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Albarrati A, Hazazi I, Alnahdi AH, Taher M, Nazer R, Alrefaee H. Psychometric properties of the Arabic version of Duke Activity Status Index in patients with chronic obstructive pulmonary disease. Disabil Rehabil 2023; 45:717-722. [PMID: 35225135 DOI: 10.1080/09638288.2022.2037748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To translate and cross-culturally adapt the original Duke Activity Status Index (DASI) into the Arabic language and examine its psychometric properties in Arabic speaking patients with Chronic Obstructive Pulmonary Disease (COPD). MATERIALS AND METHODS The DASI was translated into the Arabic language and tested on 70 Arabic patients with COPD. Patients with COPD completed also the Six-Minute Walk Test (6MWT) and Saint George Respiratory Questionnaire (SGRQ) on the first visit. On the second visit, the patients with COPD completed the Arabic version of DASI along with the global rating of change scale (GRC). The internal consistency, test-retest reliability and construct validity were examined. RESULTS Seventy Arabic speaking patients with COPD (56 males), mean (SD) age was 63.2 (11.1) year, completed the study. The patients reported no difficulty in understanding and completing the scale. Three items were modified and adapted to the Arabic culture. The Cronbach's alpha was 0.87, and the ICC2,1 was 0.95. The Arabic version of DASI correlated with the 6MWT (r = 0.55), the total score of SGRQ (r = -0.64) and its activity domain (r = -0.67), all p < 0.001. CONCLUSION The Arabic version of DASI is a simple, quick, reliable, and valid measure of functional capacity in Arabic speaking patients with COPD.Implications for practiceThe Arabic DASI can be used in all Arabic-speaking countries given that the scale was adapted to standard Arabic language.The Arabic DASI would yield similar scores with administrations over time in patients with unchanged condition and stable COPD.This questionnaire could be used for screening of functional capacity in COPD in primary care settings.
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Affiliation(s)
- Ali Albarrati
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Hazazi
- Rehabilitation Department, King Fahad Specialist Hospital, Tabuk, Saudi Arabia
| | - Ali H Alnahdi
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Taher
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Rakan Nazer
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hassan Alrefaee
- Respiratory Care Department, King Fahad Medical City, Riyadh, Saudi Arabia
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Abstract
Preview In all cases of obstructive lung disease, smoking cessation, proper use of metered-dose inhalers, up-to-date immunizations, adequate nutrition, and general physical conditioning are important components of treatment. Dr Jacobs summarizes these components as well as stepwise pharmacologic approaches to controlling the inflammation of asthma, the bronchospasm of chronic bronchitis and emphysema, and the symptoms of secondary or coexisting conditions.
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Faager G, Stâhle A, Larsen FF. Influence of spontaneous pursed lips breathing on walking endurance and oxygen saturation in patients with moderate to severe chronic obstructive pulmonary disease. Clin Rehabil 2009; 22:675-83. [PMID: 18678567 DOI: 10.1177/0269215508088986] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate how spontaneously used pursed lips breathing influences walking endurance, oxygen saturation and dyspnoea in patients with moderate to severe chronic obstructive pulmonary disease. DESIGN A randomized open-label, cross-over study of chronic obstructive pulmonary disease patients participating in a rehabilitation programme. SETTING Outpatient pulmonary rehabilitation centre at a university hospital. SUBJECTS Thirty-two patients with moderate to severe chronic obstructive pulmonary disease. INTERVENTION All patients performed two endurance shuttle walking tests in random order. During endurance shuttle walking test I a mouthpiece was used in order to prevent spontaneous pursed lips breathing. During endurance shuttle walking test II spontaneous pursed lips breathing was used freely. Heart rate, oxygen saturation and the patients' estimated dyspnoea and leg fatigue on a Borg Category Ratio 10 scale were recorded before, directly after, and 5 and 10 minutes after the tests. RESULTS When spontaneous pursed lips breathing was used the patients walked on an average for 37 seconds (16%) longer (P<0.01) than when pursed lips breathing was prevented. The patients desaturated considerably during both walking tests but the average drop in oxygen saturation was 1.2% less when spontaneous pursed lips breathing was employed. There were no significant differences in rated degree of dyspnoea or leg fatigue with or without pursed lips breathing. CONCLUSION Spontaneous pursed lips breathing can be a useful technique to increase walking endurance and reduce oxygen desaturation during walking in patients with moderate to severe chronic obstructive pulmonary disease.
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Affiliation(s)
- G Faager
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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Ng BHP, Tsang HWH. Establishing a Health Qigong protocol for rehabilitation of patients with COPD. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.1.37937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Bobby HP Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Hector WH Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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Faager G, Söderlund K, Sköld CM, Rundgren S, Tollbäck A, Jakobsson P. Creatine supplementation and physical training in patients with COPD: a double blind, placebo-controlled study. Int J Chron Obstruct Pulmon Dis 2008; 1:445-53. [PMID: 18044100 PMCID: PMC2707812 DOI: 10.2147/copd.2006.1.4.445] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Study objectives Patients with chronic obstructive pulmonary disease (COPD) have low exercise capacity and low content of high energetic phosphates in their skeletal muscles. The aim of the present study was to investigate whether creatine supplementation together with exercise training may increase physical performance compared with exercise training in patients with COPD. Design In a randomized, double-blind, placebo-controlled study, 23 patients with COPD (forced expiratory volume in one second [FEV1] < 70% of predicted) were randomized to oral creatine (n = 13) or placebo (n = 10) supplementation during an 8-week rehabilitation programme including exercise training. Physical performance was assessed by Endurance Shuttle Walking Test (ESWT), dyspnea and leg fatigue with Borg CR-10, quality of life with St George’s Respiratory Questionnaire (SGRQ). In addition, lung function test, artery blood gases, grip strength test, muscle strength and fatigue in knee extensors were measured. Results COPD patients receiving creatine supplementation increased their average walking time by 61% (ESWT) (p < 0.05) after the training period compared with 48% (p = 0.07) in the placebo group. Rated dyspnea directly after the ESWT decreased significantly from 7 to 5 (p < 0.05) in the creatine group. However, the difference between the groups was not statistically significant neither in walking time nor in rated dyspnea. Creatine supplementation did not increase the health related quality of life, lung function, artery blood gases, grip strength and knee extensor strength/fatigue. Conclusions Oral creatine supplementation in combination with exercise training showed no significant improvement in physical performance, measured as ESWT, in patients with COPD compared with exercise training alone.
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Affiliation(s)
- Gun Faager
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Department of Physiotherapy, Karolinska University Hospital, Solna, Sweden.
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Abstract
There is increasing evidence that the black box we have referred to as"biologic aging" is composed of genetic factors and many types of environmental exposures. Some of the most potentially modifiable elements of this syndrome are those attributable to disuse or insufficient exposure to certain kinds or intensities of physical stressors during the course of the life span. Beneficial adaptations to exercise once thought restricted to genetically endowed master athletes now are seen to occur just as predictably in frail elders with chronic disease, opening the door to vastly improved physical function and associated health benefits. Knowledge of the benefits of physical activity, however well substantiated, may be necessary, but it is not sufficient to change either physician-prescribing habits or the likelihood of adoption and long-term adherence to exercise on the part of patients. Ultimately, the penetration of an exercise prescription to optimize aging into the most inactive cohorts in the community,who have the most to gain from increases in levels of physical activity and fitness, will depend on a combination of clear evidence-based guidelines coupled with health professional training and behavioral programs tailored to age-specific barriers and motivational factors.
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Silva AB, Di Lorenzo VAP, Jamami M, Sampaio LMM, Demonte A, Cardello L, Costa D. Efeitos da suplementação oral de L-carnitina associada ao treinamento físico na tolerância ao exercício de pacientes com doença pulmonar obstrutiva crônica. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0102-35862003000600010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUÇÃO: Pacientes portadores de doença pulmonar obstrutiva crônica apresentam redução da tolerância ao exercício físico, principalmente devido à limitação ventilatória. A L-carnitina tem sido utilizada com o objetivo de melhorar a capacidade aeróbia de pacientes com doenças crônicas, porém não existem estudos em pacientes portadores de doença pulmonar obstrutiva crônica. OBJETIVO: Avaliar a influência da suplementação de L-carnitina, associada ao treinamento físico por seis semanas, três vezes por semana em pacientes portadores de doença pulmonar obstrutiva crônica. MÉTODO: A amostra foi constituída de 30 pacientes portadores de doença pulmonar obstrutiva crônica (69 ± 7 anos) com volume expiratório forçado no primeiro segundo < 65% do previsto, dividida em três grupos de 10 pacientes: grupo 1 com treinamento físico e suplementação com 2g/dia de L-carnitina, grupo 2 que recebeu treinamento físico e placebo e grupo 3 que não foi submetido a treinamento físico e recebeu 2g/dia de L-carnitina. Os pacientes foram submetidos a avaliação espirométrica, a teste de caminhada de seis minutos e à mensuração dos níveis plasmáticos de carnitina livre no inicio e no final do estudo. RESULTADOS: Foi constatado aumento significativo (p < 0,05) da distância percorrida no teste de caminhada de seis minutos somente nos pacientes dos dois primeiros grupos (de 421 ± 100 para 508 ± 80,7 e de 496 ± 78,7 para 526 ± 64,3 respectivamente). Além disso, com intensidade de exercício semelhante, a subida da freqüência cardíaca foi menor no grupo 1 quando comparado com o grupo 2. As variáveis espirométricas, a saturação da oxihemoglobina e a dispnéia não se alteraram em nenhum dos grupos estudados. Os valores de L-carnitina livre no plasma aumentaram somente nos pacientes do terceiro grupo (59,2 ± 13,8 para 102,3 ± 15,32mmol/L). CONCLUSÃO: A L-carnitina associada ao treinamento físico pode proporcionar maior tolerância ao exercício em pacientes com doença pulmonar obstrutiva crônica.
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Abstract
There are myriad ways in which optimal levels of physical activity over the course of the life span could potentially contribute to the prevention of functional disability in old age. These include direct effects of exercise to maximize physiologic capacity and prevent or delay the onset of disability-related conditions and more indirect effects, such as the modulation of psychosocial factors important in the expression of disability. Epidemiologic studies strongly suggest that functional disability is inversely related to physical activity level or physical fitness in various domains. Experimental studies confirm the benefits of exercise on correlates of disability, such as impairments of muscle strength or performance-based tests of functional limitations. However, the evidence that exercise can actually prevent disability in the long-term is not yet established by data from randomized clinical trials in the general population. Secondary prevention of disability in frail elders has been shown in a few trials. The available evidence, however, suggests that a rational exercise prescription for the prevention and treatment of disability at this time should include promotion of a physically active lifestyle and specific exercises targeting aerobic capacity, strength, and balance. Differential emphasis on specific elements of this prescription may be necessary and appropriate, depending on the etiology of the disability in specific cohorts, severity of physical impairments and functional limitations, and other individual characteristics relevant to exercise feasibility, safety, and efficacy.
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Singh MAF. Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sci 2002; 57:M262-82. [PMID: 11983720 DOI: 10.1093/gerona/57.5.m262] [Citation(s) in RCA: 271] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Incalzi RA, Bellia V, Catalano F, Scichilone N, Imperiale C, Maggi S, Rengo F. Evaluation of health outcomes in elderly patients with asthma and COPD using disease-specific and generic instruments: the Salute Respiratoria nell'Anziano (Sa.R.A.) Study. Chest 2001; 120:734-42. [PMID: 11555502 DOI: 10.1378/chest.120.3.734] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To compare the effects of asthma and COPD on health status (HS) in elderly patients, and to assess the correlation between disease-specific and generic instruments assessing HS. DESIGN Multicenter, cross-sectional, observational study. SETTING The Salute Respiratoria nell'Anziano (respiratory health in the elderly) Study network of outpatient departments. PATIENTS One hundred ninety-eight asthma patients and 230 COPD patients > or = 65 years old. MEASUREMENTS HS was assessed by the Saint George's Respiratory Questionnaire (SGRQ) and five generic outcomes: Barthel's index, 6-min walk test, mini mental state examination, geriatric depression scale (GDS), and quality-of-sleep index. Independent correlates of SGRQ scores were assessed by logistic regression. Patients were considered to have a "good" HS or "poor" HS according to whether they did or did not perform worse than 75% of the corresponding population of asthma or COPD patients, on at least two of the five generic outcomes. RESULTS On average, COPD patients had poorer HS than asthma patients on the SGRQ. Only polypharmacy (more than three respiratory drugs) and diagnosis of COPD qualified as independent correlates of the SGRQ score. The SGRQ "Activity" and "Impacts" scores shared the following independent correlates: polypharmacy, Barthel's index < 92, and GDS > 6. Further correlates were waist/hip ratio > 1 for the Activity score, and age and occiput-wall distance > 9 cm for the Impacts score. All sections of the SGRQ except for the Symptoms score could significantly distinguish patients with good HS and poor HS. CONCLUSIONS Individual dimensions of HS recognize different determinants. COPD outweighs asthma as a cause of distressing respiratory symptoms. A high degree of concordance exists between SGRQ and generic health outcomes, except for the Symptoms dimension in COPD patients.
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Affiliation(s)
- R A Incalzi
- Istituto di Medicina Interna e Geriatria, Catholic University of Rome, Italy
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Woodard CM, Berry MJ. Enhancing adherence to prescribed exercise: structured behavioral interventions in clinical exercise programs. JOURNAL OF CARDIOPULMONARY REHABILITATION 2001; 21:201-9. [PMID: 11508179 DOI: 10.1097/00008483-200107000-00002] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C M Woodard
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
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Chew WM, Birnbaumer DM. Evaluation of the elderly patient with weakness: an evidence based approach. Emerg Med Clin North Am 1999; 17:265-78, x. [PMID: 10101350 DOI: 10.1016/s0733-8627(05)70056-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because of the altered physiology of the elderly population, either as a result of aging or as a result of other disease processes, many illnesses may present with features that are either atypical or nonspecific in nature. Difficult and nonspecific complaints such as weakness in an elderly patient must be handled in a judicious, cost-effective, comprehensive, and expeditious manner that benefits both the patient and the emergency department. This article addresses the evaluation of the elderly patient who presents to the ED complaining of weakness.
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Affiliation(s)
- W M Chew
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, USA
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Affiliation(s)
- E D Chan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, National Jewish Medical and Research Center, Denver 80206, USA.
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Breslin E, van der Schans C, Breukink S, Meek P, Mercer K, Volz W, Louie S. Perception of fatigue and quality of life in patients with COPD. Chest 1998; 114:958-64. [PMID: 9792561 DOI: 10.1378/chest.114.4.958] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Although dyspnea is considered the primary activity-limiting symptom in patients with COPD, other symptoms, such as fatigue, are frequently reported. The purpose of this study was to determine the relationship between fatigue and pulmonary function, exercise tolerance, depression, and quality of life in patients with COPD. METHODS Forty-one patients (age = 62+/-8 years; FEV1 = 1.08+/-0.55 L; FEV1 percent predicted = 35.8+/-17%) from two sites participated in the study. Spirometric measures of pulmonary function were carried out in each patient. The Multidimensional Fatigue Inventory was used to measure five subscales of fatigue: general, physical and mental fatigue, reduction in activity, and reduction in motivation. The St. George Respiratory Questionnaire, used to measure quality of life, has three subscale dimensions (symptom, activity, and impact), as well as an overall or total quality of life score. Depression was measured with the Centers of Epidemiological Studies Depression Scale. In 19 patients, exercise tolerance was determined with the 6-min walking distance. RESULTS General fatigue correlated with FEV1, percent predicted (r = -0.32, p < 0.05), exercise tolerance (r = -0.55, p < 0.05), depression (r = 0.44, p < 0.01), and overall quality of life (r = 0.75, p < 0.01). Among the dimensions of fatigue, depression correlated with general and mental fatigue only. Physical dimensions of fatigue correlated with an increase in the severity of pulmonary impairment and reduction in exercise tolerance. The cognitive components of fatigue, such as reduction in motivation and mental fatigue, were not found to be highly correlated with physical dimensions of quality of life. All five subscales of fatigue showed relationship to the functional impact dimension and total impairment score in quality of life. CONCLUSIONS These data show a relationship between dimensions of fatigue and pulmonary function, exercise tolerance, and quality of life in COPD. Based on these results, fatigue is an important symptom requiring evaluation and management in patients with COPD. These data clarified also the relationship between depression and fatigue in this patient population.
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Affiliation(s)
- E Breslin
- University of California, Davis, Medical Center, Sacramento 95817, USA
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Berry MJ, Walschlager SA. Exercise training and chronic obstructive pulmonary disease: past and future research directions. JOURNAL OF CARDIOPULMONARY REHABILITATION 1998; 18:181-91. [PMID: 9632319 DOI: 10.1097/00008483-199805000-00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of death and disability in the United States. It is characterized by symptoms of breathlessness that result in sedentary lifestyle, physical deconditioning, and reduced quality of life. Previous research has shown that exercise training in patients with COPD will improve physical function and may help improve the quality of life. Unfortunately, the majority of these previous studies have not been pursued with adequate scientific rigor and the conclusions regarding the efficacy of exercise as an adjunct in the treatment of COPD are equivocal. The purpose of this article is to review the previous research that has focused on the effects of exercise training on individuals with COPD, to examine the problems with this previous research, and to emphasize the need and identify topics for further outcome-based research.
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Affiliation(s)
- M J Berry
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina 27109, USA
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Milani RV, Lavie CJ. Disparate effects of out-patient cardiac and pulmonary rehabilitation programs on work efficiency and peak aerobic capacity in patients with coronary disease or severe obstructive pulmonary disease. JOURNAL OF CARDIOPULMONARY REHABILITATION 1998; 18:17-22. [PMID: 9494878 DOI: 10.1097/00008483-199801000-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Exercise intolerance is an integral component of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) and is caused by several mechanisms that ultimately impact overall functional capacity. We assessed various components of exercise function in patients with CHD and COPD during the course of cardiac and pulmonary rehabilitation to evaluate changes unique to each condition. METHODS Work efficiency (WEf, defined as delta watts/delta VO2) and peak VO2 were measured and compared at baseline and after 3 months (36 sessions) of outpatient cardiac and pulmonary rehabilitation programs in 25 patients (mean age = 66 +/- 7 years) with severe COPD (mean FEV1.0 = 0.90 +/- 0.35 L) and in 25 patients (mean age = 65 +/- 8 years) with CHD. RESULTS At baseline, patients with COPD had significantly reduced values of WEf (2.04 +/- 0.86 versus 3.23 +/- 1.38 watts/mL/kg/min; P = 0.004) and peak VO2 (13.2 +/- 3.9 versus 17.1 +/- 3.9 mL/kg/min; P = 0.005) compared with patients with CHD. After rehabilitation, patients with CHD increased peak VO2 by 12% (17.1 +/- 3.9 to 19.1 +/- 4.9 mL/kg/min; P = 0.01) with no change in WEf (3.23 +/- 1.38 to 3.32 +/- 1.43 watts/mL/kg/min; P = not significant). In contrast, patients with COPD increased peak VO2 by only 5% (13.2 +/- 3.9 to 13.9 +/- 3.8 mL/kg/min; P = 0.0008), but WEf increased by 36% (2.04 +/- 0.86 to 2.78 +/- 0.84 watts/mL/kg/min; P = 0.0002). Subjective measures of functional status improved similarly in both groups. CONCLUSIONS In contrast to patients with CHD, work inefficiency contributes significantly to exercise intolerance in patients with severe COPD. Outpatient rehabilitation programs enhance functional status in patients with CHD and COPD by differing mechanisms, depending on the underlying disease. These data show the disparate effects of out-patient rehabilitation on peak VO2 and WEf in cardiac and pulmonary patients.
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Affiliation(s)
- R V Milani
- Department of Internal Medicine, Ochsner Medical Institution, New Orleans, Louisiana, USA
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Ries AL, Carlin BW, Carrieri-Kohlman V, Casaburi R, Celli BR, Emery CF, Hodgkin JE, Mahler DA, Make B, Skolnick J. Pulmonary Rehabilitation. Chest 1997. [DOI: 10.1378/chest.112.5.1363] [Citation(s) in RCA: 315] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Sporadic visits to the local doctor followed sometimes by changes in oral and inhaled bronchodilators and occasionally by the addition of steroids frequently does little to significantly improve symptoms and function in the disabled patient with COPD. As in other chronic diseases, the management of these patients is facilitated by a team approach in conjunction with general rehabilitation principles. The rationale and practical implementation of such a programme has recently been outlined by the American Association of Cardiopulmonary Rehabilitation. These are multifaceted programmes but a key component, as outlined above, is exercise training. In this brief review the various approaches available have been described. Controversy still reigns regarding the optimal modes of training and there are important differences among the several approaches. Two main groups can be delineated. One emphasises the detailed definition of the impaired physiology with therapeutic measures targeted to specific defects. There is good documentation that, conversely, unstructured programmes that use treadmill and free range walking and cycling also improve endurance for walking. Upper extremity training is of additional benefit. Programmes with as little as three sessions per week of 1-2 hours of low intensity activity have achieved success so we know that simple programmes can be helpful. Moreover, without the necessity for complex testing and training methods these programmes can be implemented with relatively low costs. Future investigations to examine the relationship between improved exercise capacity for walking and arm exercise on the one hand, and the ease of performance of activities of daily living on the other, will help to reinforce the effectiveness of exercise programmes.
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Affiliation(s)
- M J Belman
- Pulmonary Physiology Laboratory, Cedars-Sinai Medical Center, Los Angeles, California 90048
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Affiliation(s)
- S E Weinberger
- Pulmonary and Critical Care Division, Beth Israel Hospital, Boston, MA 02215
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