preferable solution for such patients.
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20
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Grosbois JM, Gephine S, Kyheng M, Henguelle J, Le Rouzic O, Saey D, Maltais F, Chenivesse C. Physical and affective components of dyspnoea are improved by pulmonary rehabilitation in COPD. BMJ Open Respir Res 2022; 9:9/1/e001160. [PMID: 35078826 PMCID: PMC8796257 DOI: 10.1136/bmjresp-2021-001160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background Dyspnoea is a multidimensional experience of breathing discomfort, but its affective dimension is unfrequently assessed in people with chronic obstructive pulmonary disease (COPD). We evaluated the effectiveness of a home-based pulmonary rehabilitation (PR) programme on the physical and affective components of dyspnoea assessed by the Dyspnoea-12 (D-12) questionnaire. We also determined the baseline characteristics that contributed to the change in D-12 scores. Methods In this retrospective study, 225 people with COPD (age, 65±11 years; forced expiratory volume in 1 s (FEV1), 35±15% of predicted value) were enrolled into a person-centric home-based PR, consisting of a weekly supervised 90 min home session during 8 weeks. D-12 questionnaire, health status, anxiety and depressive symptoms, exercise tolerance and general fatigue were assessed at baseline (M0), at the end of PR programme (M2), and 8 (M8) and 14 months (M14) after M0. Multivariable analysis of covariance (ANCOVA) models were performed to identify the baseline characteristics that contributed to the change in D-12 scores. Results Both physical and affective components of dyspnoea and all the other outcome measures were improved at M2, M8 and M14 compared with baseline (p<0.05). Baseline body mass index was the only significant independent predictor of the changes in physical dyspnoea score, while the change in the affective dimension of dyspnoea after PR was associated with FEV1, anxiety symptoms and exercise tolerance (6 min stepper test). However, since these variables had only a small impact on the changes in D-12 questionnaire scores, results from the ANCOVA analysis should be taken cautiously. Conclusion Both physical and affective components of dyspnoea were improved, at short term and long term, by 8 weeks of individualised home-based PR. The present results support the importance of assessing dyspnoea as a multidimensional experience during PR, warranting replication by robustly designed randomised and controlled studies.
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Affiliation(s)
| | - Sarah Gephine
- Univ. Lille, Univ. Artois, Univ. Littoral Côte D'opale, ULR 7369-Urepsss, Lille, France.,Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec, Quebec, Canada
| | - Maeva Kyheng
- Department of Biostatistics, CHU Lille, Univ. Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - Julie Henguelle
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, UK
| | - Olivier Le Rouzic
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, UK
| | - Didier Saey
- Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec, Quebec, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec, Quebec, Canada
| | - Cecile Chenivesse
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, UK.,Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
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21
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Lahham A, Holland AE. The Need for Expanding Pulmonary Rehabilitation Services. Life (Basel) 2021; 11:1236. [PMID: 34833112 PMCID: PMC8622005 DOI: 10.3390/life11111236] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary rehabilitation is a strongly recommended and effective treatment for people with chronic lung disease. However, access to pulmonary rehabilitation is poor. Globally, pulmonary rehabilitation is accessed by less than 3% of people with chronic lung disease. Barriers to referral, uptake and completion of pulmonary rehabilitation are well documented and linked with organizational, practitioner and patient-related factors. Enhancing the knowledge of health care professionals, family carers, and people with chronic lung disease about the program and its benefits produces modest increases in referral and uptake rates, but evidence of the sustainability of such approaches is limited. Additionally, initiatives focusing on addressing organizational barriers to access, such as expanding services and implementing alternative models to the conventional center-based setting, are not yet widely used in clinical practice. The COVID-19 pandemic has highlighted the urgent need for health care systems to deliver pulmonary rehabilitation programs remotely, safely, and efficiently. This paper will discuss the pressing need to address the issue of the low accessibility of pulmonary rehabilitation. It will also highlight the distinctive challenges to pulmonary rehabilitation delivery in rural and remote regions, as well as low-income countries.
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Affiliation(s)
- Aroub Lahham
- Department of Immunology and Pathology, Monash University, Melbourne 3800, Australia;
| | - Anne E. Holland
- Department of Immunology and Pathology, Monash University, Melbourne 3800, Australia;
- Institute for Breathing and Sleep, Melbourne 3084, Australia
- Department of Physiotherapy, Alfred Health, Melbourne 3004, Australia
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22
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Borghi-Silva A, Garcia-Araújo AS, Winkermann E, Caruso FR, Bassi-Dibai D, Goulart CDL, Dixit S, Back GD, Mendes RG. Exercise-Based Rehabilitation Delivery Models in Comorbid Chronic Pulmonary Disease and Chronic Heart Failure. Front Cardiovasc Med 2021; 8:729073. [PMID: 34722662 PMCID: PMC8548415 DOI: 10.3389/fcvm.2021.729073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Among the most prevalent multimorbidities that accompany the aging process, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) stand out, representing the main causes of hospital admissions in the world. The prevalence of COPD coexistence in patients with CHF is higher than in control subjects, given the common risk factors associated with a complex process of chronic diseases developing in the aging process. COPD-CHF coexistence confers a marked negative impact on mechanical-ventilatory, cardiocirculatory, autonomic, gas exchange, muscular, ventilatory, and cerebral blood flow, further impairing the reduced exercise capacity and health status of either condition alone. In this context, integrated approach to the cardiopulmonary based on pharmacological optimization and non-pharmacological treatment (i.e., exercise-based cardiopulmonary and metabolic rehabilitation) can be emphatically encouraged by health professionals as they are safe and well-tolerated, reducing hospital readmissions, morbidity, and mortality. This review aims to explore aerobic exercise, the cornerstone of cardiopulmonary and metabolic rehabilitation, resistance and inspiratory muscle training and exercise-based rehabilitation delivery models in patients with COPD-CHF multimorbidities across the continuum of the disease. In addition, the review address the importance of adjuncts to enhance exercise capacity in these patients, which may be used to optimize the gains obtained in these programs.
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Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Adriana S Garcia-Araújo
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Eliane Winkermann
- Graduate Program in Comprehensive Health Care, Universidade de Cruz Alta/Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, Brazil
| | - Flavia R Caruso
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Daniela Bassi-Dibai
- Postgraduate Program in Management and Health Services, Ceuma University, São Luís, Brazil
| | - Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Guilherme Dionir Back
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
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23
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Souto-Miranda S, Rodrigues G, Spruit MA, Marques A. Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: a systematic review. Ann Phys Rehabil Med 2021; 65:101564. [PMID: 34329794 DOI: 10.1016/j.rehab.2021.101564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures. OBJECTIVES This systematic review aimed to review all outcomes and measures used in clinical trials of PR for individuals with chronic obstructive pulmonary disease (COPD). METHODS The review involved a search of Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed databases for studies of stable individuals with COPD undergoing PR. Frequency of reporting for each domain, outcome and measure was synthesized by using Microsoft Excel. RESULTS We included 267 studies (43153 individuals with COPD). A broad range of domains (n=22), outcomes (n=163) and measures (n=217) were reported. Several measures were used for the same outcome. The most reported outcomes were exercise capacity (n=218) assessed with the 6-min walk test (n=140), health-related quality of life (n=204) assessed with the Saint George's respiratory questionnaire (n=99), and symptoms (n=158) assessed with the modified Medical Research Council dyspnea scale (n=56). The least reported outcomes were comorbidities, adverse events and knowledge. CONCLUSIONS This systematic review reinforces the need for a core outcome set for PR in individuals with COPD because of high heterogeneity in reported outcomes and measures. Future studies should assess the importance of each outcome for PR involving different stakeholders. PROSPERO ID CRD42017079935.
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Affiliation(s)
- Sara Souto-Miranda
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; iBiMED: Institute of Biomedicine, University of Aveiro, Aveiro, Portugal; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Guilherme Rodrigues
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Research and Development, CIRO, Horn, Netherlands
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; iBiMED: Institute of Biomedicine, University of Aveiro, Aveiro, Portugal.
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