The Effect of Single Set Resistance Training on Strength and Functional Fitness in Pulmonary Rehabilitation Patients

Comparison of Lean Mass in Women With and Without Heart Disease

PURPOSE

This proof-of-concept study compared lean mass (LM) between women with heart disease (HD) and without HD.

METHODS

Fifty-six community-dwelling women were pair-matched by age. Heart disease was defined using criteria from the US Behavioral Risk Factor Surveillance System. Body composition was measured using multifrequency bioelectrical impedance analysis. Relative LM was calculated against height (kg/m2) as the lean mass index (LMI). Sarcopenia was defined as an LMI <15.0 kg/m2. Strength was measured with a handgrip dynamometer, arm curl test, and chair stand test.

RESULTS

Those with HD had significantly less absolute (38.2 ± 0.8 vs 43.5 ± 1.0 kg; P < .001) and relative (15.3 ± 0.3 vs 16.2 ± 0.3 kg/m2, P = .015) LM compared with those without HD. Body mass was significantly greater for those without HD (76.1 ± 2.1 vs 68.4 ± 2.1 kg; P = .013) and there were no differences in fat mass. Upper body strength was significantly less and lower body strength was diminished but not significantly different in those with HD compared to those without HD (handgrip: P = .016; arm curl: P < .001; chair stand: P = .066).

CONCLUSIONS

In this group of community-dwelling women, those who reported a diagnosis of HD had significantly less LM than those without HD. Although neither group was classified as sarcopenic, women with HD were at greater risk due to lower relative LM. Based on our findings, during cardiac rehabilitation clinicians should counsel women regarding resistance exercise for maintenance of LM in addition to strength.

Impact of resistance training on the 6-minute walk test in individuals with chronic obstructive pulmonary disease: A systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review was to assess functional improvement, measured by the 6-minute walk test (6MWT) after the application of a resistance training (RT) protocol in people with chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

The search involved the databases ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, EMBASE, PubMed and Scopus from the beginning of inception to September 1, 2019. Randomized controlled trials evaluating the functional impact of RT were included. The quality of the trials was assessed with the Physiotherapy Evidence Database (PEDro) scale. Calculations were performed according to mean difference (MD) for differences between pre- and post-intervention in 6MWT distance and according to the standardized mean difference (SMD) for post-treatment results of the 6MWT and quadriceps muscle strength (QMS) improvement.

RESULTS

In total, 23 studies (690 patients) met the inclusion criteria. Meta-analysis was used to compute the best improvement on the 6MWT with an analysis of improvement pre- versus post-treatment (MD 37.3, 95% confidence interval [CI] 9.8; 64.8, I² = 86%, p = 0.008) versus post-treatment alone, intervention versus control group (MD 15.5, 95% CI -7.7; 38.6, I^2 = 71%, p = 0.19). QMS was significantly improved (SMD 2.9, 95% CI 1.1; 4.7, I^2 = 91%, p = 0.002).

CONCLUSION

The results of the meta-analysis show a significant improvement in walking ability and performance measured by the 6MWT and an improvement in QMS for people with COPD responding to the therapy. The main limitation of this review is the significant heterogeneity across the study results. Furthermore, the statistical significance does not totally coincide with the clinical significance. RT is recommended to reduce muscle dysfunction and seems useful when combined with endurance training.

Agreement and reliability of repeated bedside respiratory muscle strength measurements in acute and subacute stroke

BACKGROUND AND PURPOSE

Many stroke trials include maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) outcome measurements. However, data on agreement and reliability of repeated MIP, MEP, and SNIP measurements in acute and subacute stroke patients are scarce.

METHODS

This study employed a test-retest design. Eighteen patients (seven female) with mean (SD) age 59 (14.5) years were recruited from neurological wards. Median (range) time since first stroke was 50.5 (21-128) days. MIP, MEP, and SNIP were measured repeatedly in three testing sessions (S1-3) conducted within 24 h and following international standards. Intra-rater agreement between testing sessions was analyzed using the Bland-Altman method. Test-retest reliability was analyzed using intra-class correlation coefficient (ICC). Association between individual measurement variability, time poststroke, and level of stroke impairment was analyzed using Spearman's rho.

RESULTS

Mean difference and 95% limits of agreement for MIP were -0.40 (-23.02, 22.22) cmH₂ O between S1 and S2, and 2.14 (-12.79, 16.99) cmH₂ O between S2 and S3; for MEP, -4.56 (-29.01, 19.90) cmH₂ O between S1 and S2, and 0.29 (-24.28, 24.87) cmH₂ O between S2 and S3; and for SNIP, -10.56 (-38.48, 17.37) cmH₂ O between S1 and S2, and -6.06 (-27.32, 15.20) cmH₂ O between S2 and S3. ICCs for MIP, MEP, and SNIP were ≥0.9 throughout. There were no strong correlations between individual measurement variability and time poststroke or level of stroke impairment.

DISCUSSION

MIP, MEP, and SNIP in acute and subacute stroke patients show good test-retest reliability for group averages; however, absolute agreement can vary considerably for some individuals.

Cardiorespiratory Responses to Short Bouts of Resistance Training Exercises in Individuals With Chronic Obstructive Pulmonary Disease: A COMPARISON OF EXERCISE INTENSITIES

PURPOSE

Resistance training is recommended in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD); however, the acute cardiorespiratory responses to different intensities of resistance training are not known. We compared acute cardiorespiratory responses with high-intensity versus low-intensity resistance exercises in persons with COPD and healthy, matched controls. This research may assist in developing training parameters in COPD.

METHODS

Participants (n = 10 per group) performed 1 set of 10 repetitions of leg extension and arm elevation at 2 intensities: 40% (low) and 80% (high) of 1-repetition maximum. Minute ventilation ((Equation is included in full-text article.)E), oxygen uptake ((Equation is included in full-text article.)O2), and heart rate (HR) data were collected continuously and expressed as absolute values and relative to values at (Equation is included in full-text article.)O2peak derived from a cardiopulmonary exercise test. Blood pressure, oxygen saturation, and rating of perceived exertion (RPE) were monitored before and after each set of exercises.

RESULTS

Individuals with COPD showed similar (Equation is included in full-text article.)E, (Equation is included in full-text article.)O2, and HR with high- versus low-intensity exercises. RPE was higher after high- vs low-intensity leg extension (4 ± 1.4 vs 2 ± 1, P < .005) and arm elevation (3 ± 2 vs 1 ± 1.4, P < .005). Compared with healthy participants, relative (Equation is included in full-text article.)O2, (Equation is included in full-text article.)E, and HR were higher in COPD (≅40% vs 20% of the (Equation is included in full-text article.)O2peak; ≅60% vs 20% of (Equation is included in full-text article.)Epeak; and ≅80% vs 20% of HRpeak; all Ps ≤ .004). Absolute responses and RPE were similar between groups, irrespective of intensity and exercise.

CONCLUSION

Immediate cardiorespiratory responses to an acute bout of resistance exercise appear to be independent of the exercise intensity in COPD. Although people with COPD are working closer to their (Equation is included in full-text article.)O2peak, their responses and RPE are comparable with healthy controls.

Changes in lower limb muscle function and muscle mass following exercise-based interventions in patients with chronic obstructive pulmonary disease: A review of the English-language literature

Chronic obstructive pulmonary disease (COPD) patients often experience lower limb muscle dysfunction and wasting. Exercise-based training has potential to improve muscle function and mass, but literature on this topic is extensive and heterogeneous including numerous interventions and outcome measures. This review uses a detailed systematic approach to investigate the effect of this wide range of exercise-based interventions on muscle function and mass. PUBMED and PEDro databases were searched. In all, 70 studies (n = 2504 COPD patients) that implemented an exercise-based intervention and reported muscle strength, endurance, or mass in clinically stable COPD patients were critically appraised. Aerobic and/or resistance training, high-intensity interval training, electrical or magnetic muscle stimulation, whole-body vibration, and water-based training were investigated. Muscle strength increased in 78%, muscle endurance in 92%, and muscle mass in 88% of the cases where that specific outcome was measured. Despite large heterogeneity in exercise-based interventions and outcome measures used, most exercise-based trials showed improvements in muscle strength, endurance, and mass in COPD patients. Which intervention(s) is (are) best for which subgroup of patients remains currently unknown. Furthermore, this literature review identifies gaps in the current knowledge and generates recommendations for future research to enhance our knowledge on exercise-based interventions in COPD patients.

Effect of "add-on" interventions on exercise training in individuals with COPD: a systematic review

The aim of this review was to identify the effectiveness of therapies added on to conventional exercise training to maximise exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Electronic databases were searched, identifying trials comparing exercise training with exercise training plus "add-on" therapy. Outcomes included peak oxygen uptake (V'_O2peak), work rate and incremental/endurance cycle and field walking tests. Individual trial effects on exercise capacity were extracted and collated into eight subgroups and pooled for meta-analysis. Sensitivity analyses were conducted to explore the stability of effect estimates across studies employing patient-centred designs and those deemed to be of "high" quality (PEDro score >5 out of 10). 74 studies (2506 subjects) met review inclusion criteria. Interventions spanned a broad scope of clinical practice and were most commonly evaluated via the 6-min walking distance and V'_O2peak. Meta-analysis revealed few clinically relevant and statistically significant benefits of "add-on" therapies on exercise performance compared with exercise training. Benefits favouring "add-on" therapies were observed across six different interventions (additional exercise training, noninvasive ventilation, bronchodilator therapy, growth hormone, vitamin D and nutritional supplementation). The sensitivity analyses included considerably fewer studies, but revealed minimal differences to the primary analysis. The lack of systematic benefits of "add-on" interventions is a probable reflection of methodological limitations, such as "one size fits all" eligibility criteria, that are inherent in many of the included studies of "add-on" therapies. Future clarification regarding the exact value of such therapies may only arise from adequately powered, multicentre clinical trials of tailored interventions for carefully selected COPD patient subgroups defined according to distinct clinical phenotypes.

Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis

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.

The one repetition maximum test and the sit-to-stand test in the assessment of a specific pulmonary rehabilitation program on peripheral muscle strength in COPD patients

BACKGROUND

Individuals with COPD may present reduced peripheral muscle strength, leading to impaired mobility. Comprehensive pulmonary rehabilitation (PR) should include strength training, in particular to lower limbs. Furthermore, simple tools for the assessment of peripheral muscle performance are required.

OBJECTIVES

To assess the peripheral muscle performance of COPD patients by the sit-to-stand test (STST), as compared to the one-repetition maximum (1-RM), considered as the gold standard for assessing muscle strength in non-laboratory situations, and to evaluate the responsiveness of STST to a PR program.

METHODS

Sixty moderate-to-severe COPD inpatients were randomly included into either the specific strength training group or into the usual PR program group. Patients were assessed on a 30-second STST and 1-minute STST, 1-RM, and 6-minute walking test (6MWT), before and after PR. Bland-Altman plots were used to evaluate the agreement between 1-RM and STST.

RESULTS

The two groups were not different at baseline. In all patients, 1-RM was significantly related to the 30-second STST (r=0.48, P<0.001) and to 1-minute STST (r=0.36, P=0.005). The 30-second STST was better tolerated in terms of the perceived fatigue (P=0.002) and less time consuming (P<0.001) test. In the specific strength training group significant improvements were observed in the 30-second STST (P<0.001), 1-minute STST (P=0.005), 1-RM (P<0.001), and in the 6MWT (P=0.001). In the usual PR program group, significant improvement was observed in the 30-second STST (P=0.042) and in the 6MWT (P=0.001).

CONCLUSION

Our study shows that in stable moderate-to-severe inpatients with COPD, STST is a valid and reliable tool to assess peripheral muscle performance of lower limbs, and is sensitive to a specific PR program.

A combination of resistance and endurance training increases leg muscle strength in COPD: An evidence-based recommendation based on systematic review with meta-analyses

Resistance training (RT) is thought to be effective in preventing muscle depletion, whereas endurance training (ET) is known to improve exercise capacity and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD). Our objectives were to assess the efficiency of combining RT with ET compared with ET alone. We identified eligible studies through a systematic multi-database search. One author checked titles and abstracts for relevance using broad inclusion criteria, whilst two independent authors checked the full-text copies for eligibility. Two authors independently extracted data, and we assessed the risk of bias and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. We included 11 randomized controlled trials (331 participants) and 2 previous systematic reviews. The meta-analyses showed equal improvements in HRQoL, walking distance and exercise capacity. However, we found moderate quality evidence of a significant increase in leg muscle strength favouring a combination of RT and ET (standardized mean difference of 0.69 (95% confidence interval: 0.39-0.98). In conclusion, we found significantly increased leg muscle strength favouring a combination of RT with ET compared with ET alone. Therefore, we recommend that RT should be incorporated in rehabilitation of COPD together with ET.

Relationship between strength, function, and quality of life in older adults with chronic lung disease: is there an influence of gender?

PURPOSE

Chronic lung disease results in impaired quality of life (QOL) linked to loss of muscular strength and functional ability. Inequalities in strength and function may place women at greater risk than men. This study evaluated the influence of gender on the relationship between muscular strength, functional ability, and QOL.

METHODS

Older adults (N = 40) referred to a pulmonary rehabilitation program completed assessment of upper body and lower body strength, functional ability, and QOL. To compensate for gender differences, strength was normalized for body mass.

RESULTS

Strength was greater in men than in women (P < .001). No gender differences were observed for function. Men perceived better QOL related to physical function (score: 39.3 ± 3.3 vs 27.1 ± 2.1, P < .01) and social function (score: 58.0 ± 5.8 vs 41.6 ± 4.0, P < .05). In men, strength was related directly to QOL through physical function (r = 0.53, P < .05) and social function (r = 0.52, P < .05), and functional ability had no relationship to QOL. In women, strength was related to functional ability (r = 0.57, P < .05), and functional ability was directly related to QOL through physical function (r = 0.46, P < .05), and social function (r = 0.59, P < .01).

CONCLUSIONS

Functional ability mediates the relationship between strength and QOL in women, while in men strength is directly related to QOL. These gender-specific pathways to QOL may be of importance to clinicians planning interventions for older adults with chronic lung disease.

Single- and multiple-set resistance training improves skeletal and respiratory muscle strength in elderly women

Introduction

Aging involves a progressive reduction of respiratory muscle strength as well as muscle strength.

Purpose

Compare the effects of resistance training volume on the maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), functional performance, and muscle strength in elderly women.

Methods

Thirty elderly women were randomly assigned to a group performing either single sets (1-SET) or three sets (3-SET) of exercises. The sit-to-stand test, MIP, MEP, and muscle strength were assessed before and after 24 training sessions. Progressive resistance training was performed two times per week for a total of 8–12 repetitions, using the main muscle groups of the upper and lower limbs.

Results

The main results showed that the participants significantly increased their MEP (P<0.05; 1-SET: 34.6%; 3-SET: 35.8%) and MIP (P<0.05; 1-SET: 13.7%; 3-SET: 11.2%). Both groups also improved in the sit-to-stand test (P<0.05; 1-SET: 10.6%; 3-SET: 17.1%). After 24 training sessions, muscle strength also significantly increased (P<0.0001; 40%–80%) in both groups. An intergroup comparison did not show any statistically significant differences between the groups in any of the parameters analyzed.

Conclusion

Single- and multiple-set resistance training programs increased MIP, MEP, muscle strength, and sit-to-stand test performance in elderly women after 24 sessions of training. In conclusion, our results suggested that elderly women who are not in the habit of physical activity may start with single-set resistance training programs as a short-term strategy for the maintenance of health.

Resistance training as a preconditioning strategy for enhancing aerobic exercise training outcomes in COPD

PURPOSE

Aerobic exercise training is a recognized approach for improving functional capacity in COPD. People with greater disease severity often have difficulty achieving higher aerobic exercise training intensity. The effects of resistance training prior to aerobic training were examined to determine if this sequential approach was associated with greater gains in functional status than aerobic training alone or concurrent aerobic and resistance training.

METHODS

Patients were randomized to: 1) sequential resistance then aerobic training (RT-then-AT) (8 weeks resistance training followed by 8 weeks aerobic exercise training), 2) control group (CE-then-AT + RT) (8 weeks of 'sham' training followed by 8 weeks concurrent aerobic and resistance training), 3) control group (CE-then-AT) (8 weeks 'sham' training followed by 8 weeks aerobic training). Outcomes were assessed at study entry, after week 8, and after week 16: aerobic exercise performance; muscle strength and endurance.

RESULTS

75 patients completed training: FEV1 %pred 40 ± 10, V˙O(2peak) %predicted, 71 ± 22, fat-free mass index 19.5 ± 3.1. RT-then-AT had greater acquisition of peripheral muscle endurance than CE-then-AT + RT and CE-then-AT, but improvements in aerobic exercise performance were similar. Improvements in muscle strength were similar between RT-then-AT and CE-then-AT + RT. Sarcopenia was associated with poorer attendance, and lower aerobic and resistance training volumes.

CONCLUSION

Although the sequential approach to resistance and aerobic training yielded a greater increase in muscle endurance and higher resistance training volume compared to concurrent resistance and aerobic training, other training outcomes were similar between the two groups, thus the sequential approach is not clearly superior to the concurrent approach in severe COPD. ClinicalTrials.gov Identifier: NCT01058213.

Changes in motivational outcomes after a supervised resistance exercise training intervention in lung cancer survivors

BACKGROUND

Short-term supervised exercise interventions improve health-related fitness in lung cancer survivors; however, sustained exercise is required to maintain the health benefits. The impact of exercise interventions on motivational outcomes may be important for long-term exercise adoption.

OBJECTIVE

The objective of this study was to examine the effects of a 10-week supervised progressive resistance exercise training program on lung cancer survivors' motivational outcomes based on the Theory of Planned Behavior (TPB).

METHODS

Posttreatment lung cancer survivors were recruited to undergo a 10-week supervised resistance exercise training intervention. The 2-component model of the TPB was measured at baseline and after intervention.

RESULTS

Fifteen participants completed assessments of TPB measures. Significant increases in self-efficacy (P = .022) and perceived controllability (P = .032) and a nonsignificant increase in affective attitude (P = .090) were observed after intervention. Intention was significantly lower at postintervention (P = .044). Significant correlates of postintervention intention were instrumental attitude (P = .001), self-efficacy (P = .004), perceived behavioral control (P = .009), and affective attitude (P = .044). At postintervention, self-efficacy was significantly correlated with planning (P < .046).

CONCLUSIONS

Short-term supervised resistance exercise training may improve some motivational outcomes for lung cancer survivors. Intentions appeared to be weakened after the intervention, but there are methodological explanations for this finding.

IMPLICATIONS FOR PRACTICE

Participation in short-term supervised resistance exercise may be an effective method to improve some motivational factors related to exercise in lung cancer survivors. More research is needed to examine the long-term effects of supervised resistance exercise on motivational outcomes in lung cancer survivors. Strategies to maintain motivational changes that occur following a supervised resistance exercise intervention need to be investigated.

Reporting of exercise attendance rates for people with chronic obstructive pulmonary disease: a systematic review

While recommendations for the duration, frequency, mode and intensity of exercise programmes for people with chronic obstructive pulmonary disease (COPD) are specified in consensus statements, criteria for exercise session attendance are less clear. The review questions were: (i) how commonly are a priori criteria and attendance rates reported for people with COPD participating in exercise programmes and (ii) what is the strength of association between attendance and improvements in functional exercise capacity. Database searches identified primary studies of people with COPD participating in exercise or pulmonary rehabilitation programmes of at least 2 weeks duration. Primary outcomes were a priori criteria for attendance, reports of attendance at supervised exercise sessions and mean improvements in functional exercise assessments. Data extraction processes were confirmed prospectively (>80% agreement). Variants of exercise attendance data were described. Linear associations between attendance and improvements in exercise outcomes were explored (Pearson r, P < 0.05). Of the 234 included studies, 86 (37%) reported attendance and 29 (12%) provided a priori criteria for attendance. In the small sample of studies which reported attendance and functional exercise data before and after the intervention, there was little to no relationship between improvements in functional exercise capacity and training volume (prescribed r = -0.03, P = 0.88; attended r = -0.24, P = 0.18). Reporting of exercise programme attendance rates is low and of variable quality for people with COPD. Consistent and explicit reporting of exercise attendance in people with COPD will enable calculation of dose-response relationships and determine the value of a priori exercise attendance criteria.

Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease

The 2 most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Growing evidence supports the benefits of exercise for all patients with these diseases. Due to the etiology of COPD and the pathophysiology of asthma, there may be some additional risks of exercise for these patients, and hence accurate risk assessment and clearance is needed before patients start exercising. The purpose of this review was to evaluate the available literature regarding the risks of exercise for patients with respiratory disease and provide evidence-based recommendations to guide the screening process. A systematic review of 4 databases was performed. The literature was searched to identify adverse events specific to exercise. For COPD, 102 randomized controlled trials that involved an exercise intervention were included (n = 6938). No study directly assessed the risk of exercise, and only 15 commented on exercise-related adverse events. For asthma, 30 studies of mixed methodologies were included (n = 1278). One study directly assessed the risk of exercise, and 15 commented on exercise-related adverse events. No exercise-related fatalities were reported. The majority of adverse events in COPD patients were musculoskeletal or cardiovascular in nature. In asthma patients, exercise-induced bronchoconstriction and (or) asthma symptoms were the primary adverse events. There is no direct evidence regarding the risk of exercise for patients with COPD or asthma. However, based on the available literature, it would appear that with adequate screening and optimal medical therapy, the risk of exercise for these respiratory patients is low.

Effects of resistance training on respiratory function in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

PURPOSE

Over the last decade, the potential use of resistance training (RT) for patients with chronic obstructive pulmonary disease (COPD) has gained increasing attention. Many COPD patients experience muscle dysfunction and reduced muscle mass, primarily as a result of chronic immobilization. These symptoms have been associated with reduced exercise tolerance and complaints of fatigue and dyspnea (even after minimal exertion). This paper presents findings from a systematic review that sought to: (1) present a meta-analysis of randomized controlled trials (RCT) investigating the effects of RT on respiratory function measures in patients with COPD and (2) investigate the existence of a dose-response relationship between intensity, duration and frequency of RT and assessed outcomes.

METHODS

A systematic literature search of MEDLINE electronic database (January 1980 to December 2009) produced a body of research on the effects of RT with a control group in patients with COPD. Data analysis involved a random effects meta-analysis, in order to determine weighted mean differences with 95 confidence intervals (95% CI) for each endpoint. All data were analyzed with the software package Review Manager V 4.2.10 (of the Cochrane Collaboration); 14 RCTs were included in the meta-analysis.

RESULTS

Findings demonstrated that RT did not substantially increase forced expiratory volume in 1 s. In addition, the weighted mean difference was 2.71% of predicted (95% CI, -1.86 to 7.27; p = 0.25) or by absolute 0.08 L (95% CI, -0.03 to 0.19; p = 0.14). It appeared that maximum minute ventilation increased by 3.77 L/min (95% CI, -0.51 to 8.04; p = 0.08).

CONCLUSIONS

Based on findings from the meta-analysis, RT produces a clinically and statistically significant effect on respiratory function (such as forced vital capacity) and is therefore recommended in the management of COPD.

Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease--practical issues: a Canadian Thoracic Society Clinical Practice Guideline

Pulmonary rehabilitation (PR) participation is the standard of care for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite bronchodilator therapies. However, there are questions about specific aspects of PR programming including optimal site of rehabilitation delivery, components of rehabilitation programming, duration of rehabilitation, target populations and timing of rehabilitation. The present document was compiled to specifically address these important clinical issues, using an evidence-based, systematic review process led by a representative interprofessional panel of experts. The evidence reveals there are no differences in major patient-related outcomes of PR between nonhospital- (community or home sites) or hospital-based sites. There is strong support to recommend that COPD patients initiate PR within one month following an acute exacerbation due to benefits of improved dyspnea, exercise tolerance and health-related quality of life relative to usual care. Moreover, the benefits of PR are evident in both men and women, and in patients with moderate, severe and very severe COPD. The current review also suggests that longer PR programs, beyond six to eight weeks duration, be provided for COPD patients, and that while aerobic training is the foundation of PR, endurance and functional ability may be further improved with both aerobic and resistance training.

Benefits of wellness interventions for persons with chronic and disabling conditions: a review of the evidence

BACKGROUND

Persons living with the effects of chronic and disabling conditions are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life.

OBJECTIVE

The purpose of this study was to review the evidence for the benefits of wellness/health promotion interventions for persons with chronic and disabling conditions.

METHODS

The authors conducted a Medline search (1990-2007) using terms related to wellness and health promotion cross-referenced with general terms for chronic and disabling conditions, as well as 15 specific chronic and/or disabling conditions (e.g., multiple sclerosis, spinal cord injury). Selection of studies was limited to those published in English that reported randomized controlled trails or prospective studies that involved adult human subjects with a chronic and/or disabling condition. All selected studies focused on some aspect of a wellness or health promotion intervention and involved a comparison or control group. Of the 5,847 studies initially identified in the search using medical subject heading terms, 190 met the criteria for full review. Data were extracted from these publications and summarized using descriptive statistics.

RESULTS

Almost all studies (95%) explored the effects of wellness intervention in a sample diagnosed with a single condition (e.g., cancer, stroke, arthritis). Although the mean sample size was 100, the range in sample size varied widely (6-688); 25% of the studies had sample of 30 or fewer. Almost all studies (89.5%) reported positive effects of the wellness intervention, although the delivery and content of interventions as well as the measurement of outcomes, varied greatly.

CONCLUSIONS

Our findings support an immediate post-intervention positive impact of wellness interventions across persons with a wide variety of chronic and disabling conditions. Future research that clearly specifies primary study outcomes and follows the CONSORT guidelines will strengthen future reviews of the evidence and facilitate application of the evidence of practice.

Position stand on androgen and human growth hormone use

Hoffman, JR, Kraemer, WJ, Bhasin, S, Storer, T, Ratamess, NA, Haff, GG, Willoughby, DS, and Rogol, AD. Position stand on Androgen and human growth hormone use. J Strength Cond Res 23(5): S1-S59, 2009-Perceived yet often misunderstood demands of a sport, overt benefits of anabolic drugs, and the inability to be offered any effective alternatives has fueled anabolic drug abuse despite any consequences. Motivational interactions with many situational demands including the desire for improved body image, sport performance, physical function, and body size influence and fuel such negative decisions. Positive countermeasures to deter the abuse of anabolic drugs are complex and yet unclear. Furthermore, anabolic drugs work and the optimized training and nutritional programs needed to cut into the magnitude of improvement mediated by drug abuse require more work, dedication, and preparation on the part of both athletes and coaches alike. Few shortcuts are available to the athlete who desires to train naturally. Historically, the NSCA has placed an emphasis on education to help athletes, coaches, and strength and conditioning professionals become more knowledgeable, highly skilled, and technically trained in their approach to exercise program design and implementation. Optimizing nutritional strategies are a vital interface to help cope with exercise and sport demands (). In addition, research-based supplements will also have to be acknowledged as a strategic set of tools (e.g., protein supplements before and after resistance exercise workout) that can be used in conjunction with optimized nutrition to allow more effective adaptation and recovery from exercise. Resistance exercise is the most effective anabolic form of exercise, and over the past 20 years, the research base for resistance exercise has just started to develop to a significant volume of work to help in the decision-making process in program design (). The interface with nutritional strategies has been less studied, yet may yield even greater benefits to the individual athlete in their attempt to train naturally. Nevertheless, these are the 2 domains that require the most attention when trying to optimize the physical adaptations to exercise training without drug use.Recent surveys indicate that the prevalence of androgen use among adolescents has decreased over the past 10-15 years (). The decrease in androgen use among these students may be attributed to several factors related to education and viable alternatives (i.e., sport supplements) to substitute for illegal drug use. Although success has been achieved in using peer pressure to educate high school athletes on behaviors designed to reduce the intent to use androgens (), it has not had the far-reaching effect desired. It would appear that using the people who have the greatest influence on adolescents (coaches and teachers) be the primary focus of the educational program. It becomes imperative that coaches provide realistic training goals for their athletes and understand the difference between normal physiological adaptation to training or that is pharmaceutically enhanced. Only through a stringent coaching certification program will academic institutions be ensured that coaches that they hire will have the minimal knowledge to provide support to their athletes in helping them make the correct choices regarding sport supplements and performance-enhancing drugs.The NSCA rejects the use of androgens and hGH or any performance-enhancing drugs on the basis of ethics, the ideals of fair play in competition, and concerns for the athlete's health. The NSCA has based this position stand on a critical analysis of the scientific literature evaluating the effects of androgens and human growth hormone on human physiology and performance. The use of anabolic drugs to enhance athletic performance has become a major concern for professional sport organizations, sport governing bodies, and the federal government. It is the belief of the NSCA that through education and research we can mitigate the abuse of androgens and hGH by athletes. Due to the diversity of testosterone-related drugs and molecules, the term androgens is believed to be a more appropriate term for anabolic steroids.

Validation of functional fitness tests as surrogates for strength measurement in frail, older adults with chronic obstructive pulmonary disease

OBJECTIVE

This study evaluated the relationship of functional field tests to traditional laboratory strength tests in 40 frail, older adults with chronic obstructive pulmonary disease.

DESIGN

Participants completed two trials of upper (chest press) and lower (leg press) body maximal strength (maximal weight lifted one time) testing and one trial of functional fitness testing (Arm Curl, Lift and Reach, Chair Stand, Up and Go). The maximal weight lifted one-time values from both trials were compared with functional fitness test values to identify valid surrogates.

RESULTS

Among upper-body functional fitness tests, the Arm Curl had a moderately strong relationship to chest press (trial 1: r = 0.55, P = 0.01; trial 2: r = 0.56, P = 0.01) whereas the Lift and Reach did not. Among lower-body functional fitness tests, the Chair Stand had a fairly strong relationship to leg press (trial 1: r = 0.46, P = 0.01; trial 2: r = 0.38, P = 0.05), but the Up and Go did not.

CONCLUSIONS

Only the Arm Curl and Chair Stand tests were valid surrogates. Although multiple field tests to measure strength in a clinical setting may be desirable, these data support limiting functional testing to the Arm Curl for upper-body and the Chair Stand for lower-body strength assessment.

Progression of Resistance Training Intensity among Older COPD Patients: A Comparison of 2 Resistance Training Studies

OBJECTIVE

This comparison study examined strength and functional fitness (FF) outcomes between 2 single-set resistance training (SSRT) studies of differing intensity progressions (rapid progression [RP] versus delayed progression [DP]) among elderly pulmonary rehabilitation (PR) patients to determine if there is a threshold effect for training intensity.

METHODS

Twenty PR patients participating in identical hospital-based PR programs, which met twice a week for 8 weeks, were randomly assigned to SSRT programs, which differed in intensity progression (RP: n = 10, mean age = 71.0 +/- 3.7 years; DP: n = 10, mean age = 65.4 +/- 7.8 years). The SSRT consisted of 1 set of 8 to 15 repetitions of 5 exercises. For both studies, training loads were determined equally. Load increases in the RP study consisted of 5% to 10% immediately following a session where 10 repetitions were completed. Load increases for the DP study consisted of 3 to 5 lbs following 2 consecutive sessions wherein 12 repetitions were completed. RESULTS of the primary outcomes data from both SSRT studies were compared to determine the presence of a threshold effect for intensity progression. The outcomes evaluated in both studies were upper and lower body strength and various FF measures. Repeated measures controlling for age, pulmonary function, and body mass index (BMI) were used to assess the presence of significant differences. To determine statistical significance, alpha was set at P < 0.05.

RESULTS

Rapid progression resulted in greater increases in upper body strength (chest press; P = 0.021) and FF (arm curl test, P = 0.001; lift and reach test, P = 0.003) than DP.

CONCLUSIONS

Rapid progression of training intensity in a SSRT involving elderly PR patients appears superior to delayed progression.

KEYWORDS

strength training; weight lifting; older adults; exercise intensity; pulmonary rehabilitation; COPD.

Effect of strength training on muscle function in elderly hospitalized patients

Immobilization due to hospitalization and major surgery leads to an increased risk of morbidity, disability and a decline in muscle function especially in frail elderly individuals. In fact, many elderly patients fail to regain their level of function and self-care before admission to hospital. Given that reduced lower limb muscle strength and loss of skeletal muscle mass (i.e. sarcopenia) have been associated with functional impairments and disability with aging, attempts to counteract this process seem highly relevant. In recent years, strength training has emerged as an effective method to induce muscle hypertrophy and increase muscle strength and functional performance in frail elderly individuals. Furthermore, there is increasing evidence that strength training is an effective method to restore muscle function in post-operative patients and in patients with chronic diseases. Despite this, strength training is rarely used in the rehabilitation of hospitalized elderly patients. The current knowledge on this topic will be the focus of this review.