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Vaes AW, Burtin C, Casaburi R, Celli BR, Evans RA, Lareau SC, Nici L, Rochester CL, Troosters T. Prevalence and prognostic importance of exercise limitation and physical inactivity in COPD. Breathe (Sheff) 2024; 20:230179. [PMID: 38873237 PMCID: PMC11167648 DOI: 10.1183/20734735.0179-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/08/2024] [Indexed: 06/15/2024] Open
Abstract
Exercise limitation and physical inactivity are separate, but related constructs. Both are commonly present in individuals with COPD, contribute to disease burden over and above the respiratory impairments, and are independently predictive of adverse outcomes. Because of this, clinicians should consider assessing these variables in their patients with COPD. Field tests of exercise performance such as the 6-min walk test and the incremental and endurance shuttle walk tests require limited additional resources, and results correlate with negative outcomes. Laboratory measures of exercise performance using a treadmill or cycle ergometer assess exercise capacity, provide prognostic information and have the advantage of explaining physiological mechanisms (and their interactions) underpinning exercise limitation. Limitations in exercise capacity (i.e. "cannot do") and physical inactivity (i.e. "do not do") are both associated with mortality; exercise limitation appears to be the more important driver of this outcome.
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Affiliation(s)
- Anouk W. Vaes
- Department of Research and Development, Ciro, Horn, The Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Bartolome R. Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachael A. Evans
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Suzanne C. Lareau
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Linda Nici
- Providence Veterans Affairs Medical Center, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Carolyn L. Rochester
- Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
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Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
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Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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Asimakos A, Spetsioti S, Mavronasou A, Gounopoulos P, Siousioura D, Dima E, Gianniou N, Sigala I, Zakynthinos G, Kotanidou A, Vogiatzis I, Katsaounou P. Additive benefit of rehabilitation on physical status, symptoms and mental health after hospitalisation for severe COVID-19 pneumonia. BMJ Open Respir Res 2023; 10:e001377. [PMID: 37385736 PMCID: PMC10314701 DOI: 10.1136/bmjresp-2022-001377] [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: 07/24/2022] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION The potential additive benefits of rehabilitation beyond spontaneous recovery post-COVID-19 currently remain unknown. METHODS In this prospective, interventional, non-randomised parallel assignment two-arm study, we investigated the effects of an 8-week rehabilitation programme (Rehab, n=25) added to usual care (UC) versus UC (n=27) on respiratory symptoms, fatigue, functional capacity, mental health and health-related quality of life in patients with COVID-19 pneumonia, 6-8 weeks post-hospital discharge. The rehabilitation programme included exercise, education, dietary and psychological support. Patients with chronic obstructive pulmonary disease, respiratory and heart failure were excluded from the study. RESULTS At baseline, groups were not different in mean age (56 years), gender (53% female), intensive care unit admission (61%), intubation (39%), days of hospitalisation (25), number of symptoms (9) and number of comorbidities (1.4). Baseline evaluation was conducted at median (IQR) 76 (27) days after symptoms onset. Groups were not different regarding baseline evaluation outcomes. At 8 weeks, Rehab showed significantly greater improvement in COPD Assessment Test by a mean±SEM (95% CI) 7.07±1.36 (4.29-9.84), p <0.001 and all three fatigue questionnaires: Chalder-Likert: 5.65±1.27 (3.04-8.25), p <0.001; bimodal: 3.04±0.86 (1.28-4.79), p=0.001; Functional Assessment of Chronic Illness Therapy: 6.37±2.09 (2.08-10.65), p=0.005 and Fatigue Severity Scale: 1.36±0.433 (0.47-2.25), p=0.004. At 8 weeks rehab also showed significantly greater improvment in Short Physical Performance Battery: 1.13±0.33 (0.46-1.79), p=0.002; Hospital Anxiety and Depression Scale (HADS) Anxiety: 2.93±1.01 (0.67-5.18), p=0.013; Beck Depression Inventory: 7.81±3.07 (1.52-14.09), p=0.017; Montreal Cognitive Assessment: 2.83±0.63 (1.5-4.14), p <0.001; EuroQol (EQ-5D-5L) Utility Index: 0.21±0.05 (0.1-0.32), p=0.001 and Visual Analogue Scale: 6.57±3.21 (0.2-13.16), p=0.043. Both groups significantly improved 6-min walking distance by approximately 60 m and pulmonary function measures, whereas post-traumatic stress disorder measurement IES-R (Impact of Event Scale, Revised) and HADS-Depression score were not different between groups at 8 weeks. A 16% attrition rate was observed in the rehabilitation group exhibiting a threefold increase in training workload. There were no adverse effects reported during exercise training. DISCUSSION These findings highlight the added value of rehabilitation post-COVID-19 to amplify the natural course of physical and mental recovery that otherwise would remain incomplete with UC.
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Affiliation(s)
- Andreas Asimakos
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
| | - Stavroula Spetsioti
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aspasia Mavronasou
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, University of Thessaly, Lamia, Greece
| | | | - Dimitra Siousioura
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
| | - Effrosyni Dima
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
| | - Niki Gianniou
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
| | - Ioanna Sigala
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
| | - Georgios Zakynthinos
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
| | - Anastasia Kotanidou
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Vogiatzis
- Sport, Exercise & Rehabilitation, University of Northumbria at Newcastle, Newcastle upon Tyne, UK
| | - Paraskevi Katsaounou
- 1st Department of Critical Care and Pulmonary Services, Evaggelismos Hospital, Athens, Greece
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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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: 5] [Impact Index Per Article: 5.0] [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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Astorino TA, Causer E, Hazell TJ, Arhen BB, Gurd BJ. Change in Central Cardiovascular Function in Response to Intense Interval Training: A Systematic Review and Meta-analysis. Med Sci Sports Exerc 2022; 54:1991-2004. [PMID: 35881924 DOI: 10.1249/mss.0000000000002993] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION High-intensity interval training and sprint interval training significantly increase maximal oxygen uptake (V̇O 2max ), which enhances endurance performance and health status. Whether this response is due to increases in central cardiovascular function (cardiac output (CO) and blood volume) or peripheral factors is unknown. PURPOSE This study aimed to conduct a systematic review and meta-analysis to assess the effects of high-intensity interval training and sprint interval training (referred to as intense interval training) on changes in central cardiovascular function. METHODS We performed a systematic search of eight databases for studies denoting increases in V̇O 2max in which CO, stroke volume (SV), blood volume, plasma volume, end-diastolic/systolic volume, or hematocrit were measured. RESULTS Forty-five studies were included in this analysis, comprising 946 men and women of various health status (age and V̇O 2max , 20-76 yr and 13-61 mL·kg -1 ·min -1 ) who performed 6-96 sessions of interval training. Results showed an increase in V̇O 2max with intense interval training that was classified as a large effect ( d = 0.83). SV ( d = 0.69), and CO ( d = 0.49) had moderate effect sizes in response to intense interval training. Of 27 studies in which CO was measured, 77% exhibited significant increases in resting CO or that obtained during exercise. Similarly, 93% of studies revealed significant increases in SV in response to intense interval training. Effect sizes for these outcomes were larger for clinical versus healthy populations. Plasma volume, blood volume, and hematocrit had small effect sizes after training ( d = 0.06-0.14). CONCLUSIONS Increases in V̇O 2max demonstrated with intense interval training are attendant with increases in central O 2 delivery with little contribution from changes in hematocrit, blood volume, or plasma volume.
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Affiliation(s)
- Todd A Astorino
- Department of Kinesiology, California State University-San Marcos. San Marcos, CA
| | - Ejaz Causer
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, CANADA
| | - Tom J Hazell
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, CANADA
| | - Benjamin B Arhen
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, CANADA
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, CANADA
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Chynkiamis N, Lane ND, Megaritis D, Manifield J, Loizou I, Alexiou C, Riazati S, LoMauro A, Bourke SC, Vogiatzis I. Effect of portable noninvasive ventilation on thoracoabdominal volumes in recovery from intermittent exercise in patients with COPD. J Appl Physiol (1985) 2021; 131:401-413. [PMID: 34110232 DOI: 10.1152/japplphysiol.00081.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously showed that use of portable noninvasive ventilation (pNIV) during recovery periods within intermittent exercise improved breathlessness and exercise tolerance in patients with COPD compared with pursed-lip breathing (PLB). However, in a minority of patients recovery from dynamic hyperinflation (DH) was better with PLB, based on inspiratory capacity. We further explored this using Optoelectronic Plethysmography to assess total and compartmental thoracoabdominal volumes. Fourteen patients with COPD (means ± SD) (FEV1: 55% ± 22% predicted) underwent, in a balanced order sequence, two intermittent exercise protocols on the cycle ergometer consisting of five repeated 2-min exercise bouts at 80% peak capacity, separated by 2-min recovery periods, with application of pNIV or PLB in the 5 min of recovery. Our findings identified seven patients showing recovery in DH with pNIV (DH responders) whereas seven showed similar or better recovery in DH with PLB. When pNIV was applied, DH responders compared with DH nonresponders exhibited greater tidal volume (by 0.8 ± 0.3 L, P = 0.015), inspiratory flow rate (by 0.6 ± 0.5 L/s, P = 0.049), prolonged expiratory time (by 0.6 ± 0.5 s, P = 0.006), and duty cycle (by 0.7 ± 0.6 s, P = 0.007). DH responders showed a reduction in end-expiratory thoracoabdominal DH (by 265 ± 633 mL) predominantly driven by reduction in the abdominal compartment (by 210 ± 494 mL); this effectively offset end-inspiratory rib-cage DH. Compared with DH nonresponders, DH responders had significantly greater body mass index (BMI) by 8.4 ± 3.2 kg/m2, P = 0.022 and tended toward less severe resting hyperinflation by 0.3 ± 0.3 L. Patients with COPD who mitigate end-expiratory rib-cage DH by expiratory abdominal muscle recruitment benefit from pNIV application.NEW & NOTEWORTHY Compared with the pursed-lip breathing technique, acute application of portable noninvasive ventilation during recovery from intermittent exercise improved end-expiratory thoracoabdominal dynamic hyperinflation (DH) in 50% of patients with COPD (DH responders). DH responders, compared with DH nonresponders, exhibited a reduction in end-expiratory thoracoabdominal DH predominantly driven by the abdominal compartment that effectively offset end-expiratory rib cage DH. The essential difference between DH responders and DH nonresponders was, therefore, in the behavior of the abdomen.
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Affiliation(s)
- N Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon-Tyne, United Kingdom
| | - N D Lane
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle Upon-Tyne, United Kingdom.,Translational and Clinical Research Institute, Newcastle University, Newcastle Upon-Tyne, United Kingdom
| | - D Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon-Tyne, United Kingdom
| | - J Manifield
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon-Tyne, United Kingdom
| | - I Loizou
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon-Tyne, United Kingdom
| | - C Alexiou
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon-Tyne, United Kingdom
| | - S Riazati
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon-Tyne, United Kingdom
| | - A LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - S C Bourke
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle Upon-Tyne, United Kingdom.,Translational and Clinical Research Institute, Newcastle University, Newcastle Upon-Tyne, United Kingdom
| | - I Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon-Tyne, United Kingdom.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle Upon-Tyne, United Kingdom
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Manifield J, Chynkiamis N, Alexiou C, Megaritis D, Hume E, Barry G, Vogiatzis I. Acute thoracoabdominal and hemodynamic responses to tapered flow resistive loading in healthy adults. Respir Physiol Neurobiol 2021; 286:103617. [PMID: 33454351 DOI: 10.1016/j.resp.2021.103617] [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: 11/10/2020] [Revised: 12/22/2020] [Accepted: 01/01/2021] [Indexed: 11/17/2022]
Abstract
We investigated the acute physiological responses of tapered flow resistive loading (TFRL) at 30, 50 and 70 % maximal inspiratory pressure (PImax) in 12 healthy adults to determine an optimal resistive load. Increased end-inspiratory rib cage and decreased end-expiratory abdominal volumes equally contributed to the expansion of thoracoabdominal tidal volume (captured by optoelectronic plethysmography). A significant decrease in end-expiratory thoracoabdominal volume was observed from 30 to 50 % PImax, from 30 to 70 % PImax, and from 50 to 70 % PImax. Cardiac output (recorded by cardio-impedance) increased from rest by 30 % across the three loading trials. Borg dyspnoea increased from 2.36 ± 0.20 at 30 % PImax, to 3.45 ± 0.21 at 50 % PImax, and 4.91 ± 0.25 at 70 % PImax. End-tidal CO2 decreased from rest during 30, 50 and 70 %PImax (26.23 ± 0.59, 25.87 ± 1.02 and 24.30 ± 0.82 mmHg, respectively). Optimal intensity for TFRL is at 50 % PImax to maximise global respiratory muscle and cardiovascular loading whilst minimising hyperventilation and breathlessness.
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Affiliation(s)
- James Manifield
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK.
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Charikleia Alexiou
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Dimitrios Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
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Burge AT, Cox NS, Abramson MJ, Holland AE. Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2020; 4:CD012626. [PMID: 32297320 PMCID: PMC7160071 DOI: 10.1002/14651858.cd012626.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Escalating awareness of the magnitude of the challenge posed by low levels of physical activity in people with chronic obstructive pulmonary disease (COPD) highlights the need for interventions to increase physical activity participation. The widely-accepted benefits of physical activity, coupled with the increasing availability of wearable monitoring devices to objectively measure participation, has led to a dramatic rise in the number and variety of studies that aimed to improve the physical activity of people with COPD. However, little was known about the relative efficacy of interventions tested so far. OBJECTIVES In people with COPD, which interventions are effective at improving objectively-assessed physical activity? SEARCH METHODS We identified trials from the Cochrane Airways Trials Register Register, which contains records identified from bibliographic databases including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, AMED, and PsycINFO. We also searched PEDro, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform portal and the Australian New Zealand Clinical Trials Registry (from inception to June 2019). We checked reference lists of all primary studies and review articles for additional references, as well as respiratory journals and respiratory meeting abstracts, to identify relevant studies. SELECTION CRITERIA We included randomised controlled trials of interventions that used objective measures for the assessment of physical activity in people with COPD. Trials compared an intervention with no intervention or a sham/placebo intervention, an intervention in addition to another standard intervention common to both groups, or two different interventions. DATA COLLECTION AND ANALYSIS We used standard methods recommended by Cochrane. Subgroup analyses were possible for supervised compared to unsupervised pulmonary rehabilitation programmes in clinically-stable COPD for a range of physical activity outcomes. Secondary outcomes were health-related quality of life, exercise capacity, adverse events and adherence. Insufficient data were available to perform prespecified subgroup analyses by duration of intervention or disease severity. We undertook sensitivity analyses by removing studies that were at high or unclear risk of bias for the domains of blinding and incomplete outcome data. MAIN RESULTS We included 76 studies with 8018 participants. Most studies were funded by government bodies, although some were sponsored by equipment or drug manufacturers. Only 38 studies had physical activity as a primary outcome. A diverse range of interventions have been assessed, primarily in single studies, but improvements have not been systematically demonstrated following any particular interventions. Where improvements were demonstrated, results were confined to single studies, or data for maintained improvement were not provided. Step count was the most frequently reported outcome, but it was commonly assessed using devices with documented inaccuracy for this variable. Compared to no intervention, the mean difference (MD) in time in moderate- to vigorous-intensity physical activity (MVPA) following pulmonary rehabilitation was four minutes per day (95% confidence interval (CI) -2 to 9; 3 studies, 190 participants; low-certainty evidence). An improvement was demonstrated following high-intensity interval exercise training (6 minutes per day, 95% CI 4 to 8; 2 studies, 275 participants; moderate-certainty evidence). One study demonstrated an improvement following six months of physical activity counselling (MD 11 minutes per day, 95% CI 7 to 15; 1 study, 280 participants; moderate-certainty evidence), but we found mixed results for the addition of physical activity counselling to pulmonary rehabilitation. There was an improvement following three to four weeks of pharmacological treatment with long-acting muscarinic antagonist and long-acting beta2-agonist (LAMA/LABA) compared to placebo (MD 10 minutes per day, 95% CI 4 to 15; 2 studies, 423 participants; high-certainty evidence). These interventions also demonstrated improvements in other measures of physical activity. Other interventions included self-management strategies, nutritional supplementation, supplemental oxygen, endobronchial valve surgery, non-invasive ventilation, neuromuscular electrical stimulation and inspiratory muscle training. AUTHORS' CONCLUSIONS A diverse range of interventions have been assessed, primarily in single studies. Improvements in physical activity have not been systematically demonstrated following any particular intervention. There was limited evidence for improvement in physical activity with strategies including exercise training, physical activity counselling and pharmacological management. The optimal timing, components, duration and models for interventions are still unclear. Assessment of quality was limited by a lack of methodological detail. There was scant evidence for a continued effect over time following completion of interventions, a likely requirement for meaningful health benefits for people with COPD.
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Affiliation(s)
- Angela T Burge
- La Trobe UniversityDepartment of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and SportMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneAustralia
- Alfred HealthPhysiotherapyPO Box 315MelbourneAustraliaPrahran VIC 3181
- Monash UniversityDepartment of Allergy, Clinical Immunology and Respiratory MedicineMelbourneAustralia
| | - Narelle S Cox
- Institute for Breathing and SleepMelbourneAustralia
- Monash UniversityDepartment of Allergy, Clinical Immunology and Respiratory MedicineMelbourneAustralia
- School of Allied Health, Human Services and Sport, La Trobe UniversityDepartment of Physiotherapy, Podiatry and Prosthetics and OrthoticsMelbourneVictoriaAustralia3004
| | - Michael J Abramson
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneVictoriaAustralia3004
| | - Anne E Holland
- La Trobe UniversityDepartment of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and SportMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneAustralia
- Alfred HealthPhysiotherapyPO Box 315MelbourneAustraliaPrahran VIC 3181
- Monash UniversityDepartment of Allergy, Clinical Immunology and Respiratory MedicineMelbourneAustralia
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Fang TP, Chen YH, Hsiao HF, Cho HY, Tsai YH, Huang CC, Hsieh MJ, Wu HP, Lin HL. Effect of high flow nasal cannula on peripheral muscle oxygenation and hemodynamic during paddling exercise in patients with chronic obstructive pulmonary disease: a randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:280. [PMID: 32355724 PMCID: PMC7186666 DOI: 10.21037/atm.2020.03.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Exercise training for patients with chronic obstructive pulmonary disease (COPD) improves their endurance and oxygenation. Supplemental oxygen delivered by high flow nasal cannula (HFNC) reportedly improves the clinical outcomes during high-intensity exercise. However, the physical benefits of the provision of supplemental oxygen with HFNC for the improvement of exercise performance have not been fully investigated. This randomized trial aimed to evaluate the effect of HFNC on the hemodynamic status and peripheral muscle microcirculation during exercise training. Methods In this multicenter, randomized controlled parallel two-group study, 32 patients with moderate to severe COPD were randomly assigned into the nasal cannula (NC) group (n=15) with a flow rate of 2–3 L/min or the HFNC group (n=17) with a flow rate of 45 L/min for twelve 40 min exercise training sessions. Results The mean cardiac index (CI) and stroke volume (SV) of the NC group in the first session were significantly lower than those of the HFNC group (3.68±0.76 vs. 4.5±0.76 L/min/m2, P=0.014; 63.03±9.87 vs. 74.22±19.48, P=0.002, respectively). The systemic vascular resistance (SVR) of the NC group was significantly lower in the seventh session than in the first session (891±287 vs. 1,138±381 dyn-s/cm5, respectively, P=0.048). The mean deoxyhemoglobin level was higher in the HFNC group in the 1st session and lower in the 12th session (1.09±9.04 vs. 7.3±7.3 µm, P=0.046). The COPD Assessment Test score, Modified Medical Research Council scale score, maximum inspiratory pressure (MIP), and maximum expiratory pressure were different within and between the groups. Conclusions HFNC, with a lower oxygen concentration than that used with a traditional NC, yielded lower deoxygenated hemoglobin levels after 12 suboptimal exercise training sessions. In contrast, the higher oxygen concentration delivered by NC reduced SVR. The COPD assessment score improved on exercise training, regardless of the supplemental oxygen delivery method.
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Affiliation(s)
- Tien-Pei Fang
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi.,Department of Respiratory Therapy, Chang Gung Technical University, Chiayi
| | - Yen-Huey Chen
- Department of Respiratory Therapy, Chang Gung Technical University, Chiayi.,Department of Respiratory Therapy, Chang Gung University, Taoyuan.,Department of Respiratory Therapy, Linkou Chang Gung Memorial Hospital, Taoyuan
| | - Hsiu-Feng Hsiao
- Department of Respiratory Therapy, Chang Gung University, Taoyuan.,Department of Respiratory Therapy, Linkou Chang Gung Memorial Hospital, Taoyuan
| | - Hsiu-Ying Cho
- Department of Respiratory Therapy, Chang Gung University, Taoyuan.,Department of Respiratory Therapy, Linkou Chang Gung Memorial Hospital, Taoyuan
| | - Ying-Huang Tsai
- Department of Respiratory Therapy, Chang Gung University, Taoyuan.,Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan
| | - Chung-Chi Huang
- Department of Respiratory Therapy, Chang Gung University, Taoyuan.,Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan
| | - Meng-Jer Hsieh
- Department of Respiratory Therapy, Chang Gung University, Taoyuan.,Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi
| | - Huang-Pin Wu
- Department of Pulmonary and Critical Care Medicine, Keelung Chang Gung Memorial Hospital, Keelung
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi.,Department of Respiratory Therapy, Chang Gung Technical University, Chiayi.,Department of Respiratory Therapy, Chang Gung University, Taoyuan
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10
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Adolfo JR, Dhein W, Sbruzzi G. Intensity of physical exercise and its effect on functional capacity in COPD: systematic review and meta-analysis. ACTA ACUST UNITED AC 2019; 45:e20180011. [PMID: 31576905 PMCID: PMC7447536 DOI: 10.1590/1806-3713/e20180011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/08/2019] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the effects of high-intensity interval training (HIIT), in comparison with those of continuous exercise, on functional capacity and cardiovascular variables in patients with COPD, through a systematic review and meta-analysis of randomized controlled trials. Methods: We searched PubMed, the Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, and EMBASE, as well as performing hand searches, for articles published up through January of 2017. We included studies comparing exercise regimens of different intensities, in terms of their effects on functional capacity and cardiovascular variables in patients with COPD. Results: Of the 78 articles identified, 6 were included in the systematic review and meta-analysis. Maximal oxygen consumption (VO2max) did not differ significantly between HIIT and control interventions. That was true for relative VO2max (0.03 mL/kg/min; 95% CI: −3.05 to 3.10) and absolute VO2max (0.03 L/min, 95% CI: −0.02 to 0.08). Conclusions: The effects of HIIT appear to be comparable to those of continuous exercise in relation to functional and cardiovascular responses. However, our findings should be interpreted with caution because the studies evaluated present a high risk of bias, which could have a direct influence on the results.
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Affiliation(s)
- Juliano Rodrigues Adolfo
- . Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - William Dhein
- . Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Graciele Sbruzzi
- . Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Curso de Fisioterapia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
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11
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Berton DC, Marques RD, Palmer B, O'Donnell DE, Neder JA. Effects of lung deflation induced by tiotropium/olodaterol on the cardiocirculatory responses to exertion in COPD. Respir Med 2019; 157:59-68. [PMID: 31522031 DOI: 10.1016/j.rmed.2019.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hyperinflation has been associated with negative cardiocirculatory consequences in patients with chronic obstructive pulmonary disease (COPD). These abnormalities are likely to worsen when the demands for O2 increase, e.g., under the stress of exercise. Thus, pharmacologically-induced lung deflation may improve cardiopulmonary interactions and exertional cardiac output leading to higher limb muscle blood flow and oxygenation in hyperinflated patients with COPD. METHODS 20 patients (residual volume = 201.6 ± 63.6% predicted) performed endurance cardiopulmonary exercise tests (75% peak) 1 h after placebo or tiotropium/olodaterol 5/5 μg via the Respimat® inhaler (Boehringer Ingelheim, Ingelheim am Rhein, Germany). Cardiac output was assessed by signal-morphology impedance cardiography. Near-infrared spectroscopy determined quadriceps blood flow (indocyanine green dye) and intra-muscular oxygenation. RESULTS Tiotropium/olodaterol was associated with marked lung deflation (p < 0.01): residual volume decreased by at least 0.4 L in 14/20 patients (70%). The downward shift in the resting static lung volumes was associated with less exertional inspiratory constraints and dyspnoea thereby increasing exercise endurance by ~50%. Contrary to our premises, however, neither central and peripheral hemodynamics nor muscle oxygenation improved after active intervention compared to placebo. These results were consistent with those found in a subgroup of patients showing the largest decrements in residual volume (p < 0.05). CONCLUSIONS The beneficial effects of tiotropium/olodaterol on resting and operating lung volumes are not translated into enhanced cardiocirculatory responses to exertion in hyperinflated patients with COPD. Improvement in exercise tolerance after dual bronchodilation is unlikely to be mechanistically linked to higher muscle blood flow and/or O2 delivery.
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Affiliation(s)
- Danilo C Berton
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada; Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal Do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata D Marques
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada; Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal Do Rio Grande do Sul, Porto Alegre, Brazil
| | - Brandon Palmer
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada.
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12
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Hemodynamic effects of portable non-invasive ventilation in healthy men. Respir Physiol Neurobiol 2019; 268:103248. [PMID: 31271841 DOI: 10.1016/j.resp.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/10/2019] [Accepted: 06/29/2019] [Indexed: 11/23/2022]
Abstract
VitaBreath is a portable, non-invasive ventilation device (pNIV) that relieves shortness of breath in COPD by delivering fixed inspiratory and expiratory positive airway pressures (IPAP/EPAP: 18/8 cmH2O). Fixed pressures may cause circulatory compromise. We investigated the circulatory effects of pNIV during normal breathing (NB) and after Eucapnic Voluntary Hyperpnoea trials (EVH) sustained at 80% MVV. In a balanced order sequence, 10 healthy men performed four trials on one visit: 1-min of pNIV (intervention) or 1-min quiet breathing (QB) during NB; and 1-min pNIV (intervention) or 1-min QB during recovery from 3-min EVH. Compared to QB, pNIV application was associated with greater cardiac output (CO: 1.6 ± 1.9 L.min-1; P = 0.03). One minute into recovery from EVH, pNIV caused greater CO (2.2 ± 1.6 L.min-1; P = 0.01) compared to QB. Mean blood pressure was not different with pNIV compared to control. pNIV increased thoracoabdominal volumes and breathing frequency during NB and recovery from EVH. pNIV application does not induce adverse hemodynamic effects in healthy men.
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13
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Louvaris Z, Spetsioti S, Andrianopoulos V, Chynkiamis N, Habazettl H, Wagner H, Zakynthinos S, Wagner PD, Vogiatzis I. Cardiac output measurement during exercise in COPD: A comparison of dye dilution and impedance cardiography. CLINICAL RESPIRATORY JOURNAL 2019; 13:222-231. [PMID: 30724023 DOI: 10.1111/crj.13002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/15/2019] [Accepted: 01/26/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Impedance cardiography (IC) derived from morphological analysis of the thoracic impedance signal is now commonly used for noninvasive assessment of cardiac output (CO) at rest and during exercise. However, in Chronic Obstructive Pulmonary Disease (COPD), conflicting findings put its accuracy into question. OBJECTIVES We therefore compared concurrent CO measurements captured by IC (PhysioFlow: COIC ) and by the indocyanine green dye dilution method (CODD ) in patients with COPD. METHODS Fifty paired CO measurements were concurrently obtained using the two methods from 10 patients (FEV1 : 50.5 ± 17.5% predicted) at rest and during cycling at 25%, 50%, 75% and 100% peak work rate. RESULTS From rest to peak exercise COIC and CODD were strongly correlated (r = 0.986, P < 0.001). The mean absolute and percentage differences between COIC and CODD were 1.08 L/min (limits of agreement (LoA): 0.05-2.11 L/min) and 18 ± 2%, respectively, with IC yielding systematically higher values. Bland-Altman analysis indicated that during exercise only 7 of the 50 paired measurements differed by more than 20%. When data were expressed as changes from rest, correlations and agreement between the two methods remained strong over the entire exercise range (r = 0.974, P < 0.001, with no significant difference: 0.19 L/min; LoA: -0.76 to 1.15 L/min). Oxygen uptake (VO2 ) and CODD were linearly related: r = 0.893 (P < 0.001), CODD = 5.94 × VO2 + 2.27 L/min. Similar results were obtained for VO2 and COIC (r = 0.885, P < 0.001, COIC = 6.00 × VO2 + 3.30 L/min). CONCLUSIONS These findings suggest that IC provides an acceptable CO measurement from rest to peak cycling exercise in patients with COPD.
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Affiliation(s)
- Zafeiris Louvaris
- Faculty of Movement and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Department Rehabilitation Sciences KU Leuven, University Hospitals Leuven, Leuven, Belgium.,1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece.,Department of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Spetsioti
- 1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Nikolaos Chynkiamis
- 1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece.,Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle, United Kingdom
| | - Helmut Habazettl
- Institute of Physiology, Charite-University Medicine Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Institute of Anesthesiology, German Heart Institute Berlin, Berlin, Germany
| | - Harrieth Wagner
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Spyros Zakynthinos
- 1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece
| | - Peter D Wagner
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Ioannis Vogiatzis
- 1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece.,Department of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece.,Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle, United Kingdom
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14
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Intermittent Use of Portable NIV Increases Exercise Tolerance in COPD: A Randomised, Cross-Over Trial. J Clin Med 2019; 8:jcm8010094. [PMID: 30650617 PMCID: PMC6352193 DOI: 10.3390/jcm8010094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 12/26/2018] [Accepted: 01/14/2019] [Indexed: 01/20/2023] Open
Abstract
During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip breathing (PLB) on exercise tolerance. Twenty-four COPD patients were randomised to a high-intensity (HI: 2-min at 80% peak work rate (WRpeak) alternated with 2-min recovery; n = 13), or a moderate-intensity (MOD: 6-min at 60% WRpeak alternated with 2-min recovery; n = 11) protocol, and within these groups two tests were performed using pNIV and PLB during recovery in balanced order. Upon completion, patients were provided with pNIV; use over 12 weeks was assessed. Compared to PLB, pNIV increased exercise tolerance (HI: by 5.2 ± 6.0 min; MOD: by 5.8 ± 6.7 min) (p < 0.05). With pNIV, mean inspiratory capacity increased and breathlessness decreased by clinically meaningful margins during recovery compared to the end of exercise (HI: by 140 ± 110 mL and 1.2 ± 1.7; MOD: by 170 ± 80 mL and 1.0 ± 0.7). At 12 weeks, patients reported that pNIV reduced anxiety (median: 7.5/10 versus 4/10, p = 0.001) and recovery time from breathlessness (17/24 patients; p = 0.002); 23/24 used the device at least weekly. pNIV increased exercise tolerance by reducing dynamic hyperinflation and breathlessness in COPD patients.
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15
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Li P, Liu J, Lu Y, Liu X, Wang Z, Wu W. Effects of long-term home-based Liuzijue exercise combined with clinical guidance in elderly patients with chronic obstructive pulmonary disease. Clin Interv Aging 2018; 13:1391-1399. [PMID: 30122911 PMCID: PMC6080664 DOI: 10.2147/cia.s169671] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose This study was designed to investigate the effects of long-term home-based Liuzijue exercise combined with clinical guidance in elderly patients with chronic obstructive pulmonary disease (COPD). Methods Forty patients with COPD at stages II–III of the Global Initiative for Chronic Obstructive Lung Disease were enrolled. The subjects were randomly allocated to the Liuzijue exercise group (LG) or control group (CG) in a 1:1 ratio. Participants in the LG performed six Liuzijue training sessions, including 4 days at home and 2 days in the hospital with clinical guidance for 60 minutes/day for 6 months. Participants in the CG conducted no exercise intervention. In addition, lung function test, 6-minute walking test (6MWT), 30-second sit-to-stand test (30 s SST), and the St George’s Respiratory Questionnaire (SGRQ) were conducted at the baseline and at the end of the intervention. Results Thirty-six patients completed the study. The patients’ lung function improved significantly (p < 0.05) in the LG as well as the 6MWT, 30 s SST, and SGRQ score (p < 0.01). While the SGRQ total score, activity, and impact scores increased significantly (p < 0.05) in the CG. In addition, there were significant differences between the groups (p < 0.01) in regard to the values of forced expiratory volume in 1 second as a percentage of the predicted volume, 6MWT, 30 s SST, and SGRQ. Conclusions Long-term home-based Liuzijue exercise combined with clinical guidance can effectively improve the pulmonary function, exercise capacity, and quality of life of elderly patients with moderate to severe COPD.
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Affiliation(s)
- Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China,
| | - Jingxin Liu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China,
| | - Yufan Lu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China,
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Zhenwei Wang
- Department of Respiratory Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, People's Republic of China
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China,
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16
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Bravo DM, Gimenes AC, Amorim BC, Alencar MC, Berton DC, O’Donnell DE, Nery LE, Neder JA. Excess ventilation in COPD: Implications for dyspnoea and tolerance to interval exercise. Respir Physiol Neurobiol 2018; 250:7-13. [DOI: 10.1016/j.resp.2018.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/31/2017] [Accepted: 01/21/2018] [Indexed: 12/20/2022]
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17
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18
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Theodorakopoulou EP, Gennimata SA, Harikiopoulou M, Kaltsakas G, Palamidas A, Koutsoukou A, Roussos C, Kosmas EN, Bakakos P, Koulouris NG. Effect of pulmonary rehabilitation on tidal expiratory flow limitation at rest and during exercise in COPD patients. Respir Physiol Neurobiol 2017; 238:47-54. [PMID: 28109942 DOI: 10.1016/j.resp.2017.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Abstract
We hypothesized that severe COPD patients who present with the disadvantageous phenomenon of Expiratory Flow Limitation (EFL) may benefit as COPD patients without EFL do after implementation of a Pulmonary Rehabilitation (PR) program. Forty-two stable COPD patients were studied at rest and during exercise. EFL and dynamic hyperinflation (DH) were documented using the negative expiratory pressure (NEP) technique and inspiratory capacity (IC) maneuvers, respectively. Patient centered outcomes were evaluated by the Saint-George's Respiratory Questionnaire (SGRQ) and the mMRC dyspnea scale. Before PR, 16 patients presented with EFL at rest and/or during exercise. After PR, EFL was abolished in 15 out of those 16 EFL patients who exhibited a significant increase in IC values. These were mainly accomplished through a modification of the breathing pattern. In the 26 NFL patients no increase was noted in their IC or a modification of their breathing pattern. However, both NFL and EFL COPD patients improved exercise capacity and patients centered outcomes undergoing the same PR program.
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Affiliation(s)
- Elpida P Theodorakopoulou
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece; Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Sofia-Antiopi Gennimata
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Maria Harikiopoulou
- Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Georgios Kaltsakas
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Anastasios Palamidas
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Antonia Koutsoukou
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Charis Roussos
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Epameinondas N Kosmas
- Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Petros Bakakos
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Nickolaos G Koulouris
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
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Louvaris Z, Spetsioti S, Kortianou EA, Vasilopoulou M, Nasis I, Kaltsakas G, Koulouris NG, Vogiatzis I. Interval training induces clinically meaningful effects in daily activity levels in COPD. Eur Respir J 2016; 48:567-70. [DOI: 10.1183/13993003.00679-2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/14/2016] [Indexed: 11/05/2022]
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20
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Spruit MA, Burtin C, De Boever P, Langer D, Vogiatzis I, Wouters EF, Franssen FM. COPD and exercise: does it make a difference? Breathe (Sheff) 2016; 12:e38-49. [PMID: 27408645 PMCID: PMC4933612 DOI: 10.1183/20734735.003916] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
KEY POINTS Physiological changes are observed following a structured exercise training programme in patients with COPD, without changes in resting lung function.Exercise training is the cornerstone of a comprehensive pulmonary rehabilitation programme in patients with COPD.Most comorbidities in patients referred for pulmonary rehabilitation remain undiagnosed and untreated.After careful screening, it is safe for COPD patients with comorbidities to obtain significant and clinically relevant improvements in functional exercise capacity and health status after an exercise-based pulmonary rehabilitation programme. EDUCATIONAL AIMS To inform readers of the positive effects of exercise-based pulmonary rehabilitation in patients with COPD, even with comorbid conditions.To inform readers of the importance of physical activity in patients with COPD. Exercise training is widely regarded as the cornerstone of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). Indeed, exercise training has been identified as the best available means of improving muscle function and exercise tolerance in patients with COPD. So, exercise training truly makes a difference in the life of patients with COPD. In this review, an overview is provided on the history of exercise training (as standalone intervention or as part of a comprehensive pulmonary rehabilitation programme), exercise training in comorbid patients with COPD, and the impact of physical activity counselling in a clean air environment.
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Affiliation(s)
- Martijn A. Spruit
- Dept of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Patrick De Boever
- Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Daniël Langer
- Faculty of Kinesiology and Rehabilitation Sciences and University Hospitals Leuven, Respiratory Rehabilitation and Respiratory Division, KU Leuven-University of Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- National and Kapodistrian University of Athens, Faculty of Physical Education and Sports Sciences and 1st Dept of Respiratory Medicine, Athens, Greece
| | - Emiel F.M. Wouters
- Dept of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Frits M.E. Franssen
- Dept of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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21
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Dubé BP, Laveneziana P. Exploring cardio-pulmonary interactions by examining the ventilatory, pulmonary gas exchange, and heart rate kinetics response to high-intensity cycle exercise in COPD patients. Respir Physiol Neurobiol 2015; 219:103-5. [DOI: 10.1016/j.resp.2015.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/24/2022]
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