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Anidi IU, Kirenga B, Fennelly KP. Pulmonary Rehabilitation for Post-Tuberculosis Lung Disease. Am J Respir Crit Care Med 2023; 208:1246-1247. [PMID: 37797326 PMCID: PMC10868368 DOI: 10.1164/rccm.202309-1571le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/05/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Ifeanyichukwu U. Anidi
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, and
- T Lymphocyte Biology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; and
| | - Bruce Kirenga
- Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Kevin P. Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, and
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Orme MW, Lloyd-Evans PHI, Jayamaha AR, Katagira W, Kirenga B, Pina I, Kingsnorth AP, Maylor B, Singh SJ, Rowlands AV. A Case for Unifying Accelerometry-Derived Movement Behaviors and Tests of Exercise Capacity for the Assessment of Relative Physical Activity Intensity. J Phys Act Health 2023; 20:303-310. [PMID: 36854312 DOI: 10.1123/jpah.2022-0590] [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: 11/07/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 03/02/2023]
Abstract
Albert Einstein taught us that "everything is relative." People's experience of physical activity (PA) is no different, with "relativism" particularly pertinent to the perception of intensity. Markers of absolute and relative intensities of PA have different but complimentary utilities, with absolute intensity considered best for PA guideline adherence and relative intensity for personalized exercise prescription. Under the paradigm of exercise and PA as medicine, our Technical Note proposes a method of synchronizing accelerometry with the incremental shuttle walking test to facilitate description of the intensity of the free-living PA profile in absolute and relative terms. Our approach is able to generate and distinguish "can do" or "cannot do" (based on exercise capacity) and "does do" or "does not do" (based on relative intensity PA) classifications in a chronic respiratory disease population, facilitating the selection of potential appropriate individually tailored interventions. By synchronizing direct assessments of exercise capacity and PA, clearer insights into the intensity of PA performed during everyday life can be gleaned. We believe the next steps are as follows: (1) to determine the feasibility and effectiveness of using relative and absolute intensities in combination to personalize the approach, (2) to determine its sensitivity to change following interventions (eg, exercise-based rehabilitation), and (3) to explore the use of this approach in healthier populations and in other long-term conditions.
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Affiliation(s)
- Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicester,United Kingdom
- Center for Exercise and Rehabilitation Science (CERS), NIHR Leicester Biomedical Research Center-Respiratory, University Hospitals of Leicester NHS Trust, Leicester,United Kingdom
| | - Phoebe H I Lloyd-Evans
- Department of Respiratory Sciences, University of Leicester, Leicester,United Kingdom
- Center for Exercise and Rehabilitation Science (CERS), NIHR Leicester Biomedical Research Center-Respiratory, University Hospitals of Leicester NHS Trust, Leicester,United Kingdom
| | - Akila R Jayamaha
- Department of Respiratory Sciences, University of Leicester, Leicester,United Kingdom
- KAATSU International University, Battaramulla,Sri Lanka
| | | | - Bruce Kirenga
- Makerere University Lung Institute, Mulago Hospital, Kampala,Uganda
| | - Ilaria Pina
- Department of Respiratory Sciences, University of Leicester, Leicester,United Kingdom
- Center for Exercise and Rehabilitation Science (CERS), NIHR Leicester Biomedical Research Center-Respiratory, University Hospitals of Leicester NHS Trust, Leicester,United Kingdom
| | - Andrew P Kingsnorth
- Assessment of Movement Behaviour Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Center, University of Leicester, Leicester,United Kingdom
- NIHR Leicester Biomedical Research Centre, Leicester,United Kingdom
| | - Ben Maylor
- Assessment of Movement Behaviour Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Center, University of Leicester, Leicester,United Kingdom
- NIHR Leicester Biomedical Research Centre, Leicester,United Kingdom
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester,United Kingdom
- Center for Exercise and Rehabilitation Science (CERS), NIHR Leicester Biomedical Research Center-Respiratory, University Hospitals of Leicester NHS Trust, Leicester,United Kingdom
| | - Alex V Rowlands
- Assessment of Movement Behaviour Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Center, University of Leicester, Leicester,United Kingdom
- NIHR Leicester Biomedical Research Centre, Leicester,United Kingdom
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide,Australia
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Pina I, Ndagire P, Katagira W, Latimer L, Zatloukal J, Kirenga B, Singh SJ, Orme MW. Deriving personalised physical activity intensity thresholds by merging accelerometry with field-based walking tests: Implications for pulmonary rehabilitation. Chron Respir Dis 2022; 19:14799731221129286. [PMID: 36203407 PMCID: PMC9549080 DOI: 10.1177/14799731221129286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
During pulmonary rehabilitation (PR), patients receive individually tailored walking exercise training. The personalised nature of exercise prescription is a fundamental component of PR. Despite this, the measurement of physical activity (PA) has been limited to a 'one size fits all' approach and can be challenging to translate into clinically meaningful or real-world units, such as cadence. This discrepancy may partly explain the inconsistent evidence for the impact of PR on PA. It may also provide an opportunity to standardise PA assessment in the context of chronic respiratory disease (CRD) and PR, where field-based walking tests are routine measures. This technical note provides an example of how to develop personalised PA intensity thresholds, calibrated against an individual's performance on the Incremental Shuttle Walking Test (ISWT; maximal) and Endurance Shuttle Walk Test (ESWT; sub-maximal). These are externally paced tests, with each level (speed) of the tests denoting a specific speed (intensity); ranging 1.8 km/h (ISWT Level 1) to 8.5 km/h (ISWT Level 12). From the ESWT, it becomes possible to evaluate adherence to each individual's walking exercise prescription. Future research should explore this approach and its responsiveness to PR. It may be possible to extend this methodology with the inclusion of physiological parameters (e.g., heart rate, calorimetry, and oxygen consumption) to derive relative intensity markers (e.g. moderate-to-vigorous), accounting for individual differences in exercise capacity, under the same paradigm as PR exercise prescription.
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Affiliation(s)
- Ilaria Pina
- Department of Respiratory Sciences, University of Leicester, Leicester, UK,Centre for Exercise and
Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS
Trust, Leicester, UK,Ilaria Pina, Department of Respiratory
Sciences, University of Leicester, Leicester LE1 7RH, UK.
| | | | | | - Lorna Latimer
- Department of Respiratory Sciences, University of Leicester, Leicester, UK,Centre for Exercise and
Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS
Trust, Leicester, UK
| | - Jakub Zatloukal
- Centre for Exercise and
Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS
Trust, Leicester, UK
| | | | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK,Centre for Exercise and
Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS
Trust, Leicester, UK
| | - Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, UK,Centre for Exercise and
Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS
Trust, Leicester, UK
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Lahham A, Holland AE. The Need for Expanding Pulmonary Rehabilitation Services. Life (Basel) 2021; 11:1236. [PMID: 34833112 PMCID: PMC8622005 DOI: 10.3390/life11111236] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary rehabilitation is a strongly recommended and effective treatment for people with chronic lung disease. However, access to pulmonary rehabilitation is poor. Globally, pulmonary rehabilitation is accessed by less than 3% of people with chronic lung disease. Barriers to referral, uptake and completion of pulmonary rehabilitation are well documented and linked with organizational, practitioner and patient-related factors. Enhancing the knowledge of health care professionals, family carers, and people with chronic lung disease about the program and its benefits produces modest increases in referral and uptake rates, but evidence of the sustainability of such approaches is limited. Additionally, initiatives focusing on addressing organizational barriers to access, such as expanding services and implementing alternative models to the conventional center-based setting, are not yet widely used in clinical practice. The COVID-19 pandemic has highlighted the urgent need for health care systems to deliver pulmonary rehabilitation programs remotely, safely, and efficiently. This paper will discuss the pressing need to address the issue of the low accessibility of pulmonary rehabilitation. It will also highlight the distinctive challenges to pulmonary rehabilitation delivery in rural and remote regions, as well as low-income countries.
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Affiliation(s)
- Aroub Lahham
- Department of Immunology and Pathology, Monash University, Melbourne 3800, Australia;
| | - Anne E. Holland
- Department of Immunology and Pathology, Monash University, Melbourne 3800, Australia;
- Institute for Breathing and Sleep, Melbourne 3084, Australia
- Department of Physiotherapy, Alfred Health, Melbourne 3004, Australia
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