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Paneroni M, Vogiatzis I, Cavicchia A, Salvi B, Bertacchini L, Venturelli M, Vitacca M. Upper-limb interval versus constant-load exercise in patients with COPD: a physiological crossover study. ERJ Open Res 2024; 10:00779-2023. [PMID: 38410701 PMCID: PMC10895421 DOI: 10.1183/23120541.00779-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024] Open
Abstract
Objective Upper-limb exercise is recommended for patients with COPD, albeit there are limited data concerning the optimal modality to implement. We compared interval (INT-EX) to continuous (CONT-EX) upper-limb exercise in terms of exercise tolerance, ventilatory and metabolic responses when both conditions were sustained at an equivalent work rate. Methods 26 stable COPD patients undertook three upper-limb exercise sessions to initially establish peak work rate (PWR) via an incremental exercise test and subsequently two equivalent work rate tests to the limit tolerance in balanced order: 1) INT-EX consisting of 30-s work at 100% PWR interspersed with 30-s work at 40% of PWR; and 2) CONT-EX at 70% PWR. Results 20 patients (76.9%) had longer tolerance during INT-EX, while six out of 26 (23.1%) exhibited longer tolerance during CONT-EX. The average endurance time was 434.1±184.7 and 315.7±128.7 s for INT-EX and CONT-EX, respectively. During INT-EX at isotime (i.e. when work completed was the same between INT-EX and CONT-EX), the majority of patients manifested lower oxygen uptake, minute ventilation, pulmonary hyperinflation, heart rate, symptoms and higher CO2 blood concentration. Patients with longer INT-EX had a lower comorbidity score (Cumulative Illness Rating Scale: 1.58±0.30 versus 1.88±0.29, p=0.0395) and better-preserved lung function (forced vital capacity 84.7±15.31% versus 67.67±20.56%, p=0.0367; forced expiratory volume in 1 s 57.15±14.59 versus 44.67±12.99% predicted, p=0.0725) compared to patients with longer CONT-EX. Conclusion INT-EX is more sustainable than CONT-EX for the majority of COPD patients with moderate obstruction, leading to lower dynamic hyperinflation and symptoms at isotime. Further studies need to define the benefits of its application during pulmonary rehabilitation.
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Affiliation(s)
- Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Ioannis Vogiatzis
- Northumbria University, Faculty of Health and Life Sciences, Department of Sport, Exercise and Rehabilitation, Newcastle, UK
| | - Alessandro Cavicchia
- University of Verona, Department of Neurosciences Biomedicine and Movement Sciences, Verona, Italy
| | - Beatrice Salvi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Laura Bertacchini
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Massimo Venturelli
- University of Verona, Department of Neurosciences Biomedicine and Movement Sciences, Verona, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
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Cakmak A, Nemutlu E, Yabanoglu-Ciftci S, Baysal I, Kocaaga E, Coplu L, Inal-Ince D. Metabolomic, oxidative, and inflammatory responses to acute exercise in chronic obstructive pulmonary disease. Heart Lung 2023; 59:52-60. [PMID: 36724589 DOI: 10.1016/j.hrtlng.2023.01.011] [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: 11/02/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is currently a need to identify metabolomic responses to acute exercise in chronic obstructive pulmonary disease (COPD). OBJECTIVE We investigated the metabolomic, oxidative, and inflammatory responses to constant (CE) and intermittent (IE) work rate exercises in COPD. METHODS Sixteen males with COPD performed a symptom-limited incremental cycle exercise test (ICE). Metabolomic, oxidative, and inflammatory responses to CE and IE (based on the performance of ICE) were analyzed in the plasma. RESULTS Fructose-6-phosphate, 3-phosphoglyceric acid, l-carnitine, and acylcarnitines levels were significantly decreased, whereas alpha-ketoglutaric, malic, 2-hydroxybutyric, and 3-hydroxybutyric acids were increased, after CE and IE (p<0.05). Increases in citric, isocitric, and lactic acids, as well as decreases in pyruvic and oxalic acids, were only present with IE (p<0.05). Isoleucine was decreased after both exercises (p<0.05). We observed an increase in inosine-5'-diphosphate, uric acid, ascorbic acid, and pantothenic acid, as well as a decrease in 5-hydroxymethyluridine, threonic acid, and dehydroascorbic acid, after IE (p<0.05). Catalase, reduced glutathione, and total antioxidant status difference values for both exercises were similar (p>0.05). The change in glutathione peroxidase (GPx) with CE was more significant than that with IE (p = 0.004). The superoxide dismutase change was greater with IE than with CE (p = 0.015). There were no significant changes in inflammatory markers after exercise (p>0.05). CONCLUSION CE and IE cause isoleucine, l-carnitine, and acylcarnitine levels to decrease, whereas ketone bodies were increased, thus indicating the energy metabolism shift from carbohydrates to amino acid utilization and lipid metabolism in COPD. Compared with CE, IE produces significant changes in more metabolomics in terms of carbohydrates, lipids, amino acids, nucleotides, and vitamins. Acute CE and IE alter circulating GPx levels in COPD.
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Affiliation(s)
- Aslihan Cakmak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Emirhan Nemutlu
- Faculty of Pharmacy, Department of Analytical Chemistry, Hacettepe University, Ankara, Turkey.
| | | | - Ipek Baysal
- Vocational School of Health Services, Hacettepe University, Ankara, Turkey.
| | - Elif Kocaaga
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Lutfi Coplu
- Faculty of Medicine, Department of Chest Diseases, Hacettepe University, Ankara, Turkey.
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
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Stern G, Psycharakis SG, Phillips SM. Effect of High-Intensity Interval Training on Functional Movement in Older Adults: A Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2023; 9:5. [PMID: 36641767 PMCID: PMC9840985 DOI: 10.1186/s40798-023-00551-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/30/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Preserving physiological functional capacity (PFC), the ability to perform the activities of daily life, and the ease with which they can be performed, in older adults, defined for this study as ≥ 50 years of age, is an important consideration for maintaining health and independence through the ageing process. Physical activity, and exercise training in particular, has been positively associated with improvement in PFC. In addition to improving aerobic and anaerobic capacity, promoting and preserving functional movement as a component of PFC is an important goal of physical activity, especially for older adults. High-intensity interval training (HIIT), an exercise protocol where repeated bouts of increased intensity are interspersed with active or passive recovery periods, has often been studied as an alternative to traditional moderate-intensity continuous training (MICT) exercise, where a continuous intensity is maintained throughout the exercise session. A large body of research has determined that both types of exercise programme are effective in improving measures of aerobic and anaerobic fitness in older adults. However, the effect of the two exercise modalities on functional movement has most often been a secondary outcome, with a range of observational techniques applied for measurement. OBJECTIVES The primary objective of this research is to systematically review and meta-analyse published studies of HIIT interventions that measured functional movement in older adults to conclude if HIIT is effective for improving functional movement. A secondary objective is to determine if there are significant differences between HIIT and MICT effect on functional movement. METHODS A search strategy of terms locating studies of HIIT interventions, functional movement outcome measures, and older adult population samples was executed on seven digital databases. Randomized and pair-matched trials of > 2 weeks were considered for inclusion. Studies of participants with neurological impairment or studies using combined exercise modality were rejected. Standardized mean difference for functional movement outcome measures was calculated. A meta-analysis of the included studies and subgroups was performed along with study quality (risk of bias and publication bias) evaluation. RESULTS A total of 18 studies were included in random effects model pooled analysis. Subgroup analysis of HIIT versus MICT on functional movement showed a trivial effect in favour of HIIT (ES 0.13, 95% CI [-0.06, 0.33] p = 0.18) and did not achieve statistical significance. However, HIIT showed a medium, statistically significant favourable effect on functional movement versus non-intervention control (ES = 0.60 95% CI [0.24, 0.95] p = 0.001). Further subgroups analysis using singular and multiple functional movement outcome measures showed similar results. CONCLUSION This meta-analysis indicates that HIIT interventions in older adults may be effective at promoting improvements in functional movement, though it is unclear whether HIIT is superior to MICT.
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Affiliation(s)
- Guy Stern
- grid.4305.20000 0004 1936 7988The University of Edinburgh, St Leonard’s Land, Holyrood Road, Edinburgh, EH8 8AQ UK ,grid.4305.20000 0004 1936 7988Human Performance Science Research Group, Moray House School of Education & Sport, Institute for Sport, PE and Health Sciences, Edinburgh, Scotland ,Sport & Exercise Physiology, Institute for Sport, PE and Health Sciences, Edinburgh, Scotland
| | - Stelios G. Psycharakis
- grid.4305.20000 0004 1936 7988The University of Edinburgh, St Leonard’s Land, Holyrood Road, Edinburgh, EH8 8AQ UK ,grid.4305.20000 0004 1936 7988Biomechanics, Moray House School of Education & Sport, Institute for Sport, PE and Health Sciences, Edinburgh, Scotland
| | - Shaun M. Phillips
- grid.4305.20000 0004 1936 7988The University of Edinburgh, St Leonard’s Land, Holyrood Road, Edinburgh, EH8 8AQ UK ,Sport & Exercise Physiology, Institute for Sport, PE and Health Sciences, Edinburgh, Scotland
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Alexiou C, Ward L, Hume E, Armstrong M, Wilkinson M, Vogiatzis I. Effect of interval compared to continuous exercise training on physiological responses in patients with chronic respiratory diseases: A systematic review and meta-analysis. Chron Respir Dis 2021; 18:14799731211041506. [PMID: 34666528 PMCID: PMC8532221 DOI: 10.1177/14799731211041506] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Current evidence suggests that interval exercise training (IET) and continuous exercise training (CET) produce comparable benefits in exercise capacity, cardiorespiratory fitness and symptoms in patients with chronic obstructive pulmonary disease (COPD). However, the effects of these modalities have only been reviewed in patients with COPD. This meta-analysis compares the effectiveness of IET versus CET on exercise capacity, cardiorespiratory fitness and exertional symptoms in patients with chronic respiratory diseases (CRDs). Methods: PubMed, CINHAL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Nursing and Allied health were searched for randomised controlled trials from inception to September 2020. Eligible studies included the comparison between IET and CET, reporting measures of exercise capacity, cardiorespiratory fitness and symptoms in individuals with CRDs. Results: Thirteen randomised control trials (530 patients with CRDs) with fair to good quality on the PEDro scale were included. Eleven studies involved n = 446 patients with COPD, one involved n = 24 patients with cystic fibrosis (CF) and one n = 60 lung transplantation (LT) candidates. IET resulted in greater improvements in peak work rate (WRpeak) (2.40 W, 95% CI: 0.83 to 3.97 W; p = 0.003) and lower exercise-induced dyspnoea (−0.47, 95% CI: −0.86 to 0.09; p = 0.02) compared to CET; however, these improvements did not exceed the minimal important difference for these outcomes. No significant differences in peak values for oxygen uptake (VO2peak), heart rate (HRpeak), minute ventilation (VEpeak), lactate threshold (LAT) and leg discomfort were found between the interventions. Conclusions: IET is superior to CET in improving exercise capacity and exercise-induced dyspnoea sensations in patients with CRDs; however, the extent of the clinical benefit is not considered clinically meaningful.
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Affiliation(s)
- Charikleia Alexiou
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Lesley Ward
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Matthew Armstrong
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Mick Wilkinson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
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Abstract
Evaluating symptoms is a central part of the chronic obstructive pulmonary disease (COPD) assessment system as suggested by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Considering the pros and cons of all currently available tests, GOLD suggests using primarily the modified Medical Research Council dyspnea scale or the COPD Assessment Test. Based on the test results, patients are categorized as having a low or high level of symptoms. This level then becomes one of the 2 dimensions of the ABCD grading system, which was designed to match the best initial treatment option to the individual patient's needs.
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Louvaris Z, Chynkiamis N, Spetsioti S, Asimakos A, Zakynthinos S, Wagner PD, Vogiatzis I. Greater exercise tolerance in COPD during acute interval, compared to equivalent constant-load, cycle exercise: physiological mechanisms. J Physiol 2020; 598:3613-3629. [PMID: 32472698 DOI: 10.1113/jp279531] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
KEY POINTS Exercise intolerance is common in chronic obstructive pulmonary disease (COPD) patients. In patients with COPD, we compared an interval exercise (IE) protocol (alternating 30 s at 100% peak work rate (WRpeak ) with 30 s at 50% WRpeak ) with moderate-intensity constant-load exercise (CLE) at 75% WRpeak , which yielded the same work rate. Exercise endurance time and total work output were almost twice as high for IE than CLE. At exercise isotime (when work completed was the same between IE and CLE), IE was associated with less dynamic hyperinflation, lower blood lactate concentration, and greater respiratory and locomotor muscle oxygenation, but there were no differences in ventilation or cardiac output. However, at the limit of tolerance for each modality, dynamic hyperinflation was not different between IE and CLE, while blood lactate remained lower and muscle oxygenation higher with IE. Taken together, these findings suggest that dynamic hyperinflation and not muscle-based factors dictate the limits of tolerance in these COPD patients. ABSTRACT The relative importance of ventilatory, circulatory and peripheral muscle factors in determining tolerance to exercise in patients with chronic obstructive pulmonary disease (COPD) is not known. In 12 COPD patients (forced expiratory volume in one second: 58 ± 17%pred.) we measured ventilation, cardiac output, dynamic hyperinflation, local muscle oxygenation, blood lactate and time to exhaustion during (a) interval exercise (IE) consisting of 30 s at 100% peak work rate alternating with 30 s at 50%, and (b) constant-load exercise (CLE) at 75% peak work rate, designed to produce the same average work rate. Exercise time was substantially longer during IE than CLE (19.5 ± 4.8 versus 11.4 ± 2.1 min, p = 0.0001). Total work output was therefore greater during IE than CLE (81.3 ± 27.7 versus 48.9 ± 23.8 kJ, p = 0.0001). Dynamic hyperinflation (assessed by changes from baseline in inspiratory capacity, ΔIC) was less during IE than CLE at CLE exhaustion time (isotime, p = 0.009), but was similar at exhaustion (ΔICCLE : -0.38 ± 0.10 versus ΔICIE : -0.33 ± 0.12 l, p = 0.102). In contrast, at isotime, minute ventilation, cardiac output and systemic oxygen delivery did not differ between protocols (P > 0.05). At exhaustion in both protocols, the vastus lateralis and intercostal muscle oxygen saturation were higher in IE than CLE (p = 0.014 and p = 0.0002, respectively) and blood lactate concentrations were lower (4.9 ± 2.4 mmol l-1 versus 6.4 ± 2.2 mmol l-1 , p = 0.039). These results suggest that (1) exercise tolerance with COPD is limited by dynamic hyperinflation; and (2) cyclically lower (50%) effort intervals in IE help to preserve muscle oxygenation and reduce metabolic acidosis compared with CLE at the same average work rate; but these factors do not appear to determine time to exhaustion.
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Affiliation(s)
- Zafeiris Louvaris
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece.,Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Stavroula Spetsioti
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Andreas Asimakos
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Spyros Zakynthinos
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Peter D Wagner
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ioannis Vogiatzis
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece.,Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
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7
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Sawyer A, Cavalheri V, Hill K. Effects of high intensity interval training on exercise capacity in people with chronic pulmonary conditions: a narrative review. BMC Sports Sci Med Rehabil 2020; 12:22. [PMID: 32257221 PMCID: PMC7106755 DOI: 10.1186/s13102-020-00167-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Exercise training is important in the management of adults with chronic pulmonary conditions. However, achieving high intensity exercise may be challenging for this clinical population. There has been clinical interest in applying interval-based training as a strategy to optimise the load that can be tolerated during exercise training. Evidence for such an approach is limited in most chronic pulmonary populations. MAIN BODY In this narrative review, we provide an appraisal of studies investigating whole-body high intensity interval training (HIIT) in adults with chronic obstructive pulmonary disease (COPD). This is the first review to also include studies investigating HIIT in people with conditions other than COPD. Studies undertaken in adults with a chronic pulmonary condition were reviewed when participants were randomised to receive; (i) HIIT or no exercise or, (ii) HIIT or moderate intensity continuous exercise. Data were extracted on peak rate of oxygen uptake (VO2peak; 'cardiorespiratory fitness') and maximal work rate (Wmax; 'exercise capacity').In people with COPD, two studies demonstrated between-group differences favouring HIIT compared with no exercise. There appears to be no advantage for HIIT compared to continuous exercise on these outcomes. In people with cystic fibrosis (CF), no studies have compared HIIT to no exercise and the two studies that compared HIIT to continuous exercise reported similar benefits. In people prior to resection for non-small cell lung cancer, one study demonstrated a between-group difference in favour of HIIT compared with no exercise on VO2peak. In people with asthma, one study demonstrated a between-group difference in favour of HIIT compared with no exercise on VO2peak and one that compared HIIT to continuous exercise reported similar benefits. No studies were identified non-CF bronchiectasis or interstitial lung diseases. CONCLUSIONS High intensity interval training increases cardiorespiratory fitness and exercise capacity when compared with no exercise and produces a similar magnitude of change as continuous exercise in people with COPD. There is a paucity of studies exploring the effects of HIIT in other chronic pulmonary conditions.
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Affiliation(s)
- Abbey Sawyer
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, WA Australia
- Institute for Respiratory Health, Perth, WA Australia
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
- Institute for Respiratory Health, Perth, WA Australia
- Allied Health, South Metropolitan Health Service, Perth, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
- Institute for Respiratory Health, Perth, WA Australia
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Influence of Disease Severity and Exercise Limitation on Exercise Training Intensity and Load and Health Benefits From Pulmonary Rehabilitation in Patients With COPD: AN EXPLORATORY STUDY. J Cardiopulm Rehabil Prev 2018; 38:320-326. [PMID: 29652760 DOI: 10.1097/hcr.0000000000000321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Some patients with chronic obstructive pulmonary disease (COPD) fail to achieve health benefits with pulmonary rehabilitation (PR). Exercise intensity and load represent stimulus for adaptation but it is unclear whether inappropriate exercise intensity and/or load are affected by severity of COPD, which may affect health benefits. The purpose was to determine whether COPD severity and/or the severity of pulmonary limitation to exercise (PLE) impacted exercising intensity or load and whether resultant intensity/load affected health outcomes derived from PR. METHODS Patients with COPD (n = 58, age = 67 ± 7 y, forced expiratory volume in the first second of expiration [FEV1] % predicted = 52 ± 21%) were recruited upon referral to PR. Primary health outcomes evaluated were 6-min walk distance and St George's Respiratory Questionnaire. Patients were stratified for disease severity using Global Initiative for Obstructive Lung Disease (GOLD) staging and PLE severity by change in inspiratory capacity during exercise. Exercise intensity and load were calculated from daily exercise records. RESULTS Participants achieved comparable training duration and load regardless of GOLD severity. Patients with more severe PLE achieved greater training duration (more severe: 546 ± 143 min., less severe: 451 ± 109 min., P = .036), and relative training load (more severe: 2200.8 ± 595.3 kcal, less severe: 1648.3 ± 597.8 kcal, P = .007). Greater overall training load was associated with greater improvements in 6-min walk distance (r = 0.24, P = .035). No significant relationships were observed between PLE, GOLD severity, training parameters, and St George's Respiratory Questionnaire response. CONCLUSIONS Improvements in exercise tolerance can be explained by achieving greater training loads, demonstrating the importance of appropriate training load to maximize health outcomes in PR.
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Morris NR, Walsh J, Adams L, Alision J. Exercise training in COPD: What is it about intensity? Respirology 2016; 21:1185-92. [DOI: 10.1111/resp.12864] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Norman R. Morris
- Menzies Health Institute and School of Allied Health Sciences; Griffith University; Brisbane Gold Coast Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - James Walsh
- Menzies Health Institute and School of Allied Health Sciences; Griffith University; Brisbane Gold Coast Australia
- Queensland Lung Transplant Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Lewis Adams
- Menzies Health Institute and School of Allied Health Sciences; Griffith University; Brisbane Gold Coast Australia
| | - Jennifer Alision
- Discipline of Physiotherapy, Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
- Department of Physiotherapy; Royal Prince Alfred Hospital; Sydney New South Wales Australia
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Jordan RE, Majothi S, Heneghan NR, Blissett DB, Riley RD, Sitch AJ, Price MJ, Bates EJ, Turner AM, Bayliss S, Moore D, Singh S, Adab P, Fitzmaurice DA, Jowett S, Jolly K. Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis. Health Technol Assess 2016; 19:1-516. [PMID: 25980984 DOI: 10.3310/hta19360] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Self-management (SM) support for patients with chronic obstructive pulmonary disease (COPD) is variable in its coverage, content, method and timing of delivery. There is insufficient evidence for which SM interventions are the most effective and cost-effective. OBJECTIVES To undertake (1) a systematic review of the evidence for the effectiveness of SM interventions commencing within 6 weeks of hospital discharge for an exacerbation for COPD (review 1); (2) a systematic review of the qualitative evidence about patient satisfaction, acceptance and barriers to SM interventions (review 2); (3) a systematic review of the cost-effectiveness of SM support interventions within 6 weeks of hospital discharge for an exacerbation of COPD (review 3); (4) a cost-effectiveness analysis and economic model of post-exacerbation SM support compared with usual care (UC) (economic model); and (5) a wider systematic review of the evidence of the effectiveness of SM support, including interventions (such as pulmonary rehabilitation) in which there are significant components of SM, to identify which components are the most important in reducing exacerbations, hospital admissions/readmissions and improving quality of life (review 4). METHODS The following electronic databases were searched from inception to May 2012: MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Science Citation Index [Institute of Scientific Information (ISI)]. Subject-specific databases were also searched: PEDro physiotherapy evidence database, PsycINFO and the Cochrane Airways Group Register of Trials. Ongoing studies were sourced through the metaRegister of Current Controlled Trials, International Standard Randomised Controlled Trial Number database, World Health Organization International Clinical Trials Registry Platform Portal and ClinicalTrials.gov. Specialist abstract and conference proceedings were sourced through ISI's Conference Proceedings Citation Index and British Library's Electronic Table of Contents (Zetoc). Hand-searching through European Respiratory Society, the American Thoracic Society and British Thoracic Society conference proceedings from 2010 to 2012 was also undertaken, and selected websites were also examined. Title, abstracts and full texts of potentially relevant studies were scanned by two independent reviewers. Primary studies were included if ≈90% of the population had COPD, the majority were of at least moderate severity and reported on any intervention that included a SM component or package. Accepted study designs and outcomes differed between the reviews. Risk of bias for randomised controlled trials (RCTs) was assessed using the Cochrane tool. Random-effects meta-analysis was used to combine studies where appropriate. A Markov model, taking a 30-year time horizon, compared a SM intervention immediately following a hospital admission for an acute exacerbation with UC. Incremental costs and quality-adjusted life-years were calculated, with sensitivity analyses. RESULTS From 13,355 abstracts, 10 RCTs were included for review 1, one study each for reviews 2 and 3, and 174 RCTs for review 4. Available studies were heterogeneous and many were of poor quality. Meta-analysis identified no evidence of benefit of post-discharge SM support on admissions [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.52 to 1.17], mortality (HR 1.07, 95% CI 0.74 to 1.54) and most other health outcomes. A modest improvement in health-related quality of life (HRQoL) was identified but this was possibly biased due to high loss to follow-up. The economic model was speculative due to uncertainty in impact on readmissions. Compared with UC, post-discharge SM support (delivered within 6 weeks of discharge) was more costly and resulted in better outcomes (£683 cost difference and 0.0831 QALY gain). Studies assessing the effect of individual components were few but only exercise significantly improved HRQoL (3-month St George's Respiratory Questionnaire 4.87, 95% CI 3.96 to 5.79). Multicomponent interventions produced an improved HRQoL compared with UC (mean difference 6.50, 95% CI 3.62 to 9.39, at 3 months). Results were consistent with a potential reduction in admissions. Interventions with more enhanced care from health-care professionals improved HRQoL and reduced admissions at 1-year follow-up. Interventions that included supervised or unsupervised structured exercise resulted in significant and clinically important improvements in HRQoL up to 6 months. LIMITATIONS This review was based on a comprehensive search strategy that should have identified most of the relevant studies. The main limitations result from the heterogeneity of studies available and widespread problems with their design and reporting. CONCLUSIONS There was little evidence of benefit of providing SM support to patients shortly after discharge from hospital, although effects observed were consistent with possible improvement in HRQoL and reduction in hospital admissions. It was not easy to tease out the most effective components of SM support packages, although interventions containing exercise seemed the most effective. Future work should include qualitative studies to explore barriers and facilitators to SM post exacerbation and novel approaches to affect behaviour change, tailored to the individual and their circumstances. Any new trials should be properly designed and conducted, with special attention to reducing loss to follow-up. Individual participant data meta-analysis may help to identify the most effective components of SM interventions. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001588. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rachel E Jordan
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Saimma Majothi
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport, Exercise & Rehabilitation Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Deirdre B Blissett
- Health Economics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Richard D Riley
- Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Alice J Sitch
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Malcolm J Price
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Elizabeth J Bates
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Alice M Turner
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Susan Bayliss
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - David Moore
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sally Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Peymane Adab
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - David A Fitzmaurice
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Susan Jowett
- Health Economics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kate Jolly
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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11
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Prognostic validation of the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index in inoperable non-small-cell lung cancer. J Thorac Oncol 2015; 8:1545-50. [PMID: 24389436 DOI: 10.1097/jto.0000000000000032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To investigate the prognostic utility of the body mass index, severity of airflow obstruction, measures of exertional dyspnea, and exercise capacity (BODE) index in patients with inoperable non-small-cell lung cancer (NSCLC). METHODS One hundred consecutive patients with inoperable NSCLC and performance status 0 to 3 completed pulmonary function testing, the modified Medical Research Council dyspnea scale, a 6-minute walk test, and body mass index-the multidimensional 10-point BODE index. Cox proportional models were used to estimate the risk of all-cause mortality according to the BODE index with or without adjustment for traditional prognostic factors. RESULTS Median follow-up was 31.5 months; 61 deaths (61%) were reported during this period. There was a significant univariate association between the BODE index score and mortality (adjusted p(trend) = 0.027). Compared with patients with a BODE index of 0, the adjusted hazard ratio for risk of death was 1.37 (95% confidence interval [CI], 0.74-2.55) for a BODE index of 1, 1.22 (95% CI, 0.45-3.25) for a BODE index of 2, and 2.44 (95% CI, 1.19-4.99) for a BODE index more than 2. The BODE index provided incremental prognostic information beyond that provided traditional markers of prognosis (adjusted p(trend) = 0.051). Every one-point increase in the BODE index, the risk of death increased by 25% (hazard ratio = 1.25; 95% CI, 1.27-4.64). CONCLUSIONS The BODE index is a strong independent predictor of survival in inoperable NSCLC beyond traditional risk factors. Use of this multidimensional tool may improve risk stratification and prognostication in NSCLC.
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12
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Andrianopoulos V, Klijn P, Franssen FME, Spruit MA. Exercise training in pulmonary rehabilitation. Clin Chest Med 2014; 35:313-22. [PMID: 24874127 DOI: 10.1016/j.ccm.2014.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Exercise training remains a cornerstone of pulmonary rehabilitation (PR) in patients with chronic respiratory disease. The choice of type of exercise training depends on the physiologic requirements and goals of the individual patient as well as the available equipment at the PR center. Current evidence suggests that, at ground walking exercise training, Nordic walking exercise training, resistance training, water-based exercise training, tai chi, and nonlinear periodized exercise are all feasible and effective in (subgroups) of patients with chronic obstructive pulmonary disease. In turn, these exercise training modalities can be considered as part of a comprehensive, interdisciplinary PR program.
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Affiliation(s)
- Vasileios Andrianopoulos
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Hornerheide 1, Horn 6085 NM, The Netherlands.
| | - Peter Klijn
- Department of Pulmonology, Merem Asthma Center Heideheuvel, Soestdijkerstraatweg 129, 1213 VX Hilversum, The Netherlands
| | - Frits M E Franssen
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Hornerheide 1, Horn 6085 NM, The Netherlands
| | - Martijn A Spruit
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Hornerheide 1, Horn 6085 NM, The Netherlands; Faculty of Medicine and Life Sciences, REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Hasselt University, Agoralaan gebouw A, 3590, Diepenbeek, Belgium
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13
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Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2176] [Impact Index Per Article: 197.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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14
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Dijk WDV, Bemt LVD, Haak-Rongen SVD, Bischoff E, Weel CV, Veen JCCMI', Schermer TRJ. Multidimensional prognostic indices for use in COPD patient care. A systematic review. Respir Res 2011; 12:151. [PMID: 22082049 PMCID: PMC3228786 DOI: 10.1186/1465-9921-12-151] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 11/14/2011] [Indexed: 11/18/2022] Open
Abstract
Background A growing number of prognostic indices for chronic obstructive pulmonary disease (COPD) is developed for clinical use. Our aim is to identify, summarize and compare all published prognostic COPD indices, and to discuss their performance, usefulness and implementation in daily practice. Methods We performed a systematic literature search in both Pubmed and Embase up to September 2010. Selection criteria included primary publications of indices developed for stable COPD patients, that predict future outcome by a multidimensional scoring system, developed for and validated with COPD patients only. Two reviewers independently assessed the index quality using a structured screening form for systematically scoring prognostic studies. Results Of 7,028 articles screened, 13 studies comprising 15 indices were included. Only 1 index had been explored for its application in daily practice. We observed 21 different predictors and 7 prognostic outcomes, the latter reflecting mortality, hospitalization and exacerbation. Consistent strong predictors were FEV1 percentage predicted, age and dyspnoea. The quality of the studies underlying the indices varied between fairly poor and good. Statistical methods to assess the predictive abilities of the indices were heterogenic. They generally revealed moderate to good discrimination, when measured. Limitations: We focused on prognostic indices for stable disease only and, inevitably, quality judgment was prone to subjectivity. Conclusions We identified 15 prognostic COPD indices. Although the prognostic performance of some of the indices has been validated, they all lack sufficient evidence for implementation. Whether or not the use of prognostic indices improves COPD disease management or patients' health is currently unknown; impact studies are required to establish this.
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Affiliation(s)
- Wouter D van Dijk
- Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, the Netherlands.
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15
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Zainuldin R, Mackey MG, Alison JA. Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; 2011:CD008008. [PMID: 22071841 PMCID: PMC8939846 DOI: 10.1002/14651858.cd008008.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intensity of exercise is considered a key determinant of training response, however, no systematic review has investigated the effects of different levels of training intensity on exercise capacity, functional exercise capacity and health-related quality of life (HRQoL) in people with chronic obstructive pulmonary disease (COPD). As type of training (continuous or interval) may also affect training response, the effects of the type of training in COPD also require investigation. OBJECTIVES To determine the effects of training intensity (higher versus lower) or type (continuous versus interval training) on primary outcomes in exercise capacity and secondary outcomes in symptoms and HRQoL for people with COPD. SEARCH METHODS We searched for studies in any language from the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and PubMed. Searches were current as of June 2011. SELECTION CRITERIA We included randomised controlled trials comparing higher training intensity to lower training intensity or comparing continuous training to interval training in people with COPD. We excluded studies that compared exercise training with no exercise training. DATA COLLECTION AND ANALYSIS We pooled results of comparable groups of studies and calculated the treatment effect and 95% confidence intervals (CI) using a random-effects model. We made two separate comparisons of effects between: 1) higher and lower training intensity; 2) continuous and interval training. We contacted authors of missing data. MAIN RESULTS We analysed three included studies (231 participants) for comparisons between higher and lower-intensity training and eight included studies (367 participants) for comparisons between continuous and interval training. Primary outcomes were outcomes at peak exercise (peak work rate, peak oxygen consumption, peak minute ventilation and lactate threshold), at isowork or isotime, endurance time on a constant work rate test and functional exercise capacity (six-minute walk distance). When comparing higher versus lower-intensity training, the pooled primary outcomes were endurance time and six-minute walk distance. There were no significant differences in endurance time improvement (mean difference (MD) 1.07 minutes; 95% CI -1.53 to 3.67) and six-minute walk distance improvement (MD 2.8 metres; 95% CI -10.1 to 15.6) following higher or lower-intensity training. However, heterogeneity of the endurance time results between studies was significant. When comparing continuous and interval training, there were no significant differences in any of the primary outcomes, except for oxygen consumption at isotime (MD 0.08; 95% CI 0.01 to 0.16) but the treatment effect was not considered clinically important. According to the GRADE system, studies were of low to moderate quality. AUTHORS' CONCLUSIONS Comparisons between the higher and lower training intensity were limited due to the small number of included studies and participants. Consequently, there are insufficient data to draw any conclusions on exercise capacity, symptoms and HRQoL for this comparison. For comparisons between continuous and interval training, both appear to be equally effective in improving exercise capacity, symptoms and HRQoL.
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Affiliation(s)
- Rahizan Zainuldin
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia.
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16
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Glaab T, Vogelmeier C, Buhl R. Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitations. Respir Res 2010; 11:79. [PMID: 20565728 PMCID: PMC2902430 DOI: 10.1186/1465-9921-11-79] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 06/17/2010] [Indexed: 11/13/2022] Open
Abstract
Current methods for assessing clinical outcomes in COPD mainly rely on physiological tests combined with the use of questionnaires. The present review considers commonly used outcome measures such as lung function, health status, exercise capacity and physical activity, dyspnoea, exacerbations, the multi-dimensional BODE score, and mortality. Based on current published data, we provide a concise overview of the principles, strengths and weaknesses, and discuss open questions related to each methodology. Reviewed is the current set of markers for measuring clinically relevant outcomes with particular emphasis on their limitations and opportunities that should be recognized when assessing and interpreting their use in clinical trials of COPD.
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Affiliation(s)
- Thomas Glaab
- Pulmonary Department, University Hospital, Johannes Gutenberg-University, Mainz, Germany
| | - Claus Vogelmeier
- Department of Pneumology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Roland Buhl
- Pulmonary Department, University Hospital, Johannes Gutenberg-University, Mainz, Germany
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