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Silva RN, Goulart CDL, de Oliveira CR, Mendes RG, Arena R, Myers J, Borghi-Silva A. Respiratory muscle strength can improve the prognostic assessment in COPD. Sci Rep 2024; 14:12360. [PMID: 38811574 PMCID: PMC11137089 DOI: 10.1038/s41598-024-54264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/10/2024] [Indexed: 05/31/2024] Open
Abstract
Impaired lung function, respiratory muscle weakness and exercise intolerance are present in COPD and contribute to poor prognosis. However, the contribution of the combination of these manifestations to define prognosis in COPD is still unknown. This study aimed to define cut-off points for both inspiratory and expiratory muscle strength (MIP and MEP, respectively) for mortality prediction over 42-months in patients with COPD, and to investigate its combination with other noninvasive established prognostic measures (FEV1, V̇O2peak and 6MWD) to improve risk identification. Patients with COPD performed pulmonary function, respiratory muscle strength, six-minute walk and cardiopulmonary exercise tests, and were followed over 42 months to analyze all-cause mortality. A total of 79 patients were included. The sample was mostly (91.1%) comprised of severe (n = 37) and very severe (n = 34) COPD, and 43 (54%) patients died during the follow-up period. Cut-points of ≤ 55 and ≤ 80 cmH2O for MIP and MEP, respectively, were associated with increased risk of death (log-rank p = 0.0001 for both MIP and MEP) in 42 months. Furthermore, MIP and MEP substantially improved the mortality risk assessment when combined with FEV1 (log-ranks p = 0.006 for MIP and p < 0.001 for MEP), V̇O2peak (log-rank: p < 0.001 for both MIP and MEP) and 6MWD (log-ranks: p = 0.005 for MIP; p = 0.015 for MEP). Thus, patients severely affected by COPD presenting MIP ≤ 55 and/or MEP ≤ 80 cmH2O are at increased risk of mortality. Furthermore, MIP and MEP substantially improve the mortality risk assessment when combined with FEV1, V̇O2peak and 6MWD in patients with COPD.
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Affiliation(s)
- Rebeca Nunes Silva
- Department of Physiotherapy, Cardiopulmonary Physiotherapy Laboratory (LACAP), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
| | - Cássia da Luz Goulart
- Department of Physiotherapy, Cardiopulmonary Physiotherapy Laboratory (LACAP), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
| | - Claudio R de Oliveira
- Department of Medicine, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Renata Gonçalves Mendes
- Department of Physiotherapy, Cardiopulmonary Physiotherapy Laboratory (LACAP), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Jonathan Myers
- Veterans Affairs Palo Alto HealthCare System, Stanford University, Palo Alto, CA, USA
| | - Audrey Borghi-Silva
- Department of Physiotherapy, Cardiopulmonary Physiotherapy Laboratory (LACAP), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil.
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Jo S, Jeon J, Park G, Do HK, Kang J, Ahn KJ, Ma SY, Choi YM, Kim D, Youn B, Ki Y. Aerobic Exercise Improves Radiation Therapy Efficacy in Non-Small Cell Lung Cancer: Preclinical Study Using a Xenograft Mouse Model. Int J Mol Sci 2024; 25:2757. [PMID: 38474004 DOI: 10.3390/ijms25052757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
The "oxygen effect" improves radiation efficacy; thus, tumor cell oxygen concentration is a crucial factor for improving lung cancer treatment. In the current study, we aimed to identify aerobic exercise-induced changes in oxygen concentrations in non-small cell lung cancer (NSCLC) cells. To this end, an NSCLC xenograft mouse model was established using human A549 cells. Animals were subsequently subjected to aerobic exercise and radiation three times per week for 2 weeks. Aerobic exercise was performed at a speed of 8.0 m/m for 30 min, and the tumor was irradiated with 2 Gy of 6 MV X-rays (total radiation dose 12 Gy). Combined aerobic exercise and radiation reduced NSCLC cell growth. In addition, the positive effect of aerobic exercise on radiation efficacy through oxygenation of tumor cells was confirmed based on hypoxia-inducible factor-1 and carbonic anhydrase IX expression. Finally, whole-transcriptome analysis revealed the key factors that induce oxygenation in NSCLC cells when aerobic exercise was combined with radiation. Taken together, these results indicate that aerobic exercise improves the effectiveness of radiation in the treatment of NSCLC. This preclinical study provides a basis for the clinical application of aerobic exercise to patients with NSCLC undergoing radiation therapy.
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Affiliation(s)
- Sunmi Jo
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, Busan 48108, Republic of Korea
| | - Jaewan Jeon
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, Busan 48108, Republic of Korea
| | - Geumju Park
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, Busan 48108, Republic of Korea
| | - Hwan-Kwon Do
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University School of Medicine, Busan 48108, Republic of Korea
| | - JiHoon Kang
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Ki Jung Ahn
- Department of Radiation Oncology, Busan Paik Hospital, Inje University School of Medicine, Busan 48108, Republic of Korea
| | - Sun Young Ma
- Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Republic of Korea
| | - Young Min Choi
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan 49315, Republic of Korea
| | - Donghyun Kim
- Department of Radiation Oncology and Biomedical Research Institute, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - BuHyun Youn
- Department of Biological Sciences, Pusan National University, Busan 46241, Republic of Korea
| | - Yongkan Ki
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
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Caruso FR, Goulart CDL, Jr JCB, de Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Predictors of cardiopulmonary exercise testing in COPD patients according to the Weber classification. Heart Lung 2023; 62:95-100. [PMID: 37364368 DOI: 10.1016/j.hrtlng.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Weber classification stratifies cardiac patients based on peak oxygen consumption (V̇O2), the gold-standard measure of exercise capacity. OBJECTIVE To determine if Weber classification is a useful tool to discriminate clinical phenotypes in COPD patients and to evaluate if disease severity and other clinical measures can predict V̇O2peak. METHODS Three hundred and six COPD patients underwent cardiopulmonary exercise testing (CPX) and were divided according to Weber class: 1) Weber A (n = 34); 2) Weber B (n = 88); 3) Weber C (n = 138); and 4) Weber D (n = 46). RESULTS Weber class D patients demonstrated a reduced V̇O2 peak, heart rate (HR), minute ventilation (V̇E), oxygen (O2) pulse, circulatory power (CP), oxygen uptake efficiency slope (OUES), oxygen saturation (SpO2%), delta (Δ)HR and ΔSpO2 when compared to Weber A and B (p<0.05). Moreover, Dyspnea and the V̇E/carbon dioxide production (V̇CO2) slope were higher in Weber D compared with Weber C and A (p<0.001). Hierarchical regression analysis demonstrated significant predictors of V̇O2peak (R2= 0.131; Adj R 2 = 1.25), including HR (β=0.5757; t = 5.7; P<0.001) and forced expiratory volume in one second (FEV1) (β=0.119; t = 2.16; P<0.03). Among the Weber C + D groups, predictors of V̇O2peak (R = 0.78; R2= 0.60; Adj R2 =0.59), dyspnea (β=0.076; t = 1.111; P<0.27) and maximal voluntary ventilation (MVV) (β=0.75; t = 1.14; P<0.00). CONCLUSION Weber classification may be a useful tool to stratify cardiorespiratory fitness in COPD patients. Other clinical measures may be useful in predicting peak V̇O2 in mild-to-severe COPD, moreover different phenotypes may be important tool to improve physical capacity of chronic disease patients.
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Affiliation(s)
- Flávia Rossi Caruso
- Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | | | | | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Audrey Borghi-Silva
- Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil.
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Ogonowska-Slodownik A, Labecka MK, Maciejewska-Skrendo A, McNamara RJ, Kaczmarczyk K, Starczewski M, Gajewski J, Morgulec-Adamowicz N. Effect of Water-Based vs. Land-Based Exercise Intervention (postCOVIDkids) on Exercise Capacity, Fatigue, and Quality of Life in Children with Post COVID-19 Condition: A Randomized Controlled Trial. J Clin Med 2023; 12:6244. [PMID: 37834888 PMCID: PMC10573606 DOI: 10.3390/jcm12196244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Evidence suggests that COVID-19 can cause lasting health consequences called post-COVID-19 condition. We conducted a three-group, randomized controlled trial for children aged 10-12 years with post COVID-19 condition. Participants were randomized to AQUA, LAND, or CONTROL groups. The AQUA and LAND training sessions were conducted twice a week for eight weeks. The primary outcomes were exercise capacity, measured using the modified Balke treadmill protocol, and fatigue, measured using the Cumulative Fatigue Symptoms Questionnaire (CFSQ). The secondary outcome was health-related quality of life (HRQoL), measured with the Pediatric Quality of Life Inventory (PedsQL) for children and parents. A total of 74 of the 86 children completed the intervention and attended the post-intervention assessment. The absolute maximal oxygen uptake (VO2max) values increased after both AQUA (p = 0.001) and LAND (p = 0.004) interventions. No significant differences were found in the degree of total fatigue and individual fatigue symptoms. A significant improvement was found in the PedsQL reported by the parents in the LAND group. In conclusion, the applied eight-week water-based and land-based exercise training programs improved exercise capacity in children aged 10-12 years old with post COVID-19 condition. The parents of the children in the training groups also noted an improvement in HRQoL.
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Affiliation(s)
- Anna Ogonowska-Slodownik
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Marta Kinga Labecka
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Agnieszka Maciejewska-Skrendo
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
- Institute of Physical Culture Sciences, University of Szczecin, 70-453 Szczecin, Poland
| | - Renae J. McNamara
- Physiotherapy, Prince of Wales Hospital, Sydney, NSW 2031, Australia;
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia
- Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Katarzyna Kaczmarczyk
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Michał Starczewski
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Jan Gajewski
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
| | - Natalia Morgulec-Adamowicz
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland; (M.K.L.); (K.K.); (M.S.); (J.G.); (N.M.-A.)
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5
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Priego-Jiménez S, Torres-Costoso A, Guzmán-Pavón MJ, Lorenzo-García P, Lucerón-Lucas-Torres MI, Álvarez-Bueno C. Efficacy of Different Types of Physical Activity Interventions on Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14539. [PMID: 36361418 PMCID: PMC9656092 DOI: 10.3390/ijerph192114539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
AIM A network meta-analysis (NMA) was performed to determine the effects on the exercise capacity, measured by the 6 MWT, of patients with COPD of (i) different physical activity interventions and (ii) supervised or unsupervised programs. METHODS A literature search was carried out from inception to April 2022. Randomized controlled trials of the effectiveness of physical activity on exercise capacity in patients with COPD were included. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool, and the Grading of Recommendations, Assessment, Development, and Evaluation tool (GRADE) was used to assess the quality of the evidence. A pairwise meta-analysis for direct and indirect effects was carried out. RESULTS A total of 41 studies were included in this NMA. The highest effects were for urban training pulmonary rehabilitation (PR) programs (ES, 1.50; 95% CI: 0.46 and 2.55) versus the control group. For supervised and unsupervised PR and home-based PR programs, the highest effects were found for supervised PR (ES, 0.85; 95% CI: 0.46 to 1.23) versus the control group. CONCLUSIONS PR implemented with urban circuit training should be considered the most effective strategy to improve exercise capacity in patients with COPD. Supervision of the programs improves exercise capacity.
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Affiliation(s)
| | - Ana Torres-Costoso
- Health and Social Research Center, Universidad de Castilla La Mancha, 16071 Cuenca, Spain
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
| | - María José Guzmán-Pavón
- Health and Social Research Center, Universidad de Castilla La Mancha, 16071 Cuenca, Spain
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
| | - Patricia Lorenzo-García
- Health and Social Research Center, Universidad de Castilla La Mancha, 16071 Cuenca, Spain
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
| | - María Isabel Lucerón-Lucas-Torres
- Health and Social Research Center, Universidad de Castilla La Mancha, 16071 Cuenca, Spain
- Facultad de Enfermería de Cuenca, Edificio Melchor Cano, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, 16071 Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción 2024, Paraguay
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6
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Amorese AJ, Ryan AS. Home-Based Tele-Exercise in Musculoskeletal Conditions and Chronic Disease: A Literature Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:811465. [PMID: 36188988 PMCID: PMC9397976 DOI: 10.3389/fresc.2022.811465] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/28/2022] [Indexed: 01/28/2023]
Abstract
Exercise training is an essential component in the treatment or rehabilitation of various diseases and conditions. However, barriers to exercise such as the burdens of travel or time may hinder individuals' ability to participate in such training programs. Advancements in technology have allowed for remote, home-based exercise training to be utilized as a supplement or replacement to conventional exercise training programs. Individuals in these home-based exercise programs are able to do so under varying levels of supervision from trained professionals, with some programs having direct supervision, and others having little to no supervision at all. The purpose of this review is to examine the use of home-based, tele-exercise training programs for the treatment of different disease states and conditions, and how these programs compare to conventional clinic-based exercise training programs.
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Affiliation(s)
- Adam J Amorese
- Baltimore Veterans Affairs (VA) Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States
| | - Alice S Ryan
- Baltimore Veterans Affairs (VA) Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States.,VA Research Service, Baltimore GRECC, Department of Medicine, Division of Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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7
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Li P, Li J, Wang Y, Xia J, Liu X. Effects of Exercise Intervention on Peripheral Skeletal Muscle in Stable Patients With COPD: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:766841. [PMID: 34869477 PMCID: PMC8636927 DOI: 10.3389/fmed.2021.766841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/18/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives: Peripheral skeletal muscle dysfunction is an important extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD) that can be counteracted by exercise training. This study aimed to review the effect of three major exercise training modalities, which are used in pulmonary rehabilitation to improve on skeletal muscle mass, function, and exercise capacity in COPD. Methods: PubMed, Embase, EBSCO, Web of Science, and the PEDro database were searched on April 25, 2020. Only randomized controlled studies published in English evaluating the effects of exercise interventions on peripheral skeletal muscle mass, strength, and exercise capacity in stable COPD patients were included. The quality of included studies was evaluated using the PEDro scale. The mean difference (MD) or the standardized mean difference (SMD) with 95% CI was calculated to summarize the results. Subgroup meta-analysis was used to investigate the effects of different exercise training modalities and different outcome measures. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to rate evidence quality. Results: A total of 30 randomized controlled trials involving 1,317 participants were included. Data from trials investigating endurance exercise (EE), resistance exercise (RE), and combined aerobic and resistance exercise (CE) were pooled into a meta-analysis, and the differences compared with the non-exercising COPD control were improvement in the muscle strength and exercise capacity in stable COPD patients. Subgroup meta-analysis for different exercise training modalities showed that RE significantly improved muscle strength (SMD = 0.6, 95% CI 0.35–0.84, I2 = 61%), EE and CE significantly increased VO2peak (EE: MD = 3.5, 95% CI 1.1–5.91, I2 = 92%; CE: MD = 1.66, 95% CI 0.22–3.1, I2 = 1%). Subgroup meta-analysis for different outcome measures showed that only isotonic strength was improved after exercise interventions (SMD = 0.89, 95% CI 0.51–1.26, I2 = 71%). Conclusion: Moderate evidence supports that exercise training in stable COPD patients has meaningful and beneficial effects on peripheral skeletal muscle strength and exercise capacity. Peripheral skeletal muscle shows a higher response to RE, and the isotonic test is relatively sensitive in reflecting muscle strength changes. The proportion of aerobic and resistance exercise components in a combined exercise program still needs exploration. Systematic Review Registration: The review was registered with the PROSPERO: (The website is https://www.crd.york.ac.uk/PROSPERO/, and the ID is CRD42020164868).
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Affiliation(s)
- Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Jian Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Jun Xia
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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8
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Chen H, Li P, Li N, Wang Z, Wu W, Wang J. Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26976. [PMID: 34414971 PMCID: PMC8376316 DOI: 10.1097/md.0000000000026976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We sought to synthesize the evidence about aerobic exercise intervention during pulmonary rehabilitation, and to further explore the difference in rehabilitation effects between water and land-based aerobic exercise. This review's purpose is to provide a basis by which practitioners and therapists can select and create appropriate therapeutic programs. METHODS Data of randomized and quasi-randomized controlled trials comparing training group (TG, aerobic exercise in water or land) and control group (CG, usual care) in chronic obstructive pulmonary disease (COPD) patients (January 1, 2000-December 28, 2019) were obtained from the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases. Two researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. Review Manager software (Rev Man 5.3; Cochrane, London, UK) was used for meta-analysis. The rehabilitation effect of water- or land based aerobic exercise was evaluated by subgroup analysis. The proposed systematic review details were registered in PROSPERO (CRD 42020168331). RESULTS Eighteen studies (1311 cases of COPD) were included. Meta-analysis results show that compared with the control group, the dyspnea level and functional and endurance exercise capacity in COPD patients were significantly improved after aerobic exercise (P < .05), but there was no significant change in lung function (P > .05). Compared with land-based aerobic exercise, water-based aerobic exercise significantly improved the endurance exercise capacity in COPD patients (mean difference [MD]: 270.18, 95% CI: 74.61-465.75). CONCLUSION Medium to high-quality evidence shows that aerobic exercise can effectively improve dyspnea and exercise capacity in COPD patients. Compared with land-based aerobic exercise, water-based aerobic exercise had a significant additional effect in improving the endurance exercise capacity of COPD patients.
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Affiliation(s)
- Haixia Chen
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Ning Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Zhengrong Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Jihong Wang
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
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9
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Mohamed A, Alawna M. Enhancing oxygenation of patients with coronavirus disease 2019: Effects on immunity and other health-related conditions. World J Clin Cases 2021; 9:4939-4958. [PMID: 34307545 PMCID: PMC8283603 DOI: 10.12998/wjcc.v9.i19.4939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/26/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) distresses the pulmonary system causing acute respiratory distress syndrome, which might lead to death. There is no cure for COVID-19 infection. COVID-19 is a self-limited infection, and the methods that can enhance immunity are strongly required. Enhancing oxygenation is one safe and effective intervention to enhance immunity and pulmonary functions. This review deliberates the probable influences of enhancing oxygenation on immunity and other health-connected conditions in patients with COVID-19. An extensive search was conducted through Web of Science, Scopus, Medline databases, and EBSCO for the influence of enhancing oxygenation on immunity, pulmonary functions, psycho-immune hormones, and COVID-19 risk factors. This search included clinical trials and literature and systematic reviews. This search revealed that enhancing oxygenation has a strong effect on improving immunity and pulmonary functions and psycho-immune hormones. Also, enhancing oxygenation has a self-protective role counter to COVID-19 risk factors. Lastly, this search revealed the recommended safe and effective exercise protocol to enhance oxygenation in patients with COVID-19. Enhancing oxygenation should be involved in managing patients with COVID-19 because of its significant effects on immunity, pulmonary functions, and COVID-19 risk factors. A mild to moderate cycling or walking with 60%-80% Vo2max for 20-60 min performed 2-3 times per week could be a safe and effective aerobic exercise program in patients with COVID-19 to enhance their immunity and pulmonary functions.
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Affiliation(s)
- Ayman Mohamed
- Department of Physiotherapy and Rehabilitation, Istanbul Gelisim University, Istanbul 34522, Turkey
- Department of Basic Science and Biomechanics, Faculty of Physical Therapy, Beni Suef University, Beni Suef 62521, Egypt
| | - Motaz Alawna
- Department of Physiotherapy and Rehabilitation, Istanbul Gelisim University, Istanbul 34522, Turkey
- Department of Physiotherapy and Rehabilitation, Faculty of Allied Medical Sciences, Arab American University, Jenin 24013, Palestine
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10
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Liu X, Wu W, Li N, Li P, Wang Z, Shan C. Effects of water-based Liuzijue exercise on peak exercise capacity, functional exercise capacity, and quality of life in people with COPD. CLINICAL RESPIRATORY JOURNAL 2021; 15:956-966. [PMID: 33998778 DOI: 10.1111/crj.13399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/10/2019] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study was conducted to investigate the effect of water-based Liuzijue exercise on peak exercise capacity, functional exercise capacity, and quality of life in people with COPD. METHODS The study included 50 participants randomly divided into three groups: a control group (CG = 17), a land-based Liuzijue exercise group (LG = 17), and a water-based Liuzijue exercise group (WG = 16). The LG and WG performed Liuzijue exercise in different environments, and the CG had no exercise intervention. All participants received prescribed medical treatment. Liuzijue exercise was performed according to the description of Health Qigong Liuzijue compiled by Chinese Health Qigong Association for 60 minutes, two times per week, for 12 weeks. RESULTS After intervention, peak oxygen uptake and peak working rate were significantly improved in WG (P = .02). The results of the 6 minutes walking test (6MWT) and 30 seconds sit-to-stand test were significantly improved in both WG and LG (P < .05), and significant difference was found between WG and CG in 6MWT (P = .03). The St. George's Respiratory Questionnaire (SGRQ) activity score increased significantly in the CG (P = .03), while all domains of SGRQ significantly decreased in both training groups (P < .01). All SGRQ scores showed a significant difference between LG and CG (P < .05) and, except for the activity score, between WG and CG (P < .05). CONCLUSIONS Water-based Liuzijue exercise can effectively improve peak exercise capacity, functional exercise capacity, and quality of life in people with COPD, especially with respect to increasing peak VO2 and 6MWD.
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Affiliation(s)
- Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, China
| | - Ning Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, China
| | - Zhenwei Wang
- Department of Respiratory Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Chunlei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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11
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Noninvasive ventilation can modulate heart rate variability during high-intensity exercise in COPD-CHF patients. Heart Lung 2021; 50:609-614. [PMID: 34087678 DOI: 10.1016/j.hrtlng.2021.04.004] [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] [Received: 03/02/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE to assess the acute effects of non-invasive ventilation (NIV) during high-intensity exercise on heart rate variability (HRV) responses in chronic obstructive pulmonary disease (COPD) and Chronic heart failure (CHF) patients. METHODS This was randomized, double blinded and controlled study. Fourteen patients with COPD-HF diagnosis were evaluated. The subjects underwent to the following tests: (I) cardiopulmonary exercise testing (CPET) on a cycle ergometer ramp protocol; (II) 7 days after CPET, patients randomly underwent two constant-load exercise (CLE) with NIV or Sham ventilation until tolerance limit, with 80% of the CPET peak load. R-R intervals (RRi) were continuously collected during rest, exercise and in recovery. Time and frequency domain and nonlinear heart rate variability (HRV) indices were obtained. RESULTS NIV resulted in a decrease of Mean iRR, square root of the mean squared differences of successive RRi (rMSSD), RR tri index and high-frequency (HF), nu (p < 0.05) and increase of Mean HR, low-frequency (LF), nu and LF/HF (p < 0.05) during exercise when compared to rest. In addition, NIV during exercise induced lower rMSSD and Sample Entropy when compared with Sham (p < 0.05). Negative correlation was found between forced expiratory volume in 1 second (FEV1, L) vs HF (nu) during exercise with NIV (p = 0.04; r= -0.58). Furthermore, simple linear regression showed that the FEV1 (L) affected 30% of the HF (nu) response during the exercise with NIV. CONCLUSION NIV during exercise produced enhanced heart rate and autonomic responses in COPD-CHF patients. Additionally, COPD severity is negatively associated with a higher vagal response during exercise with NIV.
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12
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Teixeira de Carvalho EF, Aletti F, Costa IP, Gomes ELFD, da Silva NP, Damasceno N, Muramatu LH, Dos Santos Alves VL, Ferrario M, Cahalin LP, Sampaio LMM. Evaluation of autonomic modulation of lung function and heart rate in children with cystic fibrosis. Pediatr Pulmonol 2021; 56:120-128. [PMID: 33124743 DOI: 10.1002/ppul.25147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/08/2020] [Accepted: 10/22/2020] [Indexed: 11/11/2022]
Abstract
The autonomic nervous system (ANS) plays an important role in modulating bronchial smooth muscle contractility, which is altered in cystic fibrosis (CF). A convenient approach to probe ANS regulation is the quantitative analysis of heart rate variability (HRV). The purpose of this study was to evaluate ANS regulation in children with CF and to investigate the influence of colonization by Pseudonomas aeruginosa via assessment of HRV in colonized CF (CCF) children and noncolonized CF (NCCF) children. Sixteen children with CF (7 CCF and 9 NCCF) and seven healthy age-matched control children were enrolled in the study. Heart rate was recorded for 10 min at rest in the supine and standing positions and HRV analysis was carried out using autoregressive spectral analysis. The CCF group was characterized by lower forced expiratory volume than NCCF, indicating an impairment of respiratory function. The HRV parameters further confirmed the possible sympathetic overactivity in CCF. Children with CF exhibited hyperactivity of the sympathetic nervous system. In particular, the CCF group presented a greater impairment of ANS modulation. Both CCF and NCCF children showed lower supine vagal activation in the HRV indices related to sympathetic activation and reduction of indices indicating vagal activity with the postural change from supine to standing when compared to the NCCF group.
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Affiliation(s)
- Etiene F Teixeira de Carvalho
- Departament of Master's and Doctoral Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, São Paulo, Brazil
| | - Federico Aletti
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA.,Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Ivan P Costa
- Departament of Master's and Doctoral Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, São Paulo, Brazil
| | - Evelim L F D Gomes
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Natalia P da Silva
- Departament of Master's and Doctoral Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, São Paulo, Brazil
| | - Neiva Damasceno
- Departament Pediatric Pulmonology - Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Lucia H Muramatu
- Departament Pediatric Pulmonology - Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Vera L Dos Santos Alves
- Departament Pediatric Pulmonology - Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Manuela Ferrario
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Lawrence P Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Ponce de Leon Boulevard, 5th Floor - Coral Gable, Miami, FL, 5915, USA
| | - Luciana M M Sampaio
- Departament of Master's and Doctoral Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, São Paulo, Brazil
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13
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Goulart C, Caruso F, Arêas G, dos Santos P, Camargo P, de Carvalho L, Roscani M, Mendes R, Borghi-Silva A. Impact of chronic obstructive pulmonary disease on linear and nonlinear dynamics of heart rate variability in patients with heart failure. Braz J Med Biol Res 2020; 54:e10084. [PMID: 33263641 PMCID: PMC7695451 DOI: 10.1590/1414-431x202010084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
The objective of this study was to investigate the impact of chronic obstructive pulmonary disease (COPD)-heart failure (HF) coexistence on linear and nonlinear dynamics of heart rate variability (HRV). Forty-one patients (14 with COPD-HF and 27 HF) were enrolled and underwent pulmonary function and echocardiography evaluation to confirm the clinical diagnosis. Heart rate (HR) and R-R intervals (iRR) were collected during active postural maneuver (APM) [supine (10 min) to orthostasis (10 min)], respiratory sinus arrhythmia maneuver (RSA-M) (4 min), and analysis of frequency domain, time domain, and nonlinear HRV. We found expected autonomic response during orthostatic changes with reduction of mean iRR, root mean square of successive differences between heart beats (RMSSD), RR tri index, and high-frequency [HF (nu)] and an increased mean HR, low-frequency [LF (nu)], and LF/HF (nu) compared with supine only in HF patients (P<0.05). Patients with COPD-HF coexistence did not respond to postural change. In addition, in the orthostatic position, higher HF nu and lower LF nu and LF/HF (nu) were observed in COPD-HF compared with HF patients. HF patients showed an opposite response during RSA-M, with increased sympathetic modulation (LF nu) and reduced parasympathetic modulation (HF nu) (P<0.05) compared with COPD-HF patients. COPD-HF directly influenced cardiac autonomic modulation during active postural change and controlled breathing, demonstrating an autonomic imbalance during sympathetic and parasympathetic maneuvers compared with isolated HF.
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Affiliation(s)
- C.L. Goulart
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - F.R. Caruso
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - G.P.T. Arêas
- Laboratório de Fisiologia Humana, Departamento de Fisiologia, Universidade Federal do Amazonas, Manaus, AM, Brasil
| | - P.B. dos Santos
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - P.F. Camargo
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - L.C.S. de Carvalho
- Centro de Ciência e Tecnologia em Energia e Sustentabilidade, Universidade Federal do Reconcavo da Bahia, Feira de Santana, BA, Brasil
| | - M.G. Roscani
- Departamento de Medicina, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - R.G. Mendes
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - A. Borghi-Silva
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
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14
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da Luz Goulart C, Caruso FR, Garcia de Araújo AS, Tinoco Arêas GP, Garcia de Moura SC, Catai AM, Mendes RG, Phillips SA, Arena R, Gonçalves da Silva AL, Borghi-Silva A. Non-invasive ventilation improves exercise tolerance and peripheral vascular function after high-intensity exercise in COPD-HF patients. Respir Med 2020; 173:106173. [PMID: 33007709 DOI: 10.1016/j.rmed.2020.106173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
AIM Evaluate the acute effects of non-invasive positive pressure ventilation (NiPPV) during high-intensity exercise on endothelial function in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF). METHODS This is a randomized, double blinded, sham-controlled study involving 14 COPD-HF patients, who underwent a lung function test and Doppler echocardiography. On two different days, patients performed incremental cardiopulmonary exercise testing (CPET) and two constant-work rate tests (80% of CPET peak) receiving Sham or NiPPV (bilevel mode - Astral 150) in a random order until the limit of tolerance (Tlim). Endothelial function was evaluated by flow mediated vasodilation (FMD) at three time points: 1) Baseline; 2) immediately post-exercise with NiPPV; and 3) immediately post-exercise with Sham. RESULTS Our patients had a mean age of 70 ± 7 years, FEV1 1.9 ± 0.7 L and LVEF 41 ± 9%. NIPPV resulted in an increased Tlim (NiPPV: 130 ± 29s vs Sham: 98 ± 29s p = 0.015) and SpO2 (NiPPV: 94.7 ± 3.5% vs Sham: 92.7 ± 5.2% p = 0.03). Also, NiPPV was able to produce a significant increase in FMD (%) (NiPPV: 9.2 ± 3.1 vs Sham: 3.6 ± 0.7, p < 0.05), FMD (mm) (NiPPV: 0.41 ± 0.18 vs Sham: 0.20 ± 0.11, p < 0.05), Blood flow velocity (NiPPV: 33 ± 18 vs Baseline: 20 ± 14, p < 0.05) and Shear Stress (SS) (NiPPV: 72 ± 38 vs Baseline: 43 ± 25, p < 0.05). We found correlation between Tlim vs. ΔSS (p = 0.03; r = 0.57). Univariate-regression analysis revealed that increased SS influenced 32% of Tlim during exercise with NiPPV. CONCLUSION NiPPV applied during high-intensity exercise can acutely modulate endothelial function and improve exercise tolerance in COPD-HF patients. In addition, the increase of SS positively influences exercise tolerance.
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Affiliation(s)
- Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
| | - Flávia Rossi Caruso
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
| | - Adriana S Garcia de Araújo
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
| | | | - Sílvia Cristina Garcia de Moura
- Cardiovascular Physical Therapy Laboratory, Physiotherapy Department, Federal University of São Carlos, Rod Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Physiotherapy Department, Federal University of São Carlos, Rod Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
| | - Shane A Phillips
- Department of Physical Therapy, Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA.
| | - Ross Arena
- Department of Physical Therapy, Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA.
| | | | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
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15
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Silva ALGDA, Goulart CÁL, Mansour KMK, Back GD, Cabiddu R, Trimer R, Borghi-Silva A. Acute effects of expiratory positive pressure on autonomic cardiac modulation during spontaneous and slow deep breathing in COPD patients. AN ACAD BRAS CIENC 2020; 92:e20190361. [PMID: 32696842 DOI: 10.1590/0001-3765202020190361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 02/12/2019] [Indexed: 11/21/2022] Open
Abstract
AIM to evaluate the acute effects of expiratory positive airway pressure on cardiac autonomic modulation in chronic obstructive pulmonary disease patients during spontaneous breathing and slow deep breathing. METHODS 17 patients were evaluated. The R-R intervals were collected (Polar® S810i) during spontaneous breathing (10 minutes) and slow deep breathing (4 minutes), with and without 5 cmH2O expiratory positive airway pressure. Stable signals were analyzed by Kubios®. Heart rate variability indices were computed in time domain and in frequency domain. RESULTS Expiratory positive airway pressure application affected low frequency (spontaneous breathing: 62.5±4.1 vs slow deep breathing: 28.2±4.2, p<0.001) and high frequency (spontaneous breathing: 37.4±17.3 vs slow deep breathing: 58.9±18.1, p<0.001). Interactions were observed between expiratory positive airway pressure effect and slow deep breathing effect for low frequency (p<0.001), high frequency (p<0.001) and low frequency/high frequency ratio (p<0.001). When patients were stratified by disease's severity, we identified a significant low frequency reduction (p<0.001) and high frequency increase (p<0.001) for all stages when slow deep breathing was associated with expiratory positive airway pressure. CONCLUSION A 5 cmH2O expiratory positive airway pressure during spontaneous and slow deep breathing can elicit an acute response, resulting in a cardiac autonomic control improvement in moderate-to-very severe patients.
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Affiliation(s)
- AndrÉa L G DA Silva
- Departamento de Ciências da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | - CÁssia L Goulart
- Departamento de Ciências da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | - Kamila M K Mansour
- Hospital Santa Cruz, Programa de Residência Multiprofissional em Saúde/ Fisioterapia, Santa Cruz do Sul, RS, Brazil
| | - Guilherme D Back
- Departamento de Ciências da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | - Ramona Cabiddu
- Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Renata Trimer
- Departamento de Ciências da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | - Audrey Borghi-Silva
- Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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16
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Higashimoto Y, Ando M, Sano A, Saeki S, Nishikawa Y, Fukuda K, Tohda Y. Effect of pulmonary rehabilitation programs including lower limb endurance training on dyspnea in stable COPD: A systematic review and meta-analysis. Respir Investig 2020; 58:355-366. [PMID: 32660900 DOI: 10.1016/j.resinv.2020.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022]
Abstract
Pulmonary rehabilitation (PR) is recommended as an effective treatment for patients with chronic obstructive pulmonary disease (COPD). Previous meta-analyses showed that PR improves exercise capacity and health-related quality of life (HRQOL). However, they did not evaluate the effect of PR on the sensation of dyspnea. We searched six databases in May 2019 for randomized controlled trials (RCTs) that examined PR, including supervised lower limb endurance training as a minimal essential component that was continued for 4-12 weeks, in patients with stable COPD, with changes from baseline dyspnea as a primary outcome. Secondary outcomes were changes in exercise capacity, HRQOL, activity of daily life (ADL), physical activity (PA), and adverse events. We calculated the pooled weighted mean difference (MD) using a random effects model. We identified 42 studies with 2150 participants. Compared with the control, PR improved dyspnea, as shown using the British Medical Research Council (MRC) questionnaire (MD, -0.64; 95% CI, -0.99 to -0.30; p = 0.0003), transitional dyspnea index (MD, 1.95; 95% CI, 1.09 to 2.81; p = 0.0001), modified Borg score during exercise (MD, -0.62; 95% CI, -1.10 to -0.14; p = 0.01), and Chronic Respiratory Questionnaire (CRQ) dyspnea score (MD, 0.91; 95% CI, 0.39 to 1.44; p = 0.0007). PR significantly increased exercise capacity measured by the 6 min walking distance time, peak workload, and peak VO2. It improved HRQOL measured by the St. George's Respiratory Questionnaire and CRQ, but not on PA or ADL. These results indicated that PR programs including lower limb endurance training improve dyspnea, HRQOL, and exercise capacity in patients with stable COPD.
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Affiliation(s)
- Yuji Higashimoto
- Department of Rehabilitation Medicine, Kindai University, Faculty of Medicine, Osaka, Japan.
| | - Morihide Ando
- Department of Pulmonary Medicine, Ogaki Municipal Hospital, Gifu, Japan
| | - Akiko Sano
- Department of Respiratory Medicine and Allergology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Sho Saeki
- Department of Respiratory Medicine and Allergology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Yusaku Nishikawa
- Department of Respiratory Medicine and Allergology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Kanji Fukuda
- Department of Rehabilitation Medicine, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University, Faculty of Medicine, Osaka, Japan
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17
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Mohamed AA, Alawna M. Role of increasing the aerobic capacity on improving the function of immune and respiratory systems in patients with coronavirus (COVID-19): A review. Diabetes Metab Syndr 2020; 14:489-496. [PMID: 32388326 PMCID: PMC7186129 DOI: 10.1016/j.dsx.2020.04.038] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS COVID-19 is a public world crisis, however, it is a self-limited infection. In COVID-19, the strength of immune and respiratory systems is a critical element. Thus, this review was conducted to demonstrate the short and long term effects of increasing the aerobic capacity on increasing the function and strength of immune and respiratory systems, particularly those essential for overcoming COVID-19 infections and associated disorders. METHODS This review was carried out by searching in Web of Science, Scopus, EBSCO, Medline databases. The search was conducted over clinical trials and literature and systematic reviews on the effects of increasing the aerobic capacity on the function and strength of specific immune and respiratory elements essential for overcoming COVID-19 infections. RESULTS This review found that increasing the aerobic capacity could produce short-term safe improvements in the function of immune and respiratory systems, particularly those specific for COVID-19 infections. This could be mainly produced through three mechanisms. Firstly, it could improve immunity by increasing the level and function of immune cells and immunoglobulins, regulating CRP levels, and decreasing anxiety and depression. Secondly, it could improve respiratory system functions by acting as an antibiotic, antioxidant, and antimycotic, restoring normal lung tissue elasticity and strength. Lastly, it could act as a protective barrier to decrease COVID-19 risk factors, which helps to decrease the incidence and progression of COVID-19. CONCLUSION This review summarizes that increasing the aerobic capacity is recommended because it has potential of improving immune and respiratory functions which would help counter COVID-19.
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Affiliation(s)
- Ayman A Mohamed
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey.
| | - Motaz Alawna
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey.
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18
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Ward TJC, Plumptre CD, Dolmage TE, Jones AV, Trethewey R, Divall P, Singh SJ, Lindley MR, Steiner MC, Evans RA. Change in V˙O 2peak in Response to Aerobic Exercise Training and the Relationship With Exercise Prescription in People With COPD: A Systematic Review and Meta-analysis. Chest 2020; 158:131-144. [PMID: 32173489 DOI: 10.1016/j.chest.2020.01.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/07/2019] [Accepted: 01/06/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O2peak) with aerobic training. RESEARCH QUESTION The goal of this study was to investigate the effect of aerobic training and exercise prescription on V˙O2peak in COPD. STUDY DESIGN AND METHODS A systematic review was performed by using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases for all studies measuring V˙O2peak prior to and following supervised lower-limb aerobic training in COPD. A random effects meta-analysis limited to randomized controlled trials comparing aerobic training vs usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of program and patient factors on outcome. RESULTS A total of 112 studies were included (participants, N = 3,484): 21 controlled trials (n = 489), of which 13 were randomized (n = 288) and 91 were uncontrolled (n = 2,995) studies. Meta-analysis found a moderate positive change in V˙O2peak (standardized mean difference, 0.52; 95% CI, 0.34-0.69) with the intervention. The change in V˙O2peak was positively associated with target duration of exercise session (P = .01) and, when studies > 1 year duration were excluded, greater total volume of exercise training (P = .01). Similarly, the change in V˙O2peak was greater for programs > 12 weeks compared with those 6 to 12 weeks when adjusted for age and sex. However, reported prescribed exercise intensity (P = .77), training modality (P > .35), and mode (P = .29) did not affect V˙O2peak. Cohorts with more severe airflow obstruction exhibited smaller improvements in V˙O2peak (P < .001). INTERPRETATION Overall, people with COPD achieved moderate improvements in V˙O2peak through supervised aerobic training. There is sufficient evidence to show that programs with greater total exercise volume, including duration of exercise session and program duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population. CLINICAL TRIAL REGISTRATION PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Thomas J C Ward
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom; Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - Thomas E Dolmage
- Respiratory Diagnostic & Evaluation Services, West Park Healthcare Centre, Toronto, ON, Canada
| | - Amy V Jones
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom
| | - Ruth Trethewey
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom
| | - Pip Divall
- Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Sally J Singh
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom; Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Science, University of Leicester, Leicester, United Kingdom
| | - Martin R Lindley
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; Translational Cell Biology Research Group, Loughborough University, Loughborough, United Kingdom
| | - Michael C Steiner
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom; Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Science, University of Leicester, Leicester, United Kingdom
| | - Rachael A Evans
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom; Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Science, University of Leicester, Leicester, United Kingdom.
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19
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Byers BW, Fuhr DP, Moore LE, Bhutani M, Wong EYL, Stickland MK. The effect of pulmonary rehabilitation on carotid chemoreceptor activity and sensitivity in chronic obstructive pulmonary disease. J Appl Physiol (1985) 2019; 127:1278-1287. [PMID: 31295067 DOI: 10.1152/japplphysiol.00799.2018] [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] [Indexed: 11/22/2022] Open
Abstract
Recent work demonstrates that carotid chemoreceptor (CC) activity/sensitivity is elevated in patients with chronic obstructive pulmonary disease (COPD) compared with healthy controls, and this elevated chemoreception appears to contribute to increased cardiovascular risk. Exercise training has been shown to normalize CC activity/sensitivity in other populations, and therefore, the purpose of this study was to determine whether pulmonary rehabilitation (PR) can reduce CC activity/sensitivity in COPD. Forty-five COPD patients [mean FEV1 (forced expiratory volume in 1 s) = 56.6% predicted] completed PR, while 15 COPD patients (mean FEV1 = 74.6% predicted) served as non-PR controls. CC activity was determined by the reduction in ventilation while breathing transient hyperoxia ([Formula: see text] = 1.0); CC sensitivity was evaluated by the increase in ventilation relative to the drop in arterial saturation while breathing hypoxia. Dyspnea, six-minute walk and autonomic function data were also obtained. PR improved 6-minute walk distance (P < 0.001) and dyspnea (P = 0.04); however, there was no effect on CC activity (P = 0.60), sensitivity (P = 0.69), or autonomic function (P > 0.05 for all). Subgroup analyses indicated that PR reduced CC activity in those with elevated baseline CC activity, independent of changes in autonomic function. No change in dyspnea (P = 0.24), CC activity (P = 0.19), sensitivity (P = 0.80), or autonomic function (P > 0.05 for all) was observed in the control group. Despite improvements in exercise tolerance and dyspnea, PR appears to be generally ineffective at reducing CC sensitivity in stable COPD patients; while PR reduced CC activity in those with elevated basal CC activity, the physiological significance of this is unclear. Further investigations aimed at improving CC function in COPD are needed.NEW & NOTEWORTHY While work in other chronic diseases has shown that exercise training may help normalize carotid chemoreceptor (CC) activity/sensitivity, the current study found that exercise training through pulmonary rehabilitation did not consistently reduce CC activity/sensitivity in patients with chronic obstructive pulmonary disease (COPD). These results suggest that other interventions are needed to normalize CC activity/sensitivity in COPD.
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Affiliation(s)
- Bradley W Byers
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Desi P Fuhr
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Linn E Moore
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Mohit Bhutani
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Y L Wong
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,G. F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, Alberta, Canada
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20
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Cutrim ALC, Duarte AAM, Silva-Filho AC, Dias CJ, Urtado CB, Ribeiro RM, Rigatto K, Rodrigues B, Dibai-Filho AV, Mostarda CT. Inspiratory muscle training improves autonomic modulation and exercise tolerance in chronic obstructive pulmonary disease subjects: A randomized-controlled trial. Respir Physiol Neurobiol 2019; 263:31-37. [DOI: 10.1016/j.resp.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 01/19/2023]
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21
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Effects of Water-Based Aerobic Interval Training in Patients With COPD: A RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev 2019; 39:105-111. [PMID: 30720640 DOI: 10.1097/hcr.0000000000000352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease promotes systemic repercussions, which can be minimized with physical exercise. This study investigated the effects of a water-based aerobic interval training program on the autonomic modulation of heart rate (HR), quality of life (QoL), and functional capacity (FC) of patients with chronic obstructive pulmonary disease. METHODS Nineteen patients with chronic obstructive pulmonary disease were enrolled in this randomized clinical trial and allocated to either the usual care group (n = 9) or training group (n = 10). Before and after 24 sessions of water-based physical training, the patients underwent evaluation of autonomic modulation of HR by analyzing the HR variability, QoL using the St George's Respiratory Questionnaire, and FC using 6-min walk test distance. RESULTS The results showed significant improvement when comparing the variables of HR variability, QoL, and FC in the training group in the pre- and post-training conditions (P < .05). In the usual care group, there was no significant difference for any of the variables. Negative correlations were found between HR variability and QoL (r =-0. 55; P = .01) and 6-min walk test distance and QoL (r =-0.49; P = .02). CONCLUSION Water-based physical training promoted beneficial adaptations in the autonomic modulation of HR, QoL, and FC of patients with chronic obstructive pulmonary disease.
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22
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Morishita S, Tsubaki A, Nashimoto S, Fu JB, Onishi H. Face scale rating of perceived exertion during cardiopulmonary exercise test. BMJ Open Sport Exerc Med 2018; 4:e000474. [PMID: 30622732 PMCID: PMC6307607 DOI: 10.1136/bmjsem-2018-000474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 12/01/2022] Open
Abstract
Objective This study aimed to investigate the correlation between the face scale and heart rate (HR), exercise load and oxygen uptake (V̇O2) during cardiopulmonary exercise testing. Methods This was a prospective, observational study of face scale rating of perceived exertion (RPE) and HR, exercise load and V̇O2 during cardiopulmonary exercise testing. A total of 30 healthy college men and 21 healthy college women were included. Subjects performed a cardiopulmonary exercise test with ramps and an increment increase in workload of 20 W/min. We recorded the responses of subjects using a face scale for RPE, HR, exercise load and V̇O2 every minute during the cardiopulmonary exercise test. Results In men, there was a significant positive correlation between the face scale RPE and HR (ρ=0.856, p<0.01), exercise load (ρ=0.888, p<0.01) and V̇O2 (ρ=0.878, p<0.01) during the cardiopulmonary exercise test. Similarly, in women, there was a significant positive correlation between the face scale RPE and HR (ρ=0.885, p<0.01), exercise load (ρ=0.908, p<0.01) and V̇O2 (ρ=0.895, p<0.01) during the cardiopulmonary exercise tests. Conclusion The face scale proposed in this study was related to physiological parameters, which suggests that it may be used to determine the intensity of exercise in healthy adults.
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Affiliation(s)
- Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Satoshi Nashimoto
- Department of Rehabilitation, Niigata Medical Centre, Niigata, Japan
| | - Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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23
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Leite MR, Ramos EMC, Freire APCF, de Alencar Silva BS, Nicolino J, Vanderlei LCM, Ramos D. Analysis of Autonomic Modulation in Response to a Session of Aerobic Exercise at Different Intensities in Patients With Moderate and Severe COPD. COPD 2018; 15:245-253. [PMID: 30375894 DOI: 10.1080/15412555.2018.1529744] [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] [Indexed: 10/28/2022]
Abstract
Despite the many benefits of performing physical exercise in patients with chronic obstructive pulmonary disease (COPD), information on the response of acute cardiac autonomic modulation in subjects with moderate and severe COPD during and after an aerobic exercise session at different intensities is unknown. The aim of this study was to evaluate the response of cardiac autonomic modulation in patients with moderate and severe COPD during and after an aerobic exercise session at different intensities. Twenty-seven patients with COPD, divided into: Moderate Group and Severe Group, underwent an aerobic exercise sessions with intensities equivalent to 60% and 90% of velocity corresponding to peak oxygen consumption. The heart rate variability (HRV) indices were analyzed in the time and frequency domains at the following times: at rest, during exercise, immediately after, and 5, 10, and 15 minutes after exercise. In the comparison analysis between the two groups, no differences were observed in any of the HRV indices at different intensities applied. However, it was observed that the exercise caused autonomic changes when the groups were analyzed separately. Sessions of aerobic exercise influence the autonomic modulation in patients with COPD. However, COPD severity did not influence the autonomic nervous system response to exercise and recovery moments; and there was no difference between the exercise intensities.
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Affiliation(s)
- Marceli Rocha Leite
- a Department of Physiotherapy , Universidade Estadual Paulista (UNESP) , São Paulo , Brazil
| | - Ercy Mara Cipulo Ramos
- a Department of Physiotherapy , Universidade Estadual Paulista (UNESP) , São Paulo , Brazil
| | | | | | - Juliana Nicolino
- a Department of Physiotherapy , Universidade Estadual Paulista (UNESP) , São Paulo , Brazil
| | | | - Dionei Ramos
- a Department of Physiotherapy , Universidade Estadual Paulista (UNESP) , São Paulo , Brazil
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24
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Caliskan SG, Polatli M, Bilgin MD. Nonlinear analysis of heart rate variability of healthy subjects and patients with chronic obstructive pulmonary disease. J Med Eng Technol 2018; 42:298-305. [DOI: 10.1080/03091902.2018.1491650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- S. G. Caliskan
- Department of Physics, Science and Art Faculty, Adnan Menderes University, Aydın, Turkey
| | - M. Polatli
- Department of Pulmonology, School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - M. D. Bilgin
- Department of Biophysics, School of Medicine, Adnan Menderes University, Aydın, Turkey
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25
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Carvalho LP, Di Thommazo-Luporini L, Mendes RG, Cabiddu R, Ricci PA, Basso-Vanelli RP, Oliveira-Junior MC, Vieira RP, Bonjorno-Junior JC, Oliveira CR, Luporini RL, Borghi-Silva A. Metabolic syndrome impact on cardiac autonomic modulation and exercise capacity in obese adults. Auton Neurosci 2018; 213:43-50. [PMID: 30005739 DOI: 10.1016/j.autneu.2018.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/18/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
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26
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Shehata SM, Refky MM, gabry MMA, Nafae RM. Outcome of pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease at Chest Department, Zagazig University Hospitals (2014–2016). THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2018. [DOI: 10.4103/ejb.ejb_21_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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da L Goulart C, San Martin EA, Mansour KMK, Schneiders PB, da Silva ALG. Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients. ACTA ACUST UNITED AC 2018; 51:e7180. [PMID: 29694504 PMCID: PMC5937727 DOI: 10.1590/1414-431x20187180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/16/2018] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the effect of expiratory positive airway pressure (EPAP) on heart rate variability (HRV) indices at rest and during 6-min walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients. Fifteen moderate to severe COPD patients were randomized and evaluated with and without (Non-EPAP) a 5 cmH2O EPAP device. Respiratory rate (RR) was collected at rest (5 min), during the 6MWT (5 min), and at recovery (5 min). Indices of HRV were computed in the time domain, in the frequency domain, and nonlinear analysis. For EPAP and Non-EPAP during the 6MWT, we found an increased mean heart rate (HR) (P=0.001; P=0.001) while mean RR (P=0.001; P=0.015) and RR tri index decreased (P=0.006; P=0.028). Peripheral oxygen saturation (P=0.019) increased at rest only in the EPAP group. In EPAP, correlations were found between forced expiratory volume in 1 s (FEV1) and low frequency (LF) sympathetic tonus (P=0.05; r=-0.49), FEV1 and high frequency (HF) parasympathetic tonus at rest (P=0.05; r=0.49), lactate at rest and LF during the 6MWT (P=0.02; r=-0.57), and lactate at rest and HF during 6MWT (P=0.02; r=0.56). Through a linear regression model, we found that lactate at rest explained 27% of the alterations of LF during 6MWT. The use of 5 cmH2O EPAP improved autonomic cardiac modulation and its complexity at rest in COPD patients. Although it did not influence the performance of the 6MWT, the EPAP device caused alterations in resting lactate concentration with an effect on sympatho-vagal control during the test.
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Affiliation(s)
- C da L Goulart
- Iniciação Científica, Curso de Fisioterapia, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
| | - E A San Martin
- Iniciação Científica, Curso de Fisioterapia, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
| | - K M K Mansour
- Iniciação Científica, Curso de Fisioterapia, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
| | - P B Schneiders
- Iniciação Científica, Curso de Fisioterapia, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
| | - A L G da Silva
- Curso de Fisioterapia, Departamento de Educação Física e Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil
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28
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Mohammed J, Derom E, Van Oosterwijck J, Da Silva H, Calders P. Evidence for aerobic exercise training on the autonomic function in patients with chronic obstructive pulmonary disease (COPD): a systematic review. Physiotherapy 2018; 104:36-45. [DOI: 10.1016/j.physio.2017.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/12/2017] [Indexed: 02/04/2023]
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29
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Mohammed J, Derom E, De Backer T, De Wandele I, Calders P. Cardiac Autonomic Function and Reactivity Tests in Physically Active Subjects with Moderately Severe COPD. COPD 2018; 15:51-59. [DOI: 10.1080/15412555.2017.1412414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jibril Mohammed
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Eric Derom
- Department of Internal Medicine, Ghent University – Ghent University Hospital, Ghent, Belgium
| | - Tine De Backer
- Department of Internal Medicine, Ghent University – Ghent University Hospital, Ghent, Belgium
| | - Inge De Wandele
- Center for Medical Genetics, Ghent University – Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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30
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de Rezende Barbosa MPDC, Vanderlei LCM, Neves LM, Takahashi C, Torquato PRDS, Fortaleza ACDS, Freitas Júnior IF, Sorpreso ICE, Abreu LC, Pérez Riera AR. Impact of functional training on geometric indices and fractal correlation property of heart rate variability in postmenopausal women. Ann Noninvasive Electrocardiol 2018; 23:e12469. [PMID: 28741870 PMCID: PMC6931770 DOI: 10.1111/anec.12469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/17/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To evaluate the influence of functional training on the geometric indices of heart rate variability (HRV) and fractal correlation properties of the dynamics of heart rate in menopausal women. METHODS Of 39 women who were in the period of menopause for more than a year and who did not practice any regular physical activity were divided into: Functional training group (FTG = 50 ± 4.5 years; 67.64 ± 11.64 kg; 1.5 ± 0.05 m) that executed the functional training (FT) and all proposals by reviews and the Control group (58.45 ± 4.8 years; 66.91 ± 13.24 kg; 1.55 ± 0.05 m) who performed all assessments but not FT. The training consisted of 18 weeks (three times a week) and the volunteers performed three sets of 11 functional exercises followed by a walk in each of the sessions. The autonomic nervous system modulation was evaluated by analysis of HRV and the indices obtained were: RR intervals, RRTRI, TINN, SD1, SD2, SD1/SD2, qualitative analysis of Poincaré plot and DFA (alfa-1, alfa-2 and alfa-1/alfa-2). The Student's t-test for unpaired samples (normal data) or Mann-Whitney test nonnormal data) were used to compare the differences obtained between the final moment and the initial moment of the studied groups (p < .05). CONCLUSION Were observed in the FTG: increased SD1 (CG 0.13 ± 4.00 vs. 3.60 ± 8.43), beat-to-beat global dispersion much greater as an increased in the dispersion of long-term RR intervals and increased fractal properties of short-term (α1) (CG -0.04 ± 0.13 vs. 0.07 ± 0.21). FT promoted a beneficial impact on cardiac autonomic modulation, characterized by increased parasympathetic activity and short-term fractal properties of the dynamics of the heart rate.
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Affiliation(s)
| | - Luiz C. M. Vanderlei
- Physiotherapy DepartmentSão Paulo State University – FCT/UNESPPresidente PrudenteSPBrazil
| | | | - Carolina Takahashi
- Physiotherapy DepartmentSão Paulo State University – FCT/UNESPPresidente PrudenteSPBrazil
| | | | | | | | - Isabel C. E. Sorpreso
- Medicine FacultyObstetrics and Gynecology DepartmentUniversity of São Paulo (USP)São PauloBrazil
| | - Luiz C. Abreu
- ABC Medical School (FMABC)Santo AndréSão PauloBrazil
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31
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Miranda EF, Tomazoni SS, de Paiva PRV, Pinto HD, Smith D, Santos LA, de Tarso Camillo de Carvalho P, Leal-Junior ECP. When is the best moment to apply photobiomodulation therapy (PBMT) when associated to a treadmill endurance-training program? A randomized, triple-blinded, placebo-controlled clinical trial. Lasers Med Sci 2017; 33:719-727. [PMID: 29185134 DOI: 10.1007/s10103-017-2396-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022]
Abstract
Photobiomodulation therapy (PBMT) employing low-level laser therapy (LLLT) and/or light emitting diode therapy (LEDT) has emerged as an electrophysical intervention that could be associated with aerobic training to enhance beneficial effects of aerobic exercise. However, the best moment to perform irradiation with PBMT in aerobic training has not been elucidated. The aim of this study was to assess the effects of PBMT applied before and/or after each training session and to evaluate outcomes of the endurance-training program associated with PBMT. Seventy-seven healthy volunteers completed the treadmill-training protocol performed for 12 weeks, with 3 sessions per week. PBMT was performed before and/or after each training session (17 sites on each lower limb, using a cluster of 12 diodes: 4 × 905 nm super-pulsed laser diodes, 4 × 875 nm infrared LEDs, and 4 × 640 nm red LEDs, dose of 30 J per site). Volunteers were randomized in four groups according to the treatment they would receive before and after each training session: PBMT before + PBMT after, PBMT before + placebo after, placebo before + PBMT after, and placebo before + placebo after. Assessments were performed before the start of the protocol and after 4, 8, and 12 weeks of training. Primary outcome was time until exhaustion; secondary outcome measures were oxygen uptake and body fat. PBMT applied before and after aerobic exercise training sessions (PBMT before + PBMT after group) significantly increased (p < 0.05) the percentage of change of time until exhaustion and oxygen uptake compared to the group treated with placebo before and after aerobic exercise training sessions (placebo before + placebo after group) at 4th, 8th, and 12th week. PBMT applied before and after aerobic exercise training sessions (PBMT before + PBMT after group) also significantly improved (p < 0.05) the percentage of change of body fat compared to the group treated with placebo before and after aerobic exercise training sessions (placebo before + placebo after group) at 8th and 12th week. PBMT applied before and after sessions of aerobic training during 12 weeks can increase the time-to-exhaustion and oxygen uptake and also decrease the body fat in healthy volunteers when compared to placebo irradiation before and after exercise sessions. Our outcomes show that PBMT applied before and after endurance-training exercise sessions lead to improvement of endurance three times faster than exercise only.
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Affiliation(s)
- Eduardo Foschini Miranda
- Laboratory of Phototherapy in Sports and Exercise, Nove de Julho University, Sao Paulo, SP, Brazil
| | - Shaiane Silva Tomazoni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Sao Paulo, SP, Brazil
| | - Paulo Roberto Vicente de Paiva
- Laboratory of Phototherapy in Sports and Exercise, Nove de Julho University, Sao Paulo, SP, Brazil.,Post-Graduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Sao Paulo, SP, 01504-001, Brazil
| | - Henrique Dantas Pinto
- Laboratory of Phototherapy in Sports and Exercise, Nove de Julho University, Sao Paulo, SP, Brazil.,Post-Graduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Sao Paulo, SP, 01504-001, Brazil
| | - Denis Smith
- Post-Graduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Sao Paulo, SP, 01504-001, Brazil
| | - Larissa Aline Santos
- Post-Graduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Sao Paulo, SP, 01504-001, Brazil
| | | | - Ernesto Cesar Pinto Leal-Junior
- Laboratory of Phototherapy in Sports and Exercise, Nove de Julho University, Sao Paulo, SP, Brazil. .,Post-Graduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Sao Paulo, SP, 01504-001, Brazil.
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32
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Mohammed J, Da Silva H, Van Oosterwijck J, Calders P. Effect of respiratory rehabilitation techniques on the autonomic function in patients with chronic obstructive pulmonary disease: A systematic review. Chron Respir Dis 2017; 14:217-230. [PMID: 28774205 DOI: 10.1177/1479972316680844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) show several extrapulmonary abnormalities such as impairment in the autonomic function (AF). Similarly, the use of respiratory training techniques such as controlled breathing techniques, noninvasive mechanical ventilation (NIMV), and oxygen supplementation for AF modulation in patients with COPD is popular in existing literature. However, the evidence to support their use is nonexistent. A systematic search of studies reporting on the effect of controlled breathing techniques, NIMV, and/or oxygen supplementation techniques on AF outcome parameters was conducted in three online databases: PubMed, Embase, and Web of Science. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, relevant studies were retained and qualitatively analyzed for evidence synthesis. The methodological quality in these studies was evaluated using the evidence based guideline development (EBRO) checklists per designs provided by the Dutch Cochrane Centre. Eighteen studies met the inclusion criteria of the review and were included and discussed. The evidence synthesis revealed that a strong and moderate level evidence supported oxygen supplementation and slow breathing techniques, respectively, in significantly enhancing the baroreceptor sensitivity (BRS) values in patients with COPD. The effect of the examined techniques on the heart rate variability and muscle sympathetic nerve activity was of a limited or inconsistent evidence. The findings from this review suggest that oxygen supplementation and controlled breathing techniques have profound positive influence on the BRS in patients with COPD. However, it is not fully clear whether these influence translates to any therapeutic benefit on the general AF of patients with COPD in the long term.
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Affiliation(s)
- Jibril Mohammed
- 1 Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium.,2 Department of Physiotherapy, Bayero University Kano, Nigeria
| | - Hellen Da Silva
- 1 Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium
| | - Jessica Van Oosterwijck
- 1 Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium.,3 Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Patrick Calders
- 1 Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium
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33
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Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease. Am J Phys Med Rehabil 2017; 96:541-548. [DOI: 10.1097/phm.0000000000000667] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Xu J, He S, Han Y, Pan J, Cao L. Effects of modified pulmonary rehabilitation on patients with moderate to severe chronic obstructive pulmonary disease: A randomized controlled trail. Int J Nurs Sci 2017; 4:219-224. [PMID: 31406744 PMCID: PMC6626181 DOI: 10.1016/j.ijnss.2017.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jingjuan Xu
- Department of Scientific Research and Education, The Third Hospital Affiliated to Soochow University, Changzhou, People's Republic of China
| | - Shengnan He
- Department of Respiratory Diseases, The Third Hospital Affiliated to Soochow University, Changzhou, People's Republic of China
| | - Ying Han
- Department of Respiratory Diseases, The Third Hospital Affiliated to Soochow University, Changzhou, People's Republic of China
| | - Jingya Pan
- Department of Respiratory Diseases, The Third Hospital Affiliated to Soochow University, Changzhou, People's Republic of China
| | - Ling Cao
- Department of Respiratory Diseases, The Third Hospital Affiliated to Soochow University, Changzhou, People's Republic of China
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35
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Goulart CDL, Cabiddu R, Schneiders PDB, Antunes San Martin E, Trimer R, Borghi-Silva A, da Silva ALG. Is cardiac autonomic modulation during upper limb isometric contraction and Valsalva maneuver impaired in COPD patients? Int J Chron Obstruct Pulmon Dis 2017; 12:849-857. [PMID: 28331306 PMCID: PMC5357074 DOI: 10.2147/copd.s130428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the heart rate variability (HRV) indices and heart rate (HR) responses during isometric contraction (IC) and Valsalva maneuver (VM) in COPD patients. METHODS Twenty-two stable moderate to severe COPD patients were evaluated. R-R intervals were recorded (monitor Polar® S810i) during dominant upper limb IC (2 minutes). Stable signals were analyzed by Kubios HRV® software. Indices of HRV were computed in the time domain (mean HR; square root of the mean squared differences of successive RR intervals [RMSSD] and HRV triangular index [RR tri index]) and in the frequency domain (high frequency [HF]; low frequency [LF] and LF/HF ratio). The HR responses were evaluated at rest, at the peak and at the nadir of the VM (15 seconds). The Valsalva index was also calculated. RESULTS During IC: time domain indices (mean HR increased [P=0.001], RMSSD, and RR tri index decreased [P=0.005 and P=0.005, respectively]); frequency domain indices (LF increased [P=0.033] and HF decreased [P=0.002]); associations were found between forced expiratory volume in 1 second (FEV1) vs RMSSD (P=0.04; r=-0.55), FEV1 vs HR (P=0.04; r=-0.48), forced vital capacity (FVC) vs RMSSD (P=0.05; r=-0.62), maximum inspiratory pressure (MIP) vs HF (P=0.02; r=0.68). FEV1 and FVC justified 30% of mean HR. During VM: HR increased (P=0.01); the nadir showed normal bradycardic response; the Valsalva index was =0.7. CONCLUSION COPD patients responded properly to the upper limb IC and to the VM; however, HR recovery during VM was impaired in these patients. The severity of the disease and MIP were associated with increased parasympathetic modulation and higher chronotropic response.
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Affiliation(s)
| | - Ramona Cabiddu
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Renata Trimer
- Department of Physiotherapy, Federal University of Amazonas, Manaus, AM, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, Brazil
| | - Andréa Lúcia Gonçalves da Silva
- Course of Physiotherapy, Department of Health and Physical Education, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil; Pulmonary Rehabilitation Program, Santa Cruz Hospital, Santa Cruz do Sul, Rio Grande do Sul, Brazil
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Grant CC, Mongwe L, Janse van Rensburg DC, Fletcher L, Wood PS, Terblanche E, du Toit PJ. The Difference Between Exercise-Induced Autonomic and Fitness Changes Measured After 12 and 20 Weeks of Medium-to-High Intensity Military Training. J Strength Cond Res 2016; 30:2453-9. [PMID: 23838980 DOI: 10.1519/jsc.0b013e3182a1fe46] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Grant, CC, Mongwe, L, Janse van Rensburg, DC, Fletcher, L, Wood, PS, Terblanche, E, and du Toit, PJ. The difference between exercise-induced autonomic and fitness changes measured after 12 and 20 weeks of medium-to-high intensity military training. J Strength Cond Res 30(9): 2453-2459, 2016-The aim of this study was to compare the physical fitness, based on VO2max and exercise-induced cardiac autonomic changes, measured by heart rate variability (HRV) of 12 weeks with 20 weeks of training in the South African National Defence Force. Recruits (n = 154) participated in a medium-to-high intensity exercise intervention (daily energy expenditure: 8,485 kJ·d). The significant effect on VO2max between weeks 1 and 12 (48.57, SD = 9.25 vs. 53.36, SD = 7.21] did not continue during weeks 12-20 (53.36, SD = 7.21 vs. 53.87, SD = 7.87). No changes in the supine low frequency (LF)/high frequency (HF) (0.48, SD = 0.51 vs. 0.41, SD = 0.64) or the standing LF/HF (4.02, SD = 5.14 vs. 3.91, SD = 5.28), an indicator of autonomic balance and a possible indicator of overtraining syndrome, suggests that overtraining did not take place during weeks 12-20. This was confirmed with further decreases in supine and standing heart rate. However, the power of the vagal-induced variability continued to increase after 12 weeks. Increased vagal influence without concurrent change in autonomic balance may be interpreted as decreased sympathetic cardiac control. It is important to note that although no fitness changes were detected, positive cardiac autonomic conditioning did continue between weeks 12 and 20, as measured by increased vagal-induced HRV and decreased sympathetic influence on cardiac control. Results may be extrapolated to training in the normal population/athletes after a medium-to-high intensity exercise program, as this intervention was a closely monitored and standardized exercise program.
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Affiliation(s)
- Catharina C Grant
- 1Section Sports Medicine; Departments of 2Statistics; 3Biokinetics; and 4Physiology, University of Pretoria, Pretoria, South Africa; and 5South African National Defense Force, Pretoria, South Africa
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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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Janyacharoen T, Thayon M, Bushong W, Jaikla N, Sawanyawisuth K. Effects of resistance exercise on cardiopulmonary factors in sedentary individuals. J Phys Ther Sci 2016; 28:213-7. [PMID: 26957760 PMCID: PMC4756006 DOI: 10.1589/jpts.28.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the effects of resistance exercise on cardiopulmonary
functions in young sedentary subjects. [Subjects] Forty-two young and healthy subjects
with a sedentary lifestyle were included in this study. [Methods] The subjects were
randomly divided into 2 groups: control and experimental. The control group (n=21)
received health education and continued with normal activities of daily living. The
experimental group (n=21) underwent resistance training, health education, and continued
with normal activities of daily living. The resistance exercise program consisted of 3
postural exercises: chest press, dumbbell pullover, and flat-bench dumbbell fly. The
subjects received this intervention 3 times/week for 8 weeks. [Results] The baseline
characteristics were comparable between the 2 groups. The 6-minute-walk test score, peak
expiratory flow, forced vital capacity, forced expiratory volume in 1 second, maximal
voluntary ventilation, and chest expansions were significantly improved post-intervention
in the experimental group and between the 2 groups. [Conclusion] Cardiopulmonary functions
in young sedentary subjects were significantly improved with the 8-week resistance
exercise program.
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Affiliation(s)
- Taweesak Janyacharoen
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand; Department of Physiotherapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Methiya Thayon
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand
| | - Wanwisa Bushong
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand
| | - Nussamol Jaikla
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; The Research and Training Center for Enhancing Quality of Life of Working-Age People, Khon Kaen University, Thailand
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Leite MR, Ramos EMC, Kalva-Filho CA, Freire APCF, de Alencar Silva BS, Nicolino J, de Toledo-Arruda AC, Papoti M, Vanderlei LCM, Ramos D. Effects of 12 weeks of aerobic training on autonomic modulation, mucociliary clearance, and aerobic parameters in patients with COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:2549-57. [PMID: 26648712 PMCID: PMC4664442 DOI: 10.2147/copd.s81363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Patients with chronic obstructive pulmonary disease (COPD) exhibit aerobic function, autonomic nervous system, and mucociliary clearance alterations. These parameters can be attenuated by aerobic training, which can be applied with continuous or interval efforts. However, the possible effects of aerobic training, using progressively both continuous and interval sessions (ie, linear periodization), require further investigation. Aim To analyze the effects of 12-week aerobic training using continuous and interval sessions on autonomic modulation, mucociliary clearance, and aerobic function in patients with COPD. Methods Sixteen patients with COPD were divided into an aerobic (continuous and interval) training group (AT) (n=10) and a control group (CG) (n=6). An incremental test (initial speed of 2.0 km·h−1, constant slope of 3%, and increments of 0.5 km·h−1 every 2 minutes) was performed. The training group underwent training for 4 weeks at 60% of the peak velocity reached in the incremental test (vVO2peak) (50 minutes of continuous effort), followed by 4 weeks of sessions at 75% of vVO2peak (30 minutes of continuous effort), and 4 weeks of interval training (5×3-minute effort at vVO2peak, separated by 1 minute of passive recovery). Intensities were adjusted through an incremental test performed at the end of each period. Results The AT presented an increase in the high frequency index (ms2) (P=0.04), peak oxygen uptake (VO2peak) (P=0.01), vVO2peak (P=0.04), and anaerobic threshold (P=0.02). No significant changes were observed in the CG (P>0.21) group. Neither of the groups presented changes in mucociliary clearance after 12 weeks (AT: P=0.94 and CG: P=0.69). Conclusion Twelve weeks of aerobic training (continuous and interval sessions) positively influenced the autonomic modulation and aerobic parameters in patients with COPD. However, mucociliary clearance was not affected by aerobic training.
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Affiliation(s)
- Marceli Rocha Leite
- Department of Physiotherapy, São Paulo State University, Presidente Prudente, Brazil
| | | | | | | | | | - Juliana Nicolino
- Department of Physiotherapy, São Paulo State University, Presidente Prudente, Brazil
| | | | - Marcelo Papoti
- School of Physical Education and Sport of Ribeirão Preto, São Paulo University, Ribeirão Preto, São Paulo, Brazil
| | | | - Dionei Ramos
- Department of Physiotherapy, São Paulo State University, Presidente Prudente, Brazil
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Janyacharoen T, Phusririt C, Angkapattamakul S, Hurst CP, Sawanyawisuth K. Cardiopulmonary effects of traditional Thai dance on menopausal women: a randomized controlled trial. J Phys Ther Sci 2015; 27:2569-72. [PMID: 26357441 PMCID: PMC4563316 DOI: 10.1589/jpts.27.2569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/15/2015] [Indexed: 12/04/2022] Open
Abstract
[Purpose] This study evaluated the effects of Thai dance on cardiopulmonary factors in
menopausal women. [Subjects] Sixty-six menopausal women aged 40 years or more. [Methods]
Subjects were randomly assigned to either the Thai dance or control group. The Thai dance
group performed a traditional Thai dancing exercise program for 60 minutes, 3 times per
week for 6 weeks. The control group received general health guidance. The 6-minutewalk
test, peak expiratory flow, forced vital capacity, forced expiratory volume in one second,
maximal voluntary ventilation, and chest expansion were assessed at baseline and at the
end of the study. [Results] Sixty-six menopausal women were eligible. At the end of the
study, all variables were significantly better in the Thai dance group than the control
group. Moreover, all variables improved significantly compared to baseline in the Thai
dance group but not in the control group. For example, the mean 6-minutewalk test result
in Thai dance group at the end of the study was 285.4 m, which was significantly higher
than that at baseline (254.8 m) and the control group at baseline (247.0 m). [Conclusion]
A 6-week Thai dance program improves cardiorespiratory endurance in menopausal women.
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Affiliation(s)
- Taweesak Janyacharoen
- Research Center in Back, Neck Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Thailand ; Department of Physiotherapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Chonticha Phusririt
- Department of Physiotherapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Sariya Angkapattamakul
- Department of Physiotherapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | - Cameron P Hurst
- Clinical Epidemiology Unit (CEU), Faculty of Medicine, Khon Kaen University, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand ; The Research and Training Center for Enhancing Quality of Life of Working-Age People, Khon Kaen University, Thailand
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Santos AASD, Ricci-Vitor AL, Bragatto VSR, Santos APSD, Ramos EMC, Vanderlei LCM. Can geometric indices of heart rate variability predict improvement in autonomic modulation after resistance training in chronic obstructive pulmonary disease? Clin Physiol Funct Imaging 2015; 37:124-130. [DOI: 10.1111/cpf.12275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Ana Alice Soares dos Santos
- Departamento de Fisioterapia; Faculdade de Ciências e Tecnologia da Universidade Estadual Paulista (UNESP); Presidente Prudente São Paulo Brazil
| | - Ana Laura Ricci-Vitor
- Departamento de Fisioterapia; Faculdade de Ciências e Tecnologia da Universidade Estadual Paulista (UNESP); Presidente Prudente São Paulo Brazil
| | - Vanessa Santa Rosa Bragatto
- Departamento de Fisioterapia; Faculdade de Ciências e Tecnologia da Universidade Estadual Paulista (UNESP); Presidente Prudente São Paulo Brazil
| | - Ana Paula Soares dos Santos
- Departamento de Fisioterapia; Faculdade de Ciências e Tecnologia da Universidade Estadual Paulista (UNESP); Presidente Prudente São Paulo Brazil
| | - Ercy Mara Cipulo Ramos
- Departamento de Fisioterapia; Faculdade de Ciências e Tecnologia da Universidade Estadual Paulista (UNESP); Presidente Prudente São Paulo Brazil
| | - Luiz Carlos Marques Vanderlei
- Departamento de Fisioterapia; Faculdade de Ciências e Tecnologia da Universidade Estadual Paulista (UNESP); Presidente Prudente São Paulo Brazil
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Fotheringham I, Meakin G, Punekar YS, Riley JH, Cockle SM, Singh SJ. Comparison of laboratory- and field-based exercise tests for COPD: a systematic review. Int J Chron Obstruct Pulmon Dis 2015; 10:625-43. [PMID: 25834421 PMCID: PMC4372024 DOI: 10.2147/copd.s70518] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Exercise tests are often used to evaluate the functional status of patients with COPD. However, to the best of our knowledge, a comprehensive systematic comparison of these tests has not been performed. We systematically reviewed studies reporting the repeatability and/or reproducibility of these tests, and studies comparing their sensitivity to therapeutic intervention. A systematic review identified primary manuscripts in English reporting relevant data on the following exercise tests: 6-minute walk test (6MWT) and 12-minute walk test, incremental and endurance shuttle walk tests (ISWT and ESWT, respectively), incremental and endurance cycle ergometer tests, and incremental and endurance treadmill tests. We identified 71 relevant studies. Good repeatability (for the 6MWT and ESWT) and reproducibility (for the 6MWT, 12-minute walk test, ISWT, ESWT, and incremental cycle ergometer test) were reported by most studies assessing these tests, providing patients were familiarized with them beforehand. The 6MWT, ISWT, and particularly the ESWT were reported to be sensitive to therapeutic intervention. Protocol variations (eg, track layout or supplemental oxygen use) affected performance significantly in several studies. This review shows that while the validity of several tests has been established, for others further study is required. Future work will assess the link between these tests, physiological mechanisms, and patient-reported measures.
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Affiliation(s)
- Iain Fotheringham
- Value Demonstration Practice, Oxford PharmaGenesis, Oxford, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Georgina Meakin
- Value Demonstration Practice, Oxford PharmaGenesis, Oxford, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yogesh Suresh Punekar
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - John H Riley
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sarah M Cockle
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015; 2015:CD003793. [PMID: 25705944 PMCID: PMC10008021 DOI: 10.1002/14651858.cd003793.pub3] [Citation(s) in RCA: 736] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Widespread application of pulmonary rehabilitation (also known as respiratory rehabilitation) in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function (health-related quality of life, functional and maximal exercise capacity) attributable to the programmes. This review updates the review reported in 2006. OBJECTIVES To compare the effects of pulmonary rehabilitation versus usual care on health-related quality of life and functional and maximal exercise capacity in persons with COPD. SEARCH METHODS We identified additional randomised controlled trials (RCTs) from the Cochrane Airways Group Specialised Register. Searches were current as of March 2014. SELECTION CRITERIA We selected RCTs of pulmonary rehabilitation in patients with COPD in which health-related quality of life (HRQoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. We defined 'pulmonary rehabilitation' as exercise training for at least four weeks with or without education and/or psychological support. We defined 'usual care' as conventional care in which the control group was not given education or any form of additional intervention. We considered participants in the following situations to be in receipt of usual care: only verbal advice was given without additional education; and medication was altered or optimised to what was considered best practice at the start of the trial for all participants. DATA COLLECTION AND ANALYSIS We calculated mean differences (MDs) using a random-effects model. We requested missing data from the authors of the primary study. We used standard methods as recommended by The Cochrane Collaboration. MAIN RESULTS Along with the 31 RCTs included in the previous version (2006), we included 34 additional RCTs in this update, resulting in a total of 65 RCTs involving 3822 participants for inclusion in the meta-analysis.We noted no significant demographic differences at baseline between members of the intervention group and those who received usual care. For the pulmonary rehabilitation group, the mean forced expiratory volume at one second (FEV1) was 39.2% predicted, and for the usual care group 36.4%; mean age was 62.4 years and 62.5 years, respectively. The gender mix in both groups was around two males for each female. A total of 41 of the pulmonary rehabilitation programmes were hospital based (inpatient or outpatient), 23 were community based (at community centres or in individual homes) and one study had both a hospital component and a community component. Most programmes were of 12 weeks' or eight weeks' duration with an overall range of four weeks to 52 weeks.The nature of the intervention made it impossible for investigators to blind participants or those delivering the programme. In addition, it was unclear from most early studies whether allocation concealment was undertaken; along with the high attrition rates reported by several studies, this impacted the overall risk of bias.We found statistically significant improvement for all included outcomes. In four important domains of quality of life (QoL) (Chronic Respiratory Questionnaire (CRQ) scores for dyspnoea, fatigue, emotional function and mastery), the effect was larger than the minimal clinically important difference (MCID) of 0.5 units (dyspnoea: MD 0.79, 95% confidence interval (CI) 0.56 to 1.03; N = 1283; studies = 19; moderate-quality evidence; fatigue: MD 0.68, 95% CI 0.45 to 0.92; N = 1291; studies = 19; low-quality evidence; emotional function: MD 0.56, 95% CI 0.34 to 0.78; N = 1291; studies = 19; mastery: MD 0.71, 95% CI 0.47 to 0.95; N = 1212; studies = 19; low-quality evidence). Statistically significant improvements were noted in all domains of the St. George's Respiratory Questionnaire (SGRQ), and improvement in total score was better than 4 units (MD -6.89, 95% CI -9.26 to -4.52; N = 1146; studies = 19; low-quality evidence). Sensitivity analysis using the trials at lower risk of bias yielded a similar estimate of the treatment effect (MD -5.15, 95% CI -7.95 to -2.36; N = 572; studies = 7).Both functional exercise and maximal exercise showed statistically significant improvement. Researchers reported an increase in maximal exercise capacity (mean Wmax (W)) in participants allocated to pulmonary rehabilitation compared with usual care (MD 6.77, 95% CI 1.89 to 11.65; N = 779; studies = 16). The common effect size exceeded the MCID (4 watts) proposed by Puhan 2011(b). In relation to functional exercise capacity, the six-minute walk distance mean treatment effect was greater than the threshold of clinical significance (MD 43.93, 95% CI 32.64 to 55.21; participants = 1879; studies = 38).The subgroup analysis, which compared hospital-based programmes versus community-based programmes, provided evidence of a significant difference in treatment effect between subgroups for all domains of the CRQ, with higher mean values, on average, in the hospital-based pulmonary rehabilitation group than in the community-based group. The SGRQ did not reveal this difference. Subgroup analysis performed to look at the complexity of the pulmonary rehabilitation programme provided no evidence of a significant difference in treatment effect between subgroups that received exercise only and those that received exercise combined with more complex interventions. However, both subgroup analyses could be confounded and should be interpreted with caution. AUTHORS' CONCLUSIONS Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately large and clinically significant. Rehabilitation serves as an important component of the management of COPD and is beneficial in improving health-related quality of life and exercise capacity. It is our opinion that additional RCTs comparing pulmonary rehabilitation and conventional care in COPD are not warranted. Future research studies should focus on identifying which components of pulmonary rehabilitation are essential, its ideal length and location, the degree of supervision and intensity of training required and how long treatment effects persist. This endeavour is important in the light of the new subgroup analysis, which showed a difference in treatment effect on the CRQ between hospital-based and community-based programmes but no difference between exercise only and more complex pulmonary rehabilitation programmes.
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Affiliation(s)
- Bernard McCarthy
- School of Nursing and Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Co. Galway, Ireland.
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Leite MR, Ramos EMC, Kalva-Filho CA, Rodrigues FMM, Freire APCF, Tacao GY, de Toledo AC, Cecílio MJ, Vanderlei LCM, Ramos D. Correlation between heart rate variability indexes and aerobic physiological variables in patients with COPD. Respirology 2014; 20:273-8. [PMID: 25381699 DOI: 10.1111/resp.12424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 08/07/2014] [Accepted: 08/28/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Previous studies have shown a relationship between the level of physical fitness and autonomic variables. However, these relationships have not been investigated in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to correlate the resting heart rate variability (HRV) indexes with aerobic physiological variables obtained at a maximal exercise test in patients with COPD. METHODS Thirty-seven patients with COPD (63 (59-70) years; 46 (35.4-63.7) forced expiratory volume in 1 s (FEV1)%) underwent assessment of autonomic modulation at rest for 20 min to determine the HRV indexes in time and frequency domains. Soon after that, the patients performed an incremental exercise test to determine the anaerobic threshold (GET), the peak oxygen uptake (VO 2PEAK) and the velocity corresponding to VO 2PEAK (vVO 2PEAK). RESULTS The indexes that express parasympathetic component as RMSSD (11.4 [7.5-23.8], HF (ms(2)) (35 [17-195] and SD1 (8.1 [5.3-16.8]), correlated with GET (r = 0.39; r = 0.43; r = 0.39 respectively). The indexes that represent the overall variability, SDNN (19.5 [13.9-28.8]), LF (ms(2)) (111 [38-229]), and SD2 (26.8 [18.6-35.4]) correlated with vVO 2PEAK (r = 0.37; r = 0.38; r = 0.37; r = 0.44; r = 0.43; r = 0.46 respectively). Likewise, the indexes LF (ms(2)), LF (nu) (63.2 [46-77,9]), HF (nu) (36.8 [22.1-54]), and LF/HF (1.7 [0.9-3.5]) correlated with VO 2PEAK (r = 0.35; r = 0.35; r = -0.35; r = 0.40 respectively). CONCLUSIONS This study demonstrated that HRV indexes at rest may become a predictive tool for aerobic capacity in COPD patients after the development of more consistent methods.
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Affiliation(s)
- Marceli R Leite
- Department of Physiotherapy, São Paulo State University (UNESP), Presidente Prudente, Brazil
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Roque AL, Valenti VE, Massetti T, da Silva TD, Monteiro CBDM, Oliveira FR, de Almeida Junior ÁD, Lacerda SNB, Pinasco GC, Nascimento VG, Granja Filho LG, de Abreu LC, Garner DM, Ferreira C. Chronic obstructive pulmonary disease and heart rate variability: a literature update. Int Arch Med 2014; 7:43. [PMID: 25945125 PMCID: PMC4414304 DOI: 10.1186/1755-7682-7-43] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The literature indicates that chronic obstructive pulmonary disease (COPD) affects cardiac autonomic control. In this study, we conducted a literature review in order to investigate the heart rate variability (HRV) in COPD subjects. METHODS A search was performed in Medline database, using the link between the keywords: "autonomic nervous system", "cardiovascular system", "COPD" and "heart rate variability". RESULTS The search resulted in a total of 40 references. Amongst these references, the first exclusion resulted in the barring of 29 titles and abstracts, which were not clearly related to the purpose of review. This resulted in a total of 11 articles that were then read and utilized in the review. The selected studies indicated that there is significant reduction of HRV in patients with COPD, characterized by reduction of indices that assess parasympathetic activity in addition to dealing with the global autonomic modulation. We also established that supervised exercise can reduce these harmful effects in COPD patients. Also, it was reported that the use of non-invasive ventilation in these patients may contribute to the improvement of respiratory symptoms, with no impairing, and may even induce positive responses in cardiac autonomic regulation. CONCLUSION The studies indicate a need for further investigations to guide future therapies to improve the treatment of cardiovascular system in the respiratory diseases.
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Affiliation(s)
- Adriano L Roque
- />Post-graduate Program in Cardiology, Federal University of São Paulo – Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Vitor E Valenti
- />Post-graduate Program in Physical Therapy - Faculty of Science and Technology UNESP, Presidente Prudente, SP Brazil
| | - Thais Massetti
- />Post-graduate Program in Rehabilitation Sciences - Faculty of Medicine, University of São Paulo, São Paulo, SP Brazil
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Talita Dias da Silva
- />Post-graduate Program in Cardiology, Federal University of São Paulo – Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
- />Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
| | - Carlos Bandeira de Mello Monteiro
- />Post-graduate Program in Rehabilitation Sciences - Faculty of Medicine, University of São Paulo, São Paulo, SP Brazil
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Fernando R Oliveira
- />Post-graduate Program in Cardiology, Federal University of São Paulo – Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Álvaro Dantas de Almeida Junior
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Sheylla Nadjane Batista Lacerda
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Gustavo Carreiro Pinasco
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Viviane Gabriela Nascimento
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Luiz Gonzaga Granja Filho
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - Luiz Carlos de Abreu
- />Post-graduate Program in Cardiology, Federal University of São Paulo – Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil
- />Department of Public Health, Laboratory Design of Studies and Scientific Writing, School of Medicine of ABC, FMABC, Santo André, SP Brazil
| | - David M Garner
- />Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford OX3 0BP UK
| | - Celso Ferreira
- />Post-graduate Program in Cardiology, Federal University of São Paulo – Paulista School of Medicine, 715, Pedro de Toledo St, Vila Clementino, São Paulo, SP 04039-032 Brazil
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Rodríguez DA, Arbillaga A, Barberan-Garcia A, Ramirez-Sarmiento A, Torralba Y, Vilaró J, Gimeno-Santos E, Gea J, Orozco-Levi M, Roca J, Marco E. Effects of interval and continuous exercise training on autonomic cardiac function in COPD patients. CLINICAL RESPIRATORY JOURNAL 2014; 10:83-9. [PMID: 25043734 DOI: 10.1111/crj.12189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/02/2014] [Accepted: 07/03/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Both interval (IT) and continuous (CT) exercise training results in an improvement of aerobic capacity in patients with chronic obstructive pulmonary disease (COPD); however, their effects on cardiac autonomic function remains unclear. The aim of our study was to evaluate the effect of a supervised CT vs IT on autonomic cardiac function in COPD patients. METHODS COPD patients were divided into two different groups according to training modality (IT or CT). Autonomic cardiac dysfunction (ACD) was defined as a heart rate recovery lower than 12 bpm heart rate after the first minute of maximal exercise (HRR1 ) and an abnormal chronotropic response (CR) to exercise (<80%). RESULTS A total of 29 patients {mean [standard deviation (SD)] age: 68 (8) years, %FEV1 : 42 (13) predicted} were trained (15 subjects in the CT group, 14 subjects in the IT group). After training, both groups increased peak oxygen consumption [mean difference ΔVO2 peak: 156 mL/min (P = 0.04) on IT; and 210 mL/min (P = 0.01) on CT], HRR1 [IT, from 10.4 (5) to 13.8 (5) bpm (P = 0.04); and CT, from 14.3 (5) to 17.7 (5) bpm (P = 0.04)] and CR [IT, from 57% (22) to 81% (9) (P = 0.001); and CT, from 48% (28) to 73% (17) (P = 0.001)]. Sixteen patients showed ACD. Among these patients, HRR1 (P = 0.01 for IT and P = 0.04 for CT) and CR (P = 0.001 for IT and P = 0.002 for CT) were enhanced after training. CONCLUSIONS Both IT and CT exercise training improve heart rate recovery and CR in COPD patients. These benefits could help to individualize exercise training.
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Affiliation(s)
- Diego A Rodríguez
- Pulmonology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Spain.,Pulmonology Department, Hospital Clínic i Provincial de Barcelona (ICT), CIBERES, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ane Arbillaga
- Pulmonology Department, Hospital Clínic i Provincial de Barcelona (ICT), CIBERES, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Anael Barberan-Garcia
- Pulmonology Department, Hospital Clínic i Provincial de Barcelona (ICT), CIBERES, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alba Ramirez-Sarmiento
- Pulmonology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Spain.,Pulmonology Department, Fundación Cardiovascular de Colombia, Santander, Colombia
| | - Yolanda Torralba
- Pulmonology Department, Hospital Clínic i Provincial de Barcelona (ICT), CIBERES, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vilaró
- Facultat de Ciències de la Salut Blanquerna, Universitat Ramol Llull, Barcelona, Spain
| | | | - Joaquim Gea
- Pulmonology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Spain
| | - Mauricio Orozco-Levi
- Pulmonology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Spain.,Pulmonology Department, Fundación Cardiovascular de Colombia, Santander, Colombia
| | - Josep Roca
- Pulmonology Department, Hospital Clínic i Provincial de Barcelona (ICT), CIBERES, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar - Hospital de l'Esperança), Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain
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Soares-Miranda L, Sattelmair J, Chaves P, Duncan GE, Siscovick DS, Stein PK, Mozaffarian D. Physical activity and heart rate variability in older adults: the Cardiovascular Health Study. Circulation 2014; 129:2100-10. [PMID: 24799513 DOI: 10.1161/circulationaha.113.005361] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiac mortality and electrophysiological dysfunction both increase with age. Heart rate variability (HRV) provides indices of autonomic function and electrophysiology that are associated with cardiac risk. How habitual physical activity among older adults prospectively relates to HRV, including nonlinear indices of erratic sinus patterns, is not established. We hypothesized that increasing the levels of both total leisure-time activity and walking would be prospectively associated with more favorable time-domain, frequency-domain, and nonlinear HRV measures in older adults. METHODS AND RESULTS We evaluated serial longitudinal measures of both physical activity and 24-hour Holter HRV over 5 years among 985 older US adults in the community-based Cardiovascular Health Study. After multivariable adjustment, greater total leisure-time activity, walking distance, and walking pace were each prospectively associated with specific, more favorable HRV indices, including higher 24-hour standard deviation of all normal-to-normal intervals (Ptrend=0.009, 0.02, 0.06, respectively) and ultralow-frequency power (Ptrend=0.02, 0.008, 0.16, respectively). Greater walking pace was also associated with a higher short-term fractal scaling exponent (Ptrend=0.003) and lower Poincaré ratio (Ptrend=0.02), markers of less erratic sinus patterns. CONCLUSIONS Greater total leisure-time activity, and walking alone, as well, were prospectively associated with more favorable and specific indices of autonomic function in older adults, including several suggestive of more normal circadian fluctuations and less erratic sinoatrial firing. Our results suggest potential mechanisms that might contribute to lower cardiovascular mortality with habitual physical activity later in life.
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Affiliation(s)
- Luisa Soares-Miranda
- From the Department of Epidemiology, Harvard School of Public Health, Boston, MA (L.S.-M., J.S., D.M.); Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal (L.S.-M.); Benjamin Leon Center for Geriatric Research and Education and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL (P.C.); Department of Epidemiology, University of Washington, Seattle, WA (G.E.D., D.S.S.); Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA (D.S.S.); Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (P.K.S.); and Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Nutrition, Harvard School of Public Health, Boston, MA (D.M.).
| | - Jacob Sattelmair
- From the Department of Epidemiology, Harvard School of Public Health, Boston, MA (L.S.-M., J.S., D.M.); Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal (L.S.-M.); Benjamin Leon Center for Geriatric Research and Education and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL (P.C.); Department of Epidemiology, University of Washington, Seattle, WA (G.E.D., D.S.S.); Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA (D.S.S.); Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (P.K.S.); and Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Nutrition, Harvard School of Public Health, Boston, MA (D.M.)
| | - Paulo Chaves
- From the Department of Epidemiology, Harvard School of Public Health, Boston, MA (L.S.-M., J.S., D.M.); Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal (L.S.-M.); Benjamin Leon Center for Geriatric Research and Education and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL (P.C.); Department of Epidemiology, University of Washington, Seattle, WA (G.E.D., D.S.S.); Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA (D.S.S.); Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (P.K.S.); and Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Nutrition, Harvard School of Public Health, Boston, MA (D.M.)
| | - Glen E Duncan
- From the Department of Epidemiology, Harvard School of Public Health, Boston, MA (L.S.-M., J.S., D.M.); Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal (L.S.-M.); Benjamin Leon Center for Geriatric Research and Education and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL (P.C.); Department of Epidemiology, University of Washington, Seattle, WA (G.E.D., D.S.S.); Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA (D.S.S.); Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (P.K.S.); and Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Nutrition, Harvard School of Public Health, Boston, MA (D.M.)
| | - David S Siscovick
- From the Department of Epidemiology, Harvard School of Public Health, Boston, MA (L.S.-M., J.S., D.M.); Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal (L.S.-M.); Benjamin Leon Center for Geriatric Research and Education and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL (P.C.); Department of Epidemiology, University of Washington, Seattle, WA (G.E.D., D.S.S.); Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA (D.S.S.); Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (P.K.S.); and Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Nutrition, Harvard School of Public Health, Boston, MA (D.M.)
| | - Phyllis K Stein
- From the Department of Epidemiology, Harvard School of Public Health, Boston, MA (L.S.-M., J.S., D.M.); Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal (L.S.-M.); Benjamin Leon Center for Geriatric Research and Education and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL (P.C.); Department of Epidemiology, University of Washington, Seattle, WA (G.E.D., D.S.S.); Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA (D.S.S.); Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (P.K.S.); and Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Nutrition, Harvard School of Public Health, Boston, MA (D.M.)
| | - Dariush Mozaffarian
- From the Department of Epidemiology, Harvard School of Public Health, Boston, MA (L.S.-M., J.S., D.M.); Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal (L.S.-M.); Benjamin Leon Center for Geriatric Research and Education and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL (P.C.); Department of Epidemiology, University of Washington, Seattle, WA (G.E.D., D.S.S.); Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA (D.S.S.); Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (P.K.S.); and Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Nutrition, Harvard School of Public Health, Boston, MA (D.M.)
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Cheng ST, Wu YK, Yang MC, Huang CY, Huang HC, Chu WH, Lan CC. Pulmonary rehabilitation improves heart rate variability at peak exercise, exercise capacity and health-related quality of life in chronic obstructive pulmonary disease. Heart Lung 2014; 43:249-55. [DOI: 10.1016/j.hrtlng.2014.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/24/2014] [Accepted: 03/01/2014] [Indexed: 10/25/2022]
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Zupanic E, Zivanovic I, Kalisnik JM, Avbelj V, Lainscak M. The Effect of 4-week Rehabilitation on Heart Rate Variability and QTc Interval in Patients with Chronic Obstructive Pulmonary Disease. COPD 2014; 11:659-69. [DOI: 10.3109/15412555.2014.898046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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50
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Gimeno-Santos E, Rodriguez DA, Barberan-Garcia A, Blanco I, Vilaró J, Torralba Y, Rodriguez-Roisin R, Barberà JA, Roca J, Garcia-Aymerich J. Endurance Exercise Training Improves Heart Rate Recovery in Patients with COPD. COPD 2013; 11:190-6. [DOI: 10.3109/15412555.2013.831401] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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