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Kaur A, Bourbeau J, Brighton L, Celli B, Crouch R, Demeyer H, Gerardi DA, Katsura H, Meek P, Morgan M, Paneroni M, Singh S, Stickland MK. Increasing exercise capacity and physical activity in the COPD patient. Breathe (Sheff) 2024; 20:230347. [PMID: 38873235 PMCID: PMC11167654 DOI: 10.1183/20734735.0347-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/24/2024] [Indexed: 06/15/2024] Open
Abstract
Higher levels of exercise capacity and physical activity are desired outcomes in the comprehensive management of the COPD patient. In addition, improvements in exercise capacity and physical activity are instrumental to optimising other important therapeutic goals, such as improved health status, reduced healthcare utilisation and increased survival. Four general approaches towards increasing exercise capacity and physical activity in individuals with COPD will be discussed in this review: 1) pharmacological intervention, especially the administration of long-acting bronchodilators; 2) pulmonary rehabilitation, including exercise training and collaborative self-management; 3) behavioural interventions; and 4) web-based interventions. These are by no means the only approaches, nor are they mutually exclusive: indeed, combining them, as necessary, to meet the needs of the individual respiratory patient may promote optimal outcomes, although further research is necessary in this area.
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Affiliation(s)
- Antarpreet Kaur
- Section of Pulmonary, Interventional Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Lisa Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Bartolome Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca Crouch
- Duke University Hospital and Medical Center, Department of Physical and Occupational Therapy, Durham, NC, USA
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Daniel A. Gerardi
- Section of Pulmonary, Interventional Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Hideki Katsura
- Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Paula Meek
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Mike Morgan
- Retired, Department of Respiratory Sciences, University of Leicester, Biomedical Research Centre, Leicester, UK
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Sally Singh
- Department of Respiratory Sciences, University of Leicester, Biomedical Research Centre, Leicester, UK
| | - Michael K. Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and G.F. MacDonald Centre for Lung Health (Covenant Health), Edmonton, AB, Canada
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2
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Cui S, Ji H, Li L, Zhu H, Li X, Gong Y, Song Y, Hu L, Wu X. Effects and long-term outcomes of endurance versus resistance training as an adjunct to standard medication in patients with stable COPD: a multicenter randomized trial. BMC Pulm Med 2024; 24:196. [PMID: 38649893 PMCID: PMC11036716 DOI: 10.1186/s12890-024-03010-z] [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: 07/20/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Comparisons between endurance training (ET) and resistance training (RT) have produced equivocal findings in chronic obstructive pulmonary disease (COPD) patients. The purpose of our study is to investigate the effectiveness and long-term outcomes of adding ET and RT to conventional medical treatment in patients with COPD. A secondary objective is to investigate the clinical improvements resulting from exercise training in patients with different disease severities. METHODS The study was a multicenter, prospective trial in people with stable COPD. The cohort was randomized to three groups: individualized medical treatment group (MT), MT + endurance training group (MT + ET) and MT + resistance training group (MT + RT). Exercise was performed 3 times weekly over a 12-week period. The endpoints of exercise capacity, health-related quality of life, COPD symptoms, lung function, and anxiety and depression questionnaires were re-evaluated at baseline, at the completion of the intervention and at 6 and 12-month follow-up. According to the COPD assessment tool offered by GOLD guidelines, patients were stratified into GOLD A and B groups and GOLD C and D groups for further subgroup analysis. RESULTS The intention-to-treat (ITT) population included 366 patients, 328 of them completed the study protocol over 12 months (the PP-population). There were no significant differences in the primary outcome, quality of life, between patients who underwent medical treatment (MT) alone, MT + endurance training (MT + ET), or MT + resistance training (MT + RT) at the completion of the intervention, 6-, or 12-month follow-up. Additionally, no significant differences were observed between MT, MT + RT, or MT + ET groups concerning the primary outcome, exercise capacity (3MWD), after initial 3 months of intervention. However, a small statistically significant difference was noted in favor of MT + ET compared to MT + RT at 12 months (ITT: Δ3MWD in ET vs RT = 5.53 m, 95% confidence interval: 0.87 to 13.84 m, P = 0.03) (PP: Δ3MWD in ET vs RT = 7.67 m, 95% confidence interval: 0.93 to 16.27 m, P = 0.04). For patients in the GOLD C and D groups, improvement in quality of life following ET or RT was significantly superior to medical intervention alone. Furthermore, upon completion of the exercise regimen, RT exhibited a greater improvement in anxiety compared to ET in these patients (ITT: ΔHAD-A at 3-month: RT = -1.63 ± 0.31 vs ET = -0.61 ± 0.33, p < 0.01) (PP: ΔHAD-A at 3-month: RT = -1.80 ± 0.36 vs ET = -0.75 ± 0.37, p < 0.01). CONCLUSIONS Our study presents evidence of the beneficial effects of ET and RT in combination with standard medical treatment, as well as the long-term effects over time after the intervention. While the statistically significant effect favoring ET over RT in terms of exercise capacity was observed, it should be interpreted cautiously. Patients in severe stages of COPD may derive greater benefits from either ET or RT and should be encouraged accordingly. These findings have implications for exercise prescription in patients with COPD. TRIAL REGISTRATION ChiCTR-INR-16009892 (17, Nov, 2016).
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Affiliation(s)
- Shilei Cui
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China
- Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Haiying Ji
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Li Li
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Huili Zhu
- Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Xiangyang Li
- Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Ying Gong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China.
- Shanghai Respiratory Research Institute, Shanghai, 200032, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200032, China.
| | - Lijuan Hu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China.
- Shanghai Respiratory Research Institute, Shanghai, 200032, China.
| | - Xu Wu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd, Shanghai, 200032, China.
- Shanghai Respiratory Research Institute, Shanghai, 200032, China.
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3
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Kim C, Choi HE, Rhee CK, Song JH, Lee JH. Efficacy of Digital Therapeutics for Pulmonary Rehabilitation: A Multi-Center, Randomized Controlled Trial. Life (Basel) 2024; 14:469. [PMID: 38672740 PMCID: PMC11051347 DOI: 10.3390/life14040469] [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: 01/02/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This study aimed to investigate the efficacy and safety of digital therapeutics (DTx), EASYBREATH, for pulmonary rehabilitation (PR) in patients with chronic respiratory diseases (CRDs). MATERIALS AND METHODS This prospective randomized controlled trial was conducted at multiple centers. Participants were randomly allocated 1:1 to the DTx group (DTxG), provided with DTx using EASYBREATH. The DTxG underwent an 8-week PR program with evaluations conducted at baseline, four weeks, and eight weeks. The control group (CG) underwent one PR session and was advised to exercise and undergo the same evaluation. The primary outcome was the change in six-minute walking distance (6MWD) over eight weeks, and secondary outcomes included changes in scores of Modified Medical Research Council (mMRC), chronic obstructive pulmonary disease assessment test (CAT), and St. George's respiratory questionnaire (SGRQ). RESULTS The change in 6MWD after eight weeks demonstrated a significant difference between the DTxG and CG (57.68 m vs. 21.71 m, p = 0.0008). The change in mMRC scores (p = 0.0008), CAT scores (p < 0.0001), and total SGRQ scores (p = 0.0003) also showed a significant difference between the groups after eight weeks. CONCLUSIONS EASYBREATH significantly improved exercise capacity, alleviated dyspnea, and enhanced the overall quality of life at eight weeks. EASYBREATH is a highly accessible, time-efficient, and effective treatment option for CRD with high compliance.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea; (C.K.); (J.H.S.)
| | - Hee-Eun Choi
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea;
- Share and Service Inc., Busan 48002, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02812, Republic of Korea;
| | - Jun Hyeong Song
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea; (C.K.); (J.H.S.)
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
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4
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Liu WY, Spruit MA, Delbressine JM, Willems PJ, Yentes JM, Bruijn SM, Franssen FME, Wouters EFM, Meijer K. Alterations in stride-to-stride fluctuations in patients with chronic obstructive pulmonary disease during a self-paced treadmill 6-minute walk test. PLoS One 2024; 19:e0300592. [PMID: 38489297 PMCID: PMC10942081 DOI: 10.1371/journal.pone.0300592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Evaluating variability and stability using measures for nonlinear dynamics may provide additional insight into the structure of the locomotor system, reflecting the neuromuscular system's organization of gait. This is in particular of interest when this system is affected by a respiratory disease and it's extrapulmonary manifestations. This study assessed stride-to-stride fluctuations and gait stability in patients with chronic obstructive pulmonary disease (COPD) during a self-paced, treadmill 6-minute walk test (6MWT) and its association with clinical outcomes. In this cross-sectional study, eighty patients with COPD (age 62±7y; forced expiratory volume in first second 56±19%predicted) and 39 healthy older adults (62±7y) were analyzed. Gait parameters including stride-to-stride fluctuations (coefficient of variation (CoV), predictability (sample entropy) and stability (Local Divergence Exponent (LDE)) were calculated over spatiotemporal parameters and center of mass velocity. Independent t-test, Mann-Whitney U test and ANCOVA analyses were conducted. Correlations were calculated between gait parameters, functional mobility using Timed Up and Go Test, and quadriceps muscle strength using dynamometry. Patients walked slower than healthy older adults. After correction for Speed, patients demonstrated increased CoV in stride length (F(1,116) = 5.658, p = 0.019), and increased stride length predictability (F(1,116) = 3.959, p = 0.049). Moderate correlations were found between mediolateral center of mass velocity LDE and normalized maximum peak torque (ρ = -0.549). This study showed that patients with COPD demonstrate alterations in stride length fluctuations even when adjusted for walking speed, highlighting the potential of nonlinear measures to detect alterations in gait function in patients with COPD. Association with clinical outcomes were moderate to weak, indicating that these clinical test are less discriminative for gait alterations.
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Affiliation(s)
- Wai-Yan Liu
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Research and Development, Ciro, Horn, The Netherlands
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Horn, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Paul J. Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jennifer M. Yentes
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, Horn, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Emiel F. M. Wouters
- Department of Research and Development, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Brauwers B, Machado FVC, Beijers RJHCG, Spruit MA, Franssen FME. Combined Exercise Training and Nutritional Interventions or Pharmacological Treatments to Improve Exercise Capacity and Body Composition in Chronic Obstructive Pulmonary Disease: A Narrative Review. Nutrients 2023; 15:5136. [PMID: 38140395 PMCID: PMC10747351 DOI: 10.3390/nu15245136] [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: 11/29/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that is associated with significant morbidity, mortality, and healthcare costs. The burden of respiratory symptoms and airflow limitation can translate to reduced physical activity, in turn contributing to poor exercise capacity, muscle dysfunction, and body composition abnormalities. These extrapulmonary features of the disease are targeted during pulmonary rehabilitation, which provides patients with tailored therapies to improve the physical and emotional status. Patients with COPD can be divided into metabolic phenotypes, including cachectic, sarcopenic, normal weight, obese, and sarcopenic with hidden obesity. To date, there have been many studies performed investigating the individual effects of exercise training programs as well as nutritional and pharmacological treatments to improve exercise capacity and body composition in patients with COPD. However, little research is available investigating the combined effect of exercise training with nutritional or pharmacological treatments on these outcomes. Therefore, this review focuses on exploring the potential additional beneficial effects of combinations of exercise training and nutritional or pharmacological treatments to target exercise capacity and body composition in patients with COPD with different metabolic phenotypes.
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Affiliation(s)
- Bente Brauwers
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, Life Sciences, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Felipe V. C. Machado
- BIOMED (Biomedical Research Institute), REVAL (Rehabilitation Research Centre), Hasselt University, 3590 Hasselt, Belgium;
| | - Rosanne J. H. C. G. Beijers
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
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6
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Benzo-Iglesias MJ, Rocamora-Pérez P, Valverde-Martínez MÁ, García-Luengo AV, López-Liria R. Effectiveness of Water-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:8557. [PMID: 37896650 PMCID: PMC10610657 DOI: 10.3390/s23208557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that, due to dyspnea, decreases patients' physical function and quality of life. The aim of the research was to evaluate the effectiveness of water-based exercise (WE) in improving functional capacity and respiratory muscle strength in patients with COPD. It consisted of a systematic review and meta-analysis of eight randomized clinical trials (RCTs) from the last 10 years, found in PubMed, PEDro, Scopus and Web of Science databases. Methodological quality was analyzed using the PEDro scale and the Cochrane Collaboration Risk of Bias Tool. Regarding the evaluation of functional capacity, mainly assessed were lung function, respiratory muscle strength, and maximal or aerobic exercise. The results showed that WE improves functional capacity compared to a non-exercising control group (SMD: 73.42; IC 95%: 40.40 to 106.45; I2: 0%). There are no statistically significant differences between a WE treatment and a land exercise (LE) treatment (p = 0.24) in functional capacity, nor with respect to respiratory muscle strength (p = 0.97). These data should be interpreted with caution, as more RCTs with aquatic intervention in COPD patients are needed to elucidate whether there are differences between WE or LE according to patient characteristics and comorbidities.
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Affiliation(s)
- María Jesús Benzo-Iglesias
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain (M.Á.V.-M.)
| | - Patricia Rocamora-Pérez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain (M.Á.V.-M.)
| | - María Ángeles Valverde-Martínez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain (M.Á.V.-M.)
| | - Amelia Victoria García-Luengo
- Random Models and Design of Experiments, Department of Mathematics, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain
| | - Remedios López-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain (M.Á.V.-M.)
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7
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Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
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Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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8
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Hamilton A, Tetzlaff K. Editorial: Exercise intervention for prevention, management of and rehabilitation from chronic obstructive pulmonary disease (COPD). Front Physiol 2023; 14:1228431. [PMID: 37346487 PMCID: PMC10280736 DOI: 10.3389/fphys.2023.1228431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Alan Hamilton
- COPD Foundation, Miami, FL, United States
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kay Tetzlaff
- Department of Sports Medicine, University of Tübingen, Tübingen, Baden-Württemberg, Germany
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9
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Kaya M, Gurses HN, Ucgun H, Okyaltirik F. Effects of creative dance on functional capacity, pulmonary function, balance, and cognition in COPD patients: A randomized controlled trial. Heart Lung 2023; 58:13-20. [PMID: 36335909 DOI: 10.1016/j.hrtlng.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Exercise training is key to the comprehensive management of patients with chronic obstructive pulmonary disease (COPD). Creative dance can be an innovative approach as effective as traditional exercise training. OBJECTIVES This study aimed to investigate effect of creative dance-based exercise (CDE) training on functional capacity, postural stability and balance, pulmonary and cognitive functions, respiratory and peripheral muscle strength in COPD patients. METHODS Twenty-four patients with COPD were randomly allocated to either "chest physiotherapy and home-based walking program" (PT) or "CDE alongside home-based chest physiotherapy group" (PT+CDE). Both groups performed chest PT program twice a day for 5 days per week for 8 weeks. PT+CDE group received CDE training 2 days a week for 8 weeks. Primary outcome was six minute walk test (6MWT). Secondary outcomes were postural stability and balance, pulmonary function, maximum inspiratory (MIP) and expiratory (MEP) pressure, peripheral muscle strength, Montreal Cognitive Assessment (MoCA), COPD Assessment Test (CAT), and BODE index. Outcome measures were assessed at baseline and after 8 weeks of training. RESULTS Both groups showed statistically significant improvements in 6MWT distance, MIP, MEP, MoCA score, CAT, and BODE index (p < 0.05). Only with CDE training was achieved improvements in postural stability and balance scores, pulmonary function, and peripheral muscle strength (p < 0.05). The improvements in 6 MWT distance, MEP, MoCA score, and CAT were greater in PT+CDE group (p < 0.05). CONCLUSION Use of creative dance training in addition to home-based chest PT program was more effective than chest PT program regarding primary and secondary outcomes in COPD patients.
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Affiliation(s)
- Meltem Kaya
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul 34093, Turkey; Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Atlas University, Istanbul 34408, Turkey
| | - Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Silahtaraga St. No: 189, Istanbul 34060, Turkey; Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul 34060, Turkey.
| | - Hikmet Ucgun
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul 34010, Turkey
| | - Fatmanur Okyaltirik
- Department of Chest Diseases, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
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10
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Valero-Breton M, Valladares-Ide D, Álvarez C, Peñailillo RS, Peñailillo L. Changes in Blood Markers of Oxidative Stress, Inflammation and Cardiometabolic Patients with COPD after Eccentric and Concentric Cycling Training. Nutrients 2023; 15:nu15040908. [PMID: 36839267 PMCID: PMC9966444 DOI: 10.3390/nu15040908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/15/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients manifest muscle dysfunction and impaired muscle oxidative capacity, which result in reduced exercise capacity and poor health status. This study examined the effects of 12-week eccentric (ECC) and concentric (CONC) cycling training on plasma markers of cardiometabolic health, oxidative stress, and inflammation in COPD patients. A randomized trial in which moderate COPD was allocated to ECC (n = 10; 68.2 ± 10.0 year) or CONC (n = 10; 71.1 ± 10.3 year) training groups. Participants performed 12-week ECC or CONC training, 2-3 sessions per week, 10 to 30 min per session. Before and after training, peak oxygen consumption, maximal power output (VO2peak and POmax), and time-to-exhaustion (TTE) tests were performed. Plasma antioxidant and oxidative markers, insulin resistance, lipid profile, and systemic inflammation markers were measured before and after training at rest. VO2peak, POmax and TTE remained unchanged after ECC and CONC. CONC induced an increase in antioxidants (p = 0.01), while ECC decreased antioxidant (p = 0.02) markers measured at rest. CONC induced lesser increase in oxidative stress following TTE (p = 0.04), and a decrease in insulin resistance (p = 0.0006) compared to baseline. These results suggest that CONC training induced an increase in insulin sensitivity, antioxidant capacity at rest, and lesser exercise-induced oxidative stress in patients with moderate COPD.
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Affiliation(s)
- Mayalen Valero-Breton
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7550196, Chile
| | - Denisse Valladares-Ide
- Long Active Life Laboratory, Instituto de Ciencias de la Salud, Universidad de O’Higgins, Rancagua 2841959, Chile
| | - Cristian Álvarez
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7550196, Chile
| | - Reyna S. Peñailillo
- Laboratory of Reproductive Biology, Center for Biomedical Research and Innovation (CIIB), Universidad de los Andes, Santiago 7620001, Chile
| | - Luis Peñailillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7550196, Chile
- Correspondence:
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Kostorz-Nosal S, Jastrzębski D, Żebrowska A, Bartoszewicz A, Ziora D. Three Weeks of Pulmonary Rehabilitation Do Not Influence Oscillometry Parameters in Postoperative Lung Cancer Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111551. [PMID: 36363507 PMCID: PMC9696075 DOI: 10.3390/medicina58111551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 01/25/2023]
Abstract
Background: Thoracic surgery is a recommended treatment option for non-small cell lung cancer patients. An important part of a patient’s therapy, which helps to prevent postoperative complications and improve quality of life, is pulmonary rehabilitation (PR). The aim of this study was to assess whether the implementation of physical activity has an influence on forced oscillation technique (FOT) values in patients after thoracic surgery due to lung cancer. Methods: In this observational study, we enrolled 54 patients after thoracic surgery due to lung cancer, 49 patients with idiopathic interstitial fibrosis (IPF), and 54 patients with chronic obstructive pulmonary disease/asthma−COPD overlap (COPD/ACO). All patients were subjected to three weeks of in-hospital PR and assessed at the baseline as well as after completing PR by FOT, spirometry, grip strength measurement, and the 6-min walk test (6MWT). Results: We observed differences between FOT values under the influence of physical activity in studied groups, mostly between patients after thoracic surgery and COPD/ACO patients; however, no significant improvement after completing PR among FOT parameters was noticed in any group of patients. Improvements in the 6MWT distance, left hand strength, and right hand strength after PR were noticed (p < 0.001, 0.002, and 0.012, respectively). Conclusions: Three weeks of pulmonary rehabilitation had no impact on FOT values in patients after thoracic surgery due to lung cancer. Instead, we observed improvements in the 6MWT distance and the strength of both hands. Similarly, no FOT changes were observed in IPF and COPD/ACO patients after completing PR.
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Affiliation(s)
- Sabina Kostorz-Nosal
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
- Correspondence:
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
| | - Aleksandra Żebrowska
- Department of Physiological and Medical Sciences, Institute of Sport Sciences, Academy of Physical Education, 40-065 Katowice, Poland
| | - Agnieszka Bartoszewicz
- Independent Public Clinical Hospital No. 1, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
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12
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Effectiveness of pulmonary rehabilitation performed through exercise training for patients with stable COPD: A meta-analysis of randomized controlled trials. Zdr Varst 2022; 61:231-241. [DOI: 10.2478/sjph-2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
The application of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) improves functional capacity and health-related quality of life (HRQoL) at all stages of disease severity. The aim of this study was to determine the effects of PR, performed through exercise training (PR-ET), on functional capacity and HRQoL in patients with stable COPD.
Methods
The meta-analysis was performed by including randomized controlled trials (RCTs) involving patients with stable COPD who participated in different types of PR-ET in which six-minute walk distance (6MWD) and/ or St. George’s Respiratory Questionnaire total scores (SGRQ) were measured. The data search was conducted in December 2020 and January 2021.
Results
The first meta-analysis showed a statistically significant positive effect (MD=31.73m; p<0.00001) of PR-ET on 6MWD. Similarly, the second meta-analysis found a statistically significant favourable effect of pulmonary rehabilitation through exercise training on SGRQ total scores (MD=-8.09; p=0.002).
Conclusions
PR, which includes several different types of exercise training, has a positive effect on the functional capacity and HRQoL of patients with stable COPD. Further studies should be conducted to determine the effects of home-based PR-ET and PR-ET >8 weeks on SGRQ total scores.
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Nyberg A, Milad N, Martin M, Patoine D, Morissette MC, Saey D, Maltais F. Role of progression of training volume on intramuscular adaptations in patients with chronic obstructive pulmonary disease. Front Physiol 2022; 13:873465. [PMID: 36082219 PMCID: PMC9446145 DOI: 10.3389/fphys.2022.873465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Quadriceps dysfunction is a common systemic manifestation of chronic obstructive pulmonary disease (COPD), for which treatment using resistance training is highly recommended. Even though training volume is suggested to be a key explanatory factor for intramuscular adaptation to resistance training in healthy older adults, knowledge is scarce on the role of progression of training volume for intramuscular adaptations in COPD. Methods: This study was a sub-analysis of a parallel-group randomized controlled trial. Thirteen patients with severe to very severe COPD (median 66 yrs, forced expiratory volume in 1 s 44% predicted) performed 8 weeks of low-load resistance training. In a post hoc analysis, they were divided into two groups according to their training volume progression. Those in whom training volume continued to increase after the first 4 weeks of training outlined the continued progression group (n = 9), while those with limited increase (<5%) or even reduction in training volume after the initial 4 weeks composed the discontinued progression group (n = 4). Fiber-type distribution and oxidative muscle protein levels, i.e., citrate synthase (CS), hydroxyacyl-coenzyme A dehydrogenase (HADH), mitochondrial transcription factor A (TfAM) as well as quadriceps endurance measures (total work from elastic band and isokinetic knee extension tests), were assessed before and after the intervention period. Results: The continued progression group sustained their training volume progression during weeks 5–8 compared to weeks 1–4 (median +25%), while the discontinued progression group did not (median -2%) (p = 0.007 between groups). Compared with baseline values, significant between-group differences in fiber type distribution and TfAM muscle protein levels (range ± 17–62%, p < 0.05) and in individual responses to change in Type I and Type IIa fiber type proportion, CS, HADH, and TfAM muscle protein levels outcomes (median 89 vs. 50%, p = 0.001) were seen in favor of the continued progression group. Moreover, only the continued progression group had a significant increase in HADH muscle protein levels (+24%, p = 0.004), elastic band (+56%, p = 0.004) and isokinetic (+7%, p = 0.004) quadriceps endurance, but the between-group differences did not reach statistical significance (range 14–29%, p = 0.330–1.000). Discussion: The novel findings of the current study were that patients with COPD who had a continued progression of training volume across the 8-weeks intervention had an increased proportion of Type I fibers, and TfAM muscle protein levels and decreased proportion of Type II fibers compared to those that did not continue to progress their training volume after the initial weeks. Additionally, HADH muscle protein levels and quadriceps endurance measurements only improved in the continued progression group, although no significant between-group differences were seen. These findings highlight the importance of continued progression of training volume during resistive training to counteract quadriceps dysfunction within the COPD population. Still, considering the small sample size and the post hoc nature of our analyses, these results should be interpreted cautiously, and further research is necessary.
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Affiliation(s)
- Andre Nyberg
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
- Department of Community Medicine and Rehabilitation, section of Physiotherapy, Umeå University, Umeå, Sweden
- *Correspondence: Andre Nyberg,
| | - Nadia Milad
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Mickael Martin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Dany Patoine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Mathieu C Morissette
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Didier Saey
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
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Peñailillo L, Valladares-Ide D, Jannas-Velas S, Flores-Opazo M, Jalón M, Mendoza L, Nuñez I, Diaz-Patiño O. Effects of eccentric, concentric and eccentric/concentric training on muscle function and mass, functional performance, cardiometabolic health, quality of life and molecular adaptations of skeletal muscle in COPD patients: a multicentre randomised trial. BMC Pulm Med 2022; 22:278. [PMID: 35854255 PMCID: PMC9297587 DOI: 10.1186/s12890-022-02061-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the third cause of death worldwide. COPD is characterised by dyspnoea, limited exercise tolerance, and muscle dysfunction. Muscle dysfunction has been linked to dysregulation between muscle protein synthesis, myogenesis and degradation mechanisms. Conventional concentric cycling has been shown to improve several clinical outcomes and reduce muscle wasting in COPD patients. Eccentric cycling is a less explored exercise modality that allows higher training workloads imposing lower cardio-metabolic demand during exercise, which has shown to induce greater muscle mass and strength gains after training. Interestingly, the combination of eccentric and concentric cycling training has scarcely been explored. The molecular adaptations of skeletal muscle after exercise interventions in COPD have shown equivocal results. The mechanisms of muscle wasting in COPD and whether it can be reversed by exercise training are unclear. Therefore, this study aims two-fold: (1) to compare the effects of 12 weeks of eccentric (ECC), concentric (CONC), and combined eccentric/concentric (ECC/CONC) cycling training on muscle mass and function, cardiometabolic health, physical activity levels and quality of life in severe COPD patients; and (2) to examine the molecular adaptations regulating muscle growth after training, and whether they occur similarly in specific muscle fibres (i.e., I, IIa and IIx). Methods Study 1 will compare the effects of 12 weeks of CONC, ECC, versus ECC/CONC training on muscle mass and function, cardiometabolic health, levels of physical activity and quality of life of severe COPD patients using a multicentre randomised trial. Study 2 will investigate the effects of these training modalities on the molecular adaptations regulating muscle protein synthesis, myogenesis and muscle degradation in a subgroup of patients from Study 1. Changes in muscle fibres morphology, protein content, genes, and microRNA expression involved in skeletal muscle growth will be analysed in specific fibre-type pools. Discussion We aim to demonstrate that a combination of eccentric and concentric exercise could maximise the improvements in clinical outcomes and may be ideal for COPD patients. We also expect to unravel the molecular mechanisms underpinning muscle mass regulation after training in severe COPD patients. Trial Registry: Deutshches Register Klinischer Studien; Trial registration: DRKS00027331; Date of registration: 12 January 2022. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027331.
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Affiliation(s)
- Luis Peñailillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, 700 Fernández Concha, Las Condes, 7591538, Santiago, Chile.
| | - Denisse Valladares-Ide
- Long Active Life Laboratory, Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Sebastián Jannas-Velas
- Long Active Life Laboratory, Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | | | | | - Laura Mendoza
- Respiratory Unit, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Ingrid Nuñez
- Department of Pulmonary Diseases, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Critical Care, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Orlando Diaz-Patiño
- Department of Pulmonary Diseases, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Critical Care, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
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Duan W, Zeng D, Huang J, Gu J, Li S, Zhou W, Ma J, Jiang Y, Zhu L, Xiang X, Dai A. Effect of modified Total Body Recumbent Stepper training on exercise capacity and thioredoxin in COPD: a randomized clinical trial. Sci Rep 2022; 12:11139. [PMID: 35778539 PMCID: PMC9247894 DOI: 10.1038/s41598-022-15466-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/23/2022] [Indexed: 11/09/2022] Open
Abstract
Exercise intolerance is one of the major symptoms of chronic obstructive pulmonary disease (COPD). Exercise training can benefit COPD patients, but the underlying mechanism remains unclear. The modified Total Body Recumbent Stepper (TBRS, Nustep-T4) can benefit patients with stroke, spinal cord injury and amyotrophic lateral sclerosis. Nevertheless, the effect of TBRS training alone on pulmonary rehabilitation (PR) in COPD patients remains largely unknown. We aimed to explore the effect of TBRS training on exercise capacity and the thioredoxin system (TRXS) in COPD patients to provide a novel rehabilitation modality and new theoretical basis for PR of COPD patients. Ninety stable COPD patients were randomly divided into a control group (NC group) and a TBRS training group (TBRS group), with 45 cases in each group. Subjects in the TBRS training group were scheduled to undergo TBRS endurance training triweekly for 12 weeks under the guidance of a rehabilitation therapist. We assessed the primary outcome: exercise capacity (6-min walking distance, 6MWD); and secondary outcomes: perception of dyspnoea (mMRC, Borg), the COPD assessment test (CAT), the BODE index, pulmonary function, the number of acute exacerbations of COPD and oxidative stress (TRXS) at one-year follow-up. Compared with before the intervention and the control group, after the intervention, the TBRS training group, exhibited an increase in the 6MWD (from 366.92 ± 85.81 to 484.10 ± 71.90, 484.10 ± 71.90 vs 370.63 ± 79.87, P < 0.01), while the scores on the BORG, mMRC, BODE index, CAT, and the number of acute exacerbations of COPD were reduced, and the protein and mRNA expression levels of TRXS was significantly increased (P < 0.01). However, no differences were found in PF parameters in the comparison with before the intervention or between groups. TBRS training can effectively increase exercise capacity, while there are indications that it can alleviate COPD-related dyspnoea and reduce the number of acute exacerbations of COPD. Interestingly, long-term regular TBRS training may reduce oxidative stress associated with COPD to increase exercise capacity.
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Affiliation(s)
- Wentao Duan
- Department of Respiratory and Critical Care Medicine, Research Unit of Respiratory Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Dan Zeng
- Institute of Respiratory Disease, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, 410016, China
| | - Jin Huang
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), 410016, Changsha, China
| | - Jing Gu
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), 410016, Changsha, China
| | - San Li
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), 410016, Changsha, China
| | - Wei Zhou
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), 410016, Changsha, China
| | - Jinling Ma
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), 410016, Changsha, China
| | - Yan Jiang
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), 410016, Changsha, China
| | - Liming Zhu
- Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), 410016, Changsha, China.
| | - Xudong Xiang
- Department of Emergency, Institute of Emergency and Difficult Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Aiguo Dai
- Department of Respiratory Diseases, Medical School, Hunan University of Chinese Medicine/Key Laboratory of Vascular Biology and Translational Medicine in Hunan Province, Changsha, 410208, China
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Minimal important difference of two methods for assessment of quadriceps femoris strength post exercise program in individuals with COPD. Heart Lung 2022; 54:56-60. [PMID: 35390575 DOI: 10.1016/j.hrtlng.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The assessment of quadriceps femoris (QF) strength is recommended by international guidelines as an outcome of exercise training (ET) programs in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES To identify the minimal important difference (MID) of two methods for the assessment of improvement of QF strength after a high-intensity ET program in individuals with COPD: 1-repetition maximum (1RM) and maximal voluntary contraction (MVC). METHODS Individuals with moderate to very-severe stable COPD were submitted to high-intensity ET (3 days/week, 36 sessions). Lung function (spirometry), exercise capacity (6-minute walk test [6MWT]) and QF strength (1RM test and MVC by using a strain-gauge) were assessed before and after the ET program. RESULTS Twenty-one individuals were studied (65±8 years, BMI 27±6; FEV1 51±16%predicted). At the end of the ET program, QF strength improved significantly (10±4 Nm for MVC and 8 ± 6 kg for 1RM) (P<0.05 for both). The MID for improvement of the QF strength calculated by distribution-based methods ranged from 9.4 to 16 Nm (between 7.4% and 12.6% increase from baseline) for the MVC and from 2.5 to 3 kg (between 12% and 15% increase from baseline) for the 1RM test. Anchor-based MIDs could not be calculated since there was no correlation between the improvement of QF strength and the improvement of the proposed anchor (6MWT). CONCLUSIONS The MID for improvement of QF strength after a high-intensity ET program in individuals with moderate-to-severe stable COPD ranges between 9.4 and 16 Nm for the MVC assessed with a strain gauge and between 2.5 and 3 kg for the 1RM test.
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17
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Cao Y, Li P, Wang Y, Liu X, Wu W. Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 13:872277. [PMID: 35586711 PMCID: PMC9108326 DOI: 10.3389/fphys.2022.872277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the whole body and causes many extrapulmonary adverse effects, amongst which diaphragm dysfunction is one of the prominent manifestations. Diaphragm dysfunction in patients with COPD is manifested as structural changes, such as diaphragm atrophy, single-fibre dysfunction, sarcomere injury and fibre type transformation, and functional changes such as muscle strength decline, endurance change, diaphragm fatigue, decreased diaphragm mobility, etc. Diaphragm dysfunction directly affects the respiratory efficiency of patients and is one of the important pathological mechanisms leading to progressive exacerbation of COPD and respiratory failure, which is closely related to disease mortality. At present, the possible mechanisms of diaphragm dysfunction in patients with COPD include systemic inflammation, oxidative stress, hyperinflation, chronic hypoxia and malnutrition. However, the specific mechanism of diaphragm dysfunction in COPD is still unclear, which, to some extent, increases the difficulty of treatment and rehabilitation. Therefore, on the basis of the review of changes in the structure and function of COPD diaphragm, the potential mechanism of diaphragm dysfunction in COPD was discussed, the current effective rehabilitation methods were also summarised in this paper. In order to provide direction reference and new ideas for the mechanism research and rehabilitation treatment of diaphragm dysfunction in COPD.
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Affiliation(s)
- Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xiaodan Liu, ; Weibing Wu,
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
- *Correspondence: Xiaodan Liu, ; Weibing Wu,
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18
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Barman A, Sinha MK, Sahoo J, Jena D, Patel V. Respiratory rehabilitation in patients recovering from severe acute respiratory syndrome: A systematic review and meta-analysis. Heart Lung 2022; 53:11-24. [PMID: 35108624 PMCID: PMC8758335 DOI: 10.1016/j.hrtlng.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND With an increase in published reports on respiratory rehabilitation (RR) in severe acute respiratory syndrome (SARS), there is a need for a meta-analysis and systematic review to measure the effects of the RR in SARS. OBJECTIVE Objective of the review was to evaluate the efficacy and safety of RR in patients recovering from SARS. METHODS PubMed/ MEDLINE, CENTRAL, EMBASE, and Clinical Trial Registries were systematically searched (between January 1, 2003, to July 31, 2021) to identify all patients who received RR, at least for six days, following SARS. The primary outcome was exercise capacity [6-meter walking distance (6-MWD)], and secondary outcomes were change in pulmonary function test (PFT) parameters, activities in daily livings (ADLs), and quality of life (QoL). Meta-analysis was performed by using RevMan 5.4. RESULTS Twenty-one observational studies, including eight comparative studies, were included. Eight comparative studies participated in quantitative meta-analysis. The intervention group, who received RR, improved significantly in exercise capacity (6-MWD) [mean difference (MD):45.79, (95% CI:31.66-59.92)] and PFT parameters, especially in forced vital capacity (FVC%) [MD:4.38, (95% CI:0.15-8.60)], and diffusion lung capacity for carbon monoxide (DLCO%) [MD:11.78, (95% CI:5.10-18.46)]. The intervention group failed to demonstrate significant improvement in ADLs and QoL outcomes. No significant adverse events were reported during the intervention. CONCLUSION Respiratory rehabilitation can improve exercise capacity and PFT parameters in patients recovering from SARS infection. The RR does not cause serious adverse events. Clinical trials to determine the best RR program (in terms of initiation, duration, and components) in SARS and its treatment efficacy, both in the short and long- term are needed.
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Affiliation(s)
- Apurba Barman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Mithilesh K Sinha
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jagannatha Sahoo
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Debasish Jena
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vikas Patel
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
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19
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Karagiannis C, Savva C, Korakakis V, Adamide T, Georgiou A, Matheou I, Prodromou A, Xanthos T. Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev 2021; 41:426-431. [PMID: 34117184 DOI: 10.1097/hcr.0000000000000620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR. METHODS Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale. RESULTS Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group. CONCLUSIONS In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.
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Affiliation(s)
- Christos Karagiannis
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus (Drs Karagiannis and Savva and Ms Matheou); Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar (Dr Korakakis); Respiratory Clinic, Nicosia General Hospital, Nicosia, Cyprus (Dr Adamide); Private Doctor, Nicosia, Cyprus (Dr Georgiou); Physiotherapy Department, Nicosia General Hospital, and Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus (Ms Prodromou); and School of Medicine, European University Cyprus, Nicosia, Cyprus (Dr Xanthos)
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20
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Pancera S, Lopomo NF, Bianchi LNC, Pedersini P, Villafañe JH. Isolated Resistance Training Programs to Improve Peripheral Muscle Function in Outpatients with Chronic Obstructive Pulmonary Diseases: A Systematic Review. Healthcare (Basel) 2021; 9:1397. [PMID: 34683077 PMCID: PMC8535539 DOI: 10.3390/healthcare9101397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 01/01/2023] Open
Abstract
This systematic review aims to establish which isolated resistance training (RT) programs have been used in outpatients with chronic obstructive pulmonary disease (COPD) and their impact on all aspects of peripheral skeletal muscle function. Electronic databases were systematically searched up to June 2021. The eligibility criteria were: (1) randomized controlled trials investigating the effects of supervised and isolated RT programs in outpatients with COPD and (2) RT programs lasting 8-12 weeks, (3) including at least one outcome measure related to trainable muscle characteristics. Initially, 6576 studies were identified, whereas 15 trials met the inclusion criteria. All the included trials reported that isolated RT improved both upper and lower limbs' maximal strength. Muscle endurance and power also increased after RT but received less attention in the analysis. Furthermore, few studies assessed the effect of RT on muscle mass and cross-sectional area, reporting only limited improvement. Isolated RT programs carried out 2-3 days a week for 8-12 weeks improved skeletal muscle function in individuals with COPD. The RT program should be specifically focused to the trainable muscle characteristic to be improved. For this reason, we further encourage the introduction of a detailed assessment of muscle function and structure during the pulmonary rehabilitation practice.
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Affiliation(s)
- Simone Pancera
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (L.N.C.B.); (P.P.); (J.H.V.)
| | - Nicola F. Lopomo
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy;
| | - Luca N. C. Bianchi
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (L.N.C.B.); (P.P.); (J.H.V.)
| | - Paolo Pedersini
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (L.N.C.B.); (P.P.); (J.H.V.)
| | - Jorge H. Villafañe
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (L.N.C.B.); (P.P.); (J.H.V.)
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21
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Kaasgaard M, Rasmussen DB, Andreasson KH, Hilberg O, Løkke A, Vuust P, Bodtger U. Use of Singing for Lung Health as an alternative training modality within pulmonary rehabilitation for COPD: an RCT. Eur Respir J 2021; 59:13993003.01142-2021. [PMID: 34625480 PMCID: PMC9117735 DOI: 10.1183/13993003.01142-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/22/2021] [Indexed: 11/05/2022]
Abstract
Background Pulmonary rehabilitation (PR) is a cornerstone in chronic obstructive pulmonary disease (COPD) management. However, PR adherence is generally low, and barriers include availability, economic issues, motivation and an inability to attend or perform physical training. Therefore, alternative, evidence-based PR activities are required. Singing may have benefits for quality of life (QoL), respiratory control and well-being in COPD, but the impact on the PR key outcome, physical exercise capacity, is uncertain. Methods In this randomised controlled trial (NCT03280355), we investigated the effectiveness of 10 weeks of PR, including either “Singing for Lung Health” (SLH) training or standard physical exercise training (PExT). The primary outcome was a change in exercise capacity (6-min walk distance (6MWD)) from baseline to post-PR. Secondary outcomes were changes in QoL (St George's Respiratory Questionnaire (SGRQ)), Hospital Anxiety and Depression Score (HADS), lung function, dyspnoea and adherence. Results We included 270 COPD patients, and 195 completed the study. Demographics across groups were comparable, and both groups improved significantly in 6MWD and SGRQ score. SLH was non-inferior to PExT in improving 6MWD (mean±sd 13.1±36.3 m versus 14.1±32.3 m, p=0.81; difference 1.0 m, 95% CI −7.3–9.3 m) with 21.8% and 25.0%, respectively (p=0.57), reaching the 6MWD minimal important difference of 30 m. We found no significant between-group differences concerning SGRQ, HADS, lung function, dyspnoea or adherence. Conclusion Our study suggests that SLH is non-inferior to PExT in improving 6MWD during a 10-week PR programme. Future studies addressing reproducibility, long-term effects and health economics are needed. Singing for Lung Health was non-inferior to physical exercise training in short-term improvement of 6-min walk test distance in COPD patients attending pulmonary rehabilitation. In both groups, the effect was related to high adherence.https://bit.ly/3uoP4Q8
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Affiliation(s)
- Mette Kaasgaard
- Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark .,Department of Clinical Medicine, Center for Music in the Brain, Aarhus University, Denmark and the Royal Academy of Music, Aarhus/Aalborg, Denmark
| | - Daniel Bech Rasmussen
- Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Karen Hjerrild Andreasson
- Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Naestved, Denmark
| | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Lillebaelt Hospital, Denmark
| | - Anders Løkke
- Department of Respiratory Medicine, Lillebaelt Hospital, Denmark
| | - Peter Vuust
- Department of Clinical Medicine, Center for Music in the Brain, Aarhus University, Denmark and the Royal Academy of Music, Aarhus/Aalborg, Denmark
| | - Uffe Bodtger
- Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
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22
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Liu J, Song X, Zheng S, Ding H, Wang H, Sun X, Ren X. A prospective study on physical performance of Chinese chronic obstructive pulmonary disease males with type 2 diabetes. Medicine (Baltimore) 2021; 100:e27126. [PMID: 34477156 PMCID: PMC8415924 DOI: 10.1097/md.0000000000027126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/18/2021] [Indexed: 01/05/2023] Open
Abstract
Currently no research is available on muscle and functional performance of chronic obstructive pulmonary disease (COPD) patients with type 2 diabetes (T2DM) in China, even though both diseases have been reported to damage motor function.This single-center prospective study involves 55 males with COPD and T2DM and 46 males with COPD. Lung function, muscle strength and endurance of the upper limbs, and quadriceps strength of both legs were assessed using instruments. The 6-min walk (6MW) test was performed to evaluate physical performance.Between the two groups, respiratory function of COPD patients with T2DM was worse than in those without (P < .05). Mean handgrip strength and muscle endurance of upper limbs and mean quadriceps strength at both 60°/s and 120°/s in COPD males with T2DM was also significantly less (P < .05). Mean 6MW distances of COPD patients with T2DM were significantly worse (P < .05), and mean pulse rate (PR) increments of COPD patients with T2DM in 6MW test were significantly higher (P < .05).The combination of COPD and T2DM not only brings one more chronic disease to elderly patients but also significantly affects muscle strength and endurance as well as physical performance. Accordingly, in the management of chronic diseases, we recommend that clinicians as well as patients themselves actively control blood sugar and review them regularly with a view to reducing adverse effects on physical performance.
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23
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Candemir I. The narrative review of chronic obstructive pulmonary disease management in Turkey: medical treatment, pulmonary rehabilitation and endobronchial volume reduction. J Thorac Dis 2021; 13:3907-3917. [PMID: 34277080 PMCID: PMC8264693 DOI: 10.21037/jtd-20-2271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/25/2021] [Indexed: 11/15/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. In Turkey, the prevalence of COPD has been shown at rates of 9.1% to 19.1%, and COPD was found to be the third leading cause of mortality and eighth leading cause of disability. In several national multicentral studies, a high rate of non-adherence to pharmacologic treatment according to GOLD was found to be high, and the most commonly prescribed treatment was the triple regimen. The most important non-pharmacologic treatment of COPD is pulmonary rehabilitation (PR), which is also highly recommended in Turkey, but it is also underutilized, like in other countries. Awareness of healthcare professionals and patients should increase in Turkey. The recommendations in content and modality of programs are similar to international guidelines. Another non-pharmacologic treatment is endobronchial volume reduction (EBVR). Although there is limited number of studies about EBVR, in national reports, the importance of patient selection, method, close follow-up after intervention, and applications in experienced centers are emphasized to decrease the economic burden of this expensive treatment. There is still great need for further randomized studies about pharmacologic and non-pharmacologic treatment and additionally, a close collaboration between healthcare professionals, physicians, professional societies of pulmonology, planners of reimbursement system, patients, patient advocacy groups and the general public should be established.
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Affiliation(s)
- Ipek Candemir
- Ataturk Chest Disease and Chest Surgery Education and Research Hospital, Ankara, Turkey
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24
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A Survey of Factors That May Cause Practice Inconsistencies and Impact Care in Pulmonary Rehabilitation. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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de Lima FF, Cavalheri V, Silva BSA, Grigoletto I, Uzeloto JS, Ramos D, Camillo CA, Ramos EMC. Elastic Resistance Training Produces Benefits Similar to Conventional Resistance Training in People With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis. Phys Ther 2020; 100:1891-1905. [PMID: 32750124 DOI: 10.1093/ptj/pzaa149] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness of elastic resistance training on improving muscle strength, functional exercise capacity, health-related quality of life (HRQoL), and dyspnea in people with stable chronic obstructive pulmonary disease (COPD). METHODS For this systematic review, PubMed, The Cochrane Library, Embase (OVID), PEDro, SciELO, and CINAHL were searched from inception to November 2019. Included studies were randomized clinical trials in which people with stable COPD were allocated to (1) an experimental group that received lower-limb resistance training, upper-limb resistance training, or both using elastic resistance; or (2) a control group that received no or sham resistance training or conventional resistance training using weight machines. Data extraction was performed by 3 review authors. The methodological quality of the studies was assessed using the PEDro scale. Eight studies on 332 participants were included. RESULTS Knee extensor strength was higher in the experimental group (standardized mean difference = 0.52, 95% CI = 0.09-0.95) compared with the non-exercise control group. Compared with the conventional exercise control, the experimental group presented similar effects for muscle strength, functional exercise capacity, HRQoL, and dyspnea (95% CI overlapped the line of no effect for all). CONCLUSIONS Elastic resistance training improves muscle strength in people with COPD. The current review suggests elastic resistance as a potential alternative to conventional resistance training using weight machines, as they show similar effects on muscle strength, functional exercise capacity, HRQoL, and dyspnea. IMPACT Due to its beneficial effects, including reduced risk of exacerbation-related hospitalizations, exercise training is viewed as the cornerstone of pulmonary rehabilitation in people with COPD. This study shows that elastic resistance training can be an effective, portable, practical, and low-cost alternative to conventional weight resistance training. LAY SUMMARY Training with elastic resistance tubes or bands-which are easy to carry, easy to use, and relatively low cost-can be an effective way to improve strength for people with COPD and promote similar benefits to those achieved with weight machines.
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Affiliation(s)
- Fabiano F de Lima
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University; and Allied Health, South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Bruna S A Silva
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP)
| | - Isis Grigoletto
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP)
| | - Juliana S Uzeloto
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP)
| | - Dionei Ramos
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP)
| | - Carlos A Camillo
- Department of Physiotherapy, Postgraduate Program in Rehabilitation Sciences, State University of Londrina (UEL); and Department of Rehabilitation Sciences, University Pitágoras UNOPAR, Londrina, Brazil
| | - Ercy M C Ramos
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), Rua Paulo Marques 757, Presidente Prudente, São Paulo 19020410, Brazil
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26
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Li N, Li P, Lu Y, Wang Z, Li J, Liu X, Wu W. Effects of resistance training on exercise capacity in elderly patients with chronic obstructive pulmonary disease: a meta-analysis and systematic review. Aging Clin Exp Res 2020; 32:1911-1922. [PMID: 31494915 DOI: 10.1007/s40520-019-01339-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/27/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to summarize and determine the effectiveness of resistance training on exercise capacity in patients with chronic obstructive pulmonary disease (COPD). METHODS We searched PubMed, EMBASE, Cochrane Library, and two Chinese databases (China National Knowledge Infrastructure and Wanfang Data) to identify articles written in English or Chinese and published from January 2000 to January 2019. Randomized controlled trials were included if they evaluated the effects of resistance training on exercise capacity in COPD patients. We assessed the quality of the trials using the Physiotherapy Evidence Database Scale. Data from these studies were pooled to calculate weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS Eleven studies with a total of 405 participants met the inclusion criteria. Compared with the non-exercise control group, resistance training significantly improved 6-min walking distance (WMD, 54.52; 95% CI 25.47-83.56; I2 = 43%; P = 0.14), transfer numbers for the 6-min pegboard and ring test (WMD, 25.17; 95% CI 10.17-40.16; I2 = 0%; P = 0.55), and tolerance time for the unsupported upper-limb exercise test (SMD, 0.41; 95% CI 0.03-0.79; I2 = 0%; P = 0.83). There were no significant differences in constant work rate endurance test results or in peak oxygen uptake between the two groups. CONCLUSIONS Resistance training was an effective approach to improve functional exercise capacity, endurance exercise capacity, and peak exercise capacity in COPD patients.
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Affiliation(s)
- Ning Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Yufan Lu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Zhengrong Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Jian Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China.
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27
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Meys R, Stoffels AAF, de Brandt J, van Hees HWH, Franssen FME, Sillen MJH, Wouters EFM, Burtin C, Klijn P, Bij de Vaate E, van den Borst B, Otker JM, Donkers J, Schleich FN, Hayot M, Pomiès P, Everaert I, Derave W, Spruit MA. Beta-alanine supplementation in patients with COPD receiving non-linear periodised exercise training or neuromuscular electrical stimulation: protocol of two randomised, double-blind, placebo-controlled trials. BMJ Open 2020; 10:e038836. [PMID: 32928863 PMCID: PMC7488791 DOI: 10.1136/bmjopen-2020-038836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Exercise intolerance is common in patients with chronic obstructive pulmonary disease (COPD) and, although multifactorial, it is largely caused by lower-limb muscle dysfunction. Research has shown that patients with severe to very severe COPD have significantly lower levels of muscle carnosine, which acts as a pH buffer and antioxidant. Beta-alanine (BA) supplementation has been shown to consistently elevate muscle carnosine in a variety of populations and may therefore improve exercise tolerance and lower-limb muscle function. The primary objective of the current studies is to assess the beneficial effects of BA supplementation in enhancing exercise tolerance on top of two types of exercise training (non-linear periodised exercise (NLPE) training or neuromuscular electrical stimulation (NMES)) in patients with COPD. METHODS AND ANALYSIS Two randomised, double-blind, placebo-controlled trials have been designed. Patients will routinely receive either NLPE (BASE-TRAIN trial) or NMES (BASE-ELECTRIC trial) as part of standard exercise-based care during their 8-to-10 week pulmonary rehabilitation (PR) programme. A total of 222 patients with COPD (2×77 = 154 patients in the BASE-TRAIN trial and 2×34 = 68 patients in the BASE-ELECTRIC trial) will be recruited from two specialised PR centres in The Netherlands. For study purposes, patients will receive 3.2 g of oral BA supplementation or placebo per day. Exercise tolerance is the primary outcome, which will be assessed using the endurance shuttle walk test (BASE-TRAIN) or the constant work rate cycle test (BASE-ELECTRIC). Furthermore, quadriceps muscle strength and endurance, cognitive function, carnosine levels (in muscle), BA levels (in blood and muscle), markers of oxidative stress and inflammation (in blood, muscles and lungs), physical activity and quality of life will be measured. ETHICS AND DISSEMINATION Both trials were approved by CMO Regio Arnhem-Nijmegen, The Netherlands (NL70781.091.19. and NL68757.091.19). TRIAL REGISTRATION NUMBER NTR8427 (BASE-TRAIN) and NTR8419 (BASE-ELECTRIC).
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Affiliation(s)
- Roy Meys
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Anouk A F Stoffels
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, The Netherlands
| | - Jana de Brandt
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, DIepenbeek, Belgium
| | | | - Frits M E Franssen
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | - Emiel F M Wouters
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Chris Burtin
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, DIepenbeek, Belgium
| | - Peter Klijn
- Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, The Netherlands
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Eline Bij de Vaate
- Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, The Netherlands
| | - Jacqueline M Otker
- Patient Advisory Council, Lung Foundation Netherlands, Amersfoort, The Netherlands
- Client Council, CIRO, Horn, The Netherlands
| | | | - Florence N Schleich
- Department of Respiratory Medicine, CHU Sart-Tilman Liege, GIGA I3, Liege, Belgium
| | - Maurice Hayot
- PhyMedExp, INSERM - CNRS, University of Montpellier - Montpellier CHU, Montpellier, France
| | - Pascal Pomiès
- PhyMedExp, INSERM - CNRS, University of Montpellier - Montpellier CHU, Montpellier, France
| | - Inge Everaert
- Department of Movement and Sport Sciences, University Ghent, Ghent, Belgium
| | - Wim Derave
- Department of Movement and Sport Sciences, University Ghent, Ghent, Belgium
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, DIepenbeek, Belgium
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28
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Karagiannis C, Savva C, Korakakis V, Matheou I, Adamide T, Georgiou A, Xanthos T. Test-Retest Reliability of Handgrip Strength in Patients with Chronic Obstructive Pulmonary Disease. COPD 2020; 17:568-574. [PMID: 32814452 DOI: 10.1080/15412555.2020.1808604] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to investigate the intra-rater reliability and agreement of handgrip strength (HGS) measurement using a hydraulic hand dynamometer in patients with chronic obstructive pulmonary disease (COPD). A sample of 19 COPD patients (18 males and 1 female; mean ± SD age, 66.9 ± 6.3 years) was evaluated using a hand dynamometer by the same rater in two different testing sessions with a 7-d interval. During each session, patients were asked to exert three maximal isometric contractions on the dominant hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and Bland-Altman methods were used to estimate the degree of test-retest reliability and the measurement error, respectively. HGS in COPD patients revealed an ICC2,1 score of 0.99, suggesting excellent test-retest reliability. The calculated SEM was relatively small (0.59 Kgf), and the MDC presented a clinically acceptable value of 1.64 Kgf. These findings, in conjunction with the narrow width of the 95% limits of agreements (95% limits of agreement, -2.5-2.1 Kgf) in the Bland-Altman plot, reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. The results of this study demonstrated an excellent test-retest reliability of HGS measurement, indicating that this method is reliable for repeated monitoring of peripheral muscle strength in patients with COPD.
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Affiliation(s)
- Christos Karagiannis
- Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | - Christos Savva
- Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | | | - Ioanna Matheou
- Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | - Tonia Adamide
- Respiratory Clinic, Nicosia General Hospital, Nicosia, Cyprus
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29
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Iepsen UW, Pedersen BK. Development of Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease: Smoking, Inflammation, or Simply Disuse? Am J Respir Cell Mol Biol 2020; 62:134-135. [PMID: 31532223 PMCID: PMC6993543 DOI: 10.1165/rcmb.2019-0319ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ulrik W Iepsen
- Centre of Inflammation and Metabolismand.,Centre for Physical Activity ResearchUniversity of CopenhagenRigshospitalet, Denmark
| | - Bente K Pedersen
- Centre of Inflammation and Metabolismand.,Centre for Physical Activity ResearchUniversity of CopenhagenRigshospitalet, Denmark
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30
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Li J, Lu Y, Li N, Li P, Su J, Wang Z, Wang T, Yang Z, Yang Y, Chen H, Xiao L, Duan H, Wu W, Liu X. Muscle metabolomics analysis reveals potential biomarkers of exercise‑dependent improvement of the diaphragm function in chronic obstructive pulmonary disease. Int J Mol Med 2020; 45:1644-1660. [PMID: 32186768 PMCID: PMC7169662 DOI: 10.3892/ijmm.2020.4537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/17/2020] [Indexed: 12/25/2022] Open
Abstract
Decreased diaphragm function is a crucial factor leading to reduced ventilatory efficiency and worsening of quality of life in chronic obstructive pulmonary disease (COPD). Exercise training has been demonstrated to effectively improve the function of the diaphragm. However, the mechanism of this process has not been identified. The emergence of metabolomics has allowed the exploration of new ideas. The present study aimed to analyze the potential biomarkers of exercise-dependent enhancement of diaphragm function in COPD using metabolomics. Sprague Dawley rats were divided into three groups: COPD + exercise group (CEG); COPD model group (CMG); and control group (CG). The first two groups were exposed to cigarette smoke for 16 weeks to establish a COPD model. Then, the rats in the CEG underwent aerobic exercise training for 9 weeks. Following confirmation that exercise effectively improved the diaphragm function, a gas chromatography tandem time-of-flight mass spectrometry analysis system was used to detect the differential metabolites and associated pathways in the diaphragm muscles of the different groups. Following exercise intervention, the pulmonary function and diaphragm contractility of the CEG rats were significantly improved compared with those of the CMG rats. A total of 36 different metabolites were identified in the comparison between the CMG and the CG. Pathway enrichment analysis indicated that these different metabolites were involved in 17 pathways. A total of 29 different metabolites were identified in the comparison between the CMG and the CEG, which are involved in 14 pathways. Candidate biomarkers were selected, and the pathways analysis of these metabolites demonstrated that 2 types of metabolic pathways, the nicotinic acid and nicotinamide metabolism and arginine and proline metabolism pathways, were associated with exercise-induced pulmonary rehabilitation.
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Affiliation(s)
- Jian Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Yufan Lu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Ning Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Jianqing Su
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Zhengrong Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Ting Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Zhaoyu Yang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Yahui Yang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Haixia Chen
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Lu Xiao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
| | - Hongxia Duan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
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Wouters EF, Posthuma R, Koopman M, Liu WY, Sillen MJ, Hajian B, Sastry M, Spruit MA, Franssen FM. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2020; 14:149-161. [PMID: 31931636 DOI: 10.1080/17476348.2020.1700796] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Pulmonary rehabilitation (PR) is one of the core components in the management of patients with chronic obstructive pulmonary disease (COPD). In order to achieve the maximal level of independence, autonomy, and functioning of the patient, targeted therapies and interventions based on the identification of physical, emotional and social traits need to be provided by a dedicated, interdisciplinary PR team.Areas covered: The review discusses cardiopulmonary exercise testing in the selection of different modes of training modalities. Neuromuscular electrical stimulation as well as gait assessment and training are discussed as well as add-on therapies as oxygen, noninvasive ventilator support or endoscopic lung volume reduction in selected patients. The potentials of pulsed inhaled nitric oxide in patients with underlying pulmonary hypertension is explored as well as nutritional support. The impact of sleep quality on outcomes of PR is reviewed.Expert opinion: Individualized, comprehensive intervention based on thorough assessment of physical, emotional, and social traits in COPD patients forms a continuous challenge for health-care professionals and PR organizations in order to dynamically implement and adapt these strategies based on dynamic, more optimal understanding of underlying pathophysiological mechanisms.
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Affiliation(s)
- Emiel Fm Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands
| | - Maud Koopman
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Wai-Yan Liu
- CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Maurice J Sillen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Bita Hajian
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Manu Sastry
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Frits M Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
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32
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Xavier VB, Avanzi O, de Carvalho BDMC, Alves VLDS. Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: a randomised trial. J Physiother 2020; 66:33-38. [PMID: 31859153 DOI: 10.1016/j.jphys.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/25/2019] [Indexed: 11/17/2022] Open
Abstract
QUESTION In adolescents with idiopathic scoliosis, does combined aerobic and resistance training improve respiratory function, perceived exertion and functional exercise capacity more than aerobic training only? DESIGN Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS Forty adolescents with idiopathic scoliosis and formal indication for surgical correction (spinal curvature ≥ 45 deg). INTERVENTION Both groups undertook three 60-minute training sessions per week for 12 weeks. The experimental group performed combined aerobic and resistance training and the control group performed only aerobic training. OUTCOME MEASURES At baseline and upon completion of treatment, participants completed: a 6-minute walk test with Borg scale (0 to 10) rating of exertion, spirometry, maximal respiratory pressures and peak expiratory flow measurement. RESULTS After 12 weeks of training, the experimental group improved more than the control group on the 6-minute walk test (MD 22 m, 95% CI 4 to 40), with lower perceived exertion at the end of the test (MD -1.2, 95% CI -1.9 to -0.4). The experimental group also improved more than the control group on several respiratory measures, including: FEV1 (MD 270 ml, 95% CI 30 to 510), maximal inspiratory pressure (MD 4 cmH2O, 95% CI 1 to 8) and peak expiratory flow (MD 33 l/minute, 95% CI 7 to 58). CONCLUSION In adolescents with idiopathic scoliosis, combined aerobic and resistance training improves functional exercise capacity and several respiratory outcomes more than a similar training regimen with aerobic training only. It is unclear whether the magnitude of the benefits is large enough to be worthwhile. TRIAL REGISTRATION NCT02413788.
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Affiliation(s)
| | - Osmar Avanzi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Vera Lúcia Dos Santos Alves
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil; Universidade de Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil.
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33
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Nolan CM, Rochester CL. Exercise Training Modalities for People with Chronic Obstructive Pulmonary Disease. COPD 2019; 16:378-389. [PMID: 31684769 DOI: 10.1080/15412555.2019.1637834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Exercise training confers health benefits for people with chronic obstructive pulmonary disease (COPD). This article reviews the evidence for several exercise training modalities shown to be beneficial among individuals with COPD. These modalities include aerobic, resistance, nonlinear periodized, upper limb and balance training, as well as yoga, Tai Chi, inspiratory muscle training, whole body vibration training and neuromuscular electrical stimulation. The literature pertaining to each modality was critically reviewed, and information on the rationale, mechanism(s) of action (where known), benefits, and exercise prescription is described to facilitate easy implementation into clinical practice.
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Affiliation(s)
- Claire M Nolan
- Harefield Respiratory Research Unit, Royal Brompton and Harefield NHS Foundation Trust, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
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Ko FWS, Chan KP, Hui DSC. Comprehensive care for chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:S2181-S2191. [PMID: 31737345 PMCID: PMC6831924 DOI: 10.21037/jtd.2019.09.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common chronic disease worldwide and incurs heavy utilization of healthcare resources. Many COPD patients have comorbidities and experience exacerbations in the course of the disease. Correct diagnosis and appropriate disease assessment are essential for clinical management. Comprehensive care for patients with different severity of disease aims to offer personalized treatment to suit individual needs. Patients with recent exacerbations also need extra care for the post-acute and rehabilitation phases. Comprehensive care consists of self-management and pulmonary rehabilitation and involves multiple healthcare providers working together closely to provide formal structured programmes for patients. The setting, professionals involved, content and the duration of programme vary a lot among different comprehensive care models. Some randomized controlled trials suggested there was improvement in quality of life, exercise capacity and reduced hospital admissions for participants in comprehensive care programmes compared with controls. However, other studies showed that such programmes might not confer benefits and might even bring harm. The reason for the differences in clinical effect of programmes might be due to differences in study design, components and subjects involved in the studies. Careful evaluation of each programme is thus mandatory. Further research is needed to evaluate the safety and effectiveness of comprehensive care management for COPD patients, both at the stable and post-acute exacerbation state.
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Affiliation(s)
- Fanny Wai San Ko
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Pang Chan
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - David Shu Cheong Hui
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Machado A, Quadflieg K, Oliveira A, Keytsman C, Marques A, Hansen D, Burtin C. Exercise Training in Patients with Chronic Respiratory Diseases: Are Cardiovascular Comorbidities and Outcomes Taken into Account?-A Systematic Review. J Clin Med 2019; 8:E1458. [PMID: 31540240 PMCID: PMC6780679 DOI: 10.3390/jcm8091458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.
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Affiliation(s)
- Ana Machado
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
| | - Kirsten Quadflieg
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Charly Keytsman
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810 Aveiro, Portugal
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
- Jessa hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | - Chris Burtin
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium.
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Jaitovich A, Barreiro E. Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients. Am J Respir Crit Care Med 2019; 198:175-186. [PMID: 29554438 DOI: 10.1164/rccm.201710-2140ci] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Skeletal muscle dysfunction occurs in patients with chronic obstructive pulmonary disease (COPD) and affects both ventilatory and nonventilatory muscle groups. It represents a very important comorbidity that is associated with poor quality of life and reduced survival. It results from a complex combination of functional, metabolic, and anatomical alterations leading to suboptimal muscle work. Muscle atrophy, altered fiber type and metabolism, and chest wall remodeling, in the case of the respiratory muscles, are relevant etiological contributors to this process. Muscle dysfunction worsens during COPD exacerbations, rendering patients progressively less able to perform activities of daily living, and it is also associated with poor outcomes. Muscle recovery measures consisting of a combination of pulmonary rehabilitation, optimized nutrition, and other strategies are associated with better prognosis when administered in stable patients as well as after exacerbations. A deeper understanding of this process' pathophysiology and clinical relevance will facilitate the use of measures to alleviate its effects and potentially improve patients' outcomes. In this review, a general overview of skeletal muscle dysfunction in COPD is offered to highlight its relevance and magnitude to expert practitioners and scientists as well as to the average clinician dealing with patients with chronic respiratory diseases.
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Affiliation(s)
- Ariel Jaitovich
- 1 Division of Pulmonary and Critical Care Medicine and.,2 Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | - Esther Barreiro
- 3 Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain; and.,4 Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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37
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Spruit MA, Wouters EF. Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases. Respirology 2019; 24:838-843. [PMID: 30810256 PMCID: PMC6849848 DOI: 10.1111/resp.13512] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/20/2022]
Abstract
Adult patients with chronic respiratory diseases may suffer from multiple physical (pulmonary and extra-pulmonary), emotional and social features which necessitate a comprehensive, interdisciplinary rehabilitation programme. To date, pulmonary rehabilitation programmes show a lot of variation in setting, content, frequency and duration. Future projects should strive for a standard set of assessment measures to identify patients eligible for pulmonary rehabilitation, taking disease complexity into consideration, which should result in referral to an appropriate rehabilitation setting. Local circumstances may complicate this crucial endeavour.
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Affiliation(s)
- Martijn A. Spruit
- Department of Research and EducationCIRO, Centre of Expertise for Chronic Organ FailureHornThe Netherlands
- Department of Respiratory MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastrichtThe Netherlands
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation SciencesHasselt UniversityDiepenbeekBelgium
| | - Emiel F.M. Wouters
- Department of Research and EducationCIRO, Centre of Expertise for Chronic Organ FailureHornThe Netherlands
- Department of Respiratory MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
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38
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The Relevance of Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. Clin Chest Med 2019; 40:367-383. [DOI: 10.1016/j.ccm.2019.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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39
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Tsang EW, Kwok H, Chan AKY, Choo KL, Chan KS, Lau KS, Chan CCH. Outcomes of community-based and home-based pulmonary rehabilitation for pneumoconiosis patients: a retrospective study. BMC Pulm Med 2018; 18:133. [PMID: 30092783 PMCID: PMC6085700 DOI: 10.1186/s12890-018-0692-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/17/2018] [Indexed: 11/20/2022] Open
Abstract
Background Pneumoconiosis patients receive community-based or home-based pulmonary rehabilitation (PR) for symptom management and enhancement of physical and mental well-being. This study aimed to review the clinical benefits of community-based rehabilitation programmes (CBRP) and home-based rehabilitation programmes (HBRP) for PR of pneumoconiosis patients. Methods Archival data of pneumoconiosis patients who participated in CBRP and HBRP between 2008 and 2011 was analysed. There were 155 and 26 patients in the CBRP and HBRP respectively. The outcome measures used in the pre- and post-tests were Knowledge, Health Survey Short Form-12 (SF-12), Hospital Anxiety and Depression Scale (HADS), 6-Min Walk Test (6MWT), and Chronic Respiratory Questionnaire (CRQ). Paired t-tests and the Analysis of Covariance (ANCOVA) using the patients’ baseline lung functions as the covariates were performed to examine the changes in the outcomes after completing the programmes. Hierarchical multiple regression analyses were used to examine the relationships between patient’s programme participation factors and different scores of the outcome measures. Results After controlling for patients’ baseline lung capacities, significant improvements were revealed among patients participated in CBRP in the scores of the 6MWT, Knowledge, HADS, SF-12 PCS, and CRQ emotion and mastery. The different scores in the Knowledge and HADS were correlated with the patients’ levels of programme participation. In contrast, significant improvements were only found in the scores of the Knowledge and 6MWT among patients who participated in HBRP. The gain scores of the 6MWT were correlated with the patients’ levels of programme participation. Conclusions Both CBRP and HBRP benefited patients’ levels of exercise tolerance and knowledge about the disease. CBRP provided greater benefits to patients’ mental and psychosocial needs. In contrast, HBRP was found to improve patients’ physical function, but did not have significant impacts on patients’ mental health and health-related quality of life. The attendance of patients and the participation of their relatives in treatment sessions were important factors in enhancing the positive effects of CBRP and HBRP. These positive outcomes confirm the value of pulmonary rehabilitation programmes for community-dwelling pneumoconiosis patients. Electronic supplementary material The online version of this article (10.1186/s12890-018-0692-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eric W Tsang
- The Laboratory of Neuroscience for Education, Faculty of Education, The University of Hong Kong, Hong Kong, China.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Henry Kwok
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Aidan K Y Chan
- Department of Life Science, Imperial College of London, London, UK
| | - Kah Lin Choo
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Kin Sang Chan
- Department of Medicine, Haven of Hope Hospital, Hong Kong, China
| | - Kam Shing Lau
- Department of Medicine, Ruttonjee Hospital, Hong Kong, China
| | - Chetwyn C H Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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40
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Chronic Obstructive Pulmonary Disease Education in Pulmonary Rehabilitation. An Official American Thoracic Society/Thoracic Society of Australia and New Zealand/Canadian Thoracic Society/British Thoracic Society Workshop Report. Ann Am Thorac Soc 2018; 15:769-784. [DOI: 10.1513/annalsats.201804-253ws] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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41
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Ryrsø CK, Thaning P, Siebenmann C, Lundby C, Lange P, Pedersen BK, Hellsten Y, Iepsen UW. Effect of endurance versus resistance training on local muscle and systemic inflammation and oxidative stress in COPD. Scand J Med Sci Sports 2018; 28:2339-2348. [DOI: 10.1111/sms.13227] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 12/25/2022]
Affiliation(s)
- C. K. Ryrsø
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - P. Thaning
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Department of Respiratory Medicine; University Hospital Hvidovre; Copenhagen Denmark
| | - C. Siebenmann
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - C. Lundby
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - P. Lange
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Department of Public Health, Section of Social Medicine; University of Copenhagen; Copenhagen Denmark
- Medical Department O, Respiratory Section; Herlev and Gentofte Hospital; Herlev Denmark
| | - B. K. Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Y. Hellsten
- Department of Nutrition, Exercise, and Sports; University of Copenhagen; Copenhagen Denmark
| | - U. W. Iepsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
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Cardiorespiratory Responses to Short Bouts of Resistance Training Exercises in Individuals With Chronic Obstructive Pulmonary Disease: A COMPARISON OF EXERCISE INTENSITIES. J Cardiopulm Rehabil Prev 2018; 37:356-362. [PMID: 28858033 DOI: 10.1097/hcr.0000000000000282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Gea J, Sancho-Muñoz A, Chalela R. Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations. J Thorac Dis 2018; 10:S1332-S1354. [PMID: 29928517 PMCID: PMC5989104 DOI: 10.21037/jtd.2018.02.66] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/22/2018] [Indexed: 12/22/2022]
Abstract
Nutritional abnormalities are frequent in different chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), interstitial fibrosis and lung cancer, having important clinical consequences. However, nutritional abnormalities often remained underdiagnosed due to the relative lack of awareness of health professionals. Therefore, systematic anthropometry or even better, assessment of body composition, should be performed in all patients with chronic respiratory conditions, especially following exacerbation periods when malnutrition becomes more accentuated. Nutritional abnormalities very often include the loss of muscle mass, which is an important factor for the occurrence of muscle dysfunction. The latter can be easily detected with the specific assessment of muscle strength and endurance, and also negatively influences patients' quality of life and prognosis. Both nutritional abnormalities and muscle dysfunction result from the interaction of several factors, including tobacco smoking, low physical activity-sedentarism, systemic inflammation and the imbalance between energy supply and requirements, which essentially lead to a negative balance between protein breakdown and synthesis. Therapeutic approaches include improvements in lifestyle, nutritional supplementation and training. Anabolic drugs may be administered in some cases.
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Affiliation(s)
- Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
| | - Antoni Sancho-Muñoz
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
| | - Roberto Chalela
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
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Lakhdar R, Rabinovich RA. Can muscle protein metabolism be specifically targeted by nutritional support and exercise training in chronic obstructive pulmonary disease? J Thorac Dis 2018; 10:S1377-S1389. [PMID: 29928520 PMCID: PMC5989103 DOI: 10.21037/jtd.2018.05.81] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) associates with several extra-pulmonary effects. Muscle dysfunction and wasting is one of the most prominent extra-pulmonary effects and contributes to exercise limitation and health related quality of life (HRQoL), morbidity as well as mortality. The loss of muscle mass is characterised by an impaired balance between protein synthesis (anabolism) and protein breakdown (catabolism) which relates to nutritional disturbances, muscle disuse and the presence of a systemic inflammation, among other factors. Current approaches to reverse skeletal muscle dysfunction and wasting attain only modest improvements. The development of new therapeutic strategies aiming at improving skeletal muscle dysfunction and wasting are needed. This requires a better understanding of the underlying molecular pathways responsible for these abnormalities. In this review we update recent research on protein metabolism, nutritional depletion as well as physical (in)activity in relation to muscle wasting and dysfunction in patients with COPD. We also discuss the role of nutritional supplementation and exercise training as strategies to re-establish the disrupted balance of protein metabolism in the muscle of patients with COPD. Future areas of research and clinical practice directions are also addressed.
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Affiliation(s)
- Ramzi Lakhdar
- ELEGI Colt Laboratory, MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Scotland, UK
| | - Roberto A. Rabinovich
- ELEGI Colt Laboratory, MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Scotland, UK
- Respiratory Medicine Department, Royal Infirmary of Edinburgh, Scotland, UK
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Berry MJ, Sheilds KL, Adair NE. Comparison of Effects of Endurance and Strength Training Programs in Patients with COPD. COPD 2018; 15:192-199. [PMID: 29658804 DOI: 10.1080/15412555.2018.1446926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Comparisons between endurance and strength training in chronic obstructive pulmonary disease (COPD) patients have produced equivocal findings when examining physical function and health-related quality of life (HRQL). One reason for these differences may be due to individual patient responses to the different training modalities. PURPOSE To compare changes in physical function and HRQL in a group of COPD patients completing both an endurance and a strength training program. METHODS Eleven mildly diseased patients completed a three month endurance training program and, approximately 5 years later, completed a three month strength training program. Changes in 6 minute walk distance (6 MW), time to rise from a chair five times (CRT), and the total score and subscores from the SF-36 and Chronic Respiratory Disease Questionnaire (CRQ) were examined. RESULTS The forced expiratory volume as a percent of predicted remained relatively constant over the 5 years (61.1 ± 5.9 vs. 60.0 ± 10.3). Endurance and strength training increased 6 MW by 48.2 ± 11.2 (p = 0.008) and 39.8 ± 9.8 (p = 0.001) meters, respectively. Endurance and strength training decreased CRT by 4.8 ± 0.7 (p = 0.001) and 1.3 ± 1.2 (p = 0.056) seconds, respectively. Endurance training resulted in greater improvements in HRQL as compared to strength training. CONCLUSION These results show that walk distance improves as a result of participating in either an endurance or a strength training program. However, an endurance training program leads to greater improvements in both general and disease specific measures of HRQL.
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Affiliation(s)
- Michael J Berry
- a Health and Exercise Science Department , Wake Forest University , Winston-Salem , North Carolina , USA
| | - Katherine L Sheilds
- a Health and Exercise Science Department , Wake Forest University , Winston-Salem , North Carolina , USA
| | - Norman E Adair
- b Department of Medicine , Wake Forest University , Winston-Salem , North Carolina , USA
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Short- and Long-term Effects of Pulmonary Rehabilitation in Patients With Mild COPD: A COMPARISON WITH PATIENTS WITH MODERATE TO SEVERE COPD. J Cardiopulm Rehabil Prev 2017; 36:445-453. [PMID: 27779550 DOI: 10.1097/hcr.0000000000000219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) is effective in patients with moderate to severe chronic obstructive pulmonary disease (COPD). However, the effects of PR in patients with mild COPD have not yet been established. Thus, this study investigated the short- and long-term effects of PR in patients with mild COPD in comparison with patients with moderate to severe disease. METHODS A total of 32 patients with mild (group 1) and 29 with moderate to severe (group 2) COPD completed the study. Both groups participated in a 12-week PR program with exercise training and psychosocial support and education. Outcome measures at baseline, 3 (post-PR), 6, and 9 months later included 6-minute walk test (6MWT); Modified Medical Research Council Dyspnea Scale; 1-repetition maximum chest press and knee extension; a brief physical activity assessment; the number of exacerbations in the past 3 months and the St. George Respiratory Questionnaire (SGRQ). RESULTS Improvements in the 6MWT, chest press, knee extension, and physical activity were observed post-PR (P < .001), with no differences between the 2 groups. Reduction in the number of exacerbations (P < .001) and improvements in the SGRQ total (P < .001) were also observed, however, with greater magnitude in group 2 (P = .029 and P < .001, respectively). Except for peripheral muscle strength (P < .002), all the achieved benefits were sustained at 6 and 9 months (P > .05). CONCLUSIONS Pulmonary rehabilitation improves exercise tolerance, muscle strength, physical activity, and health-related quality of life and reduces exacerbations in patients with mild COPD as it does in patients with moderate to severe COPD. Moreover, most of these benefits were maintained at 9-month follow-up, suggesting that PR could be part of the management of mild COPD.
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Machado FVC, Bisca GW, Morita AA, Rodrigues A, Probst VS, Furlanetto KC, Pitta F, Hernandes NA. Agreement of different reference equations to classify patients with COPD as having reduced or preserved 6MWD. Pulmonology 2017; 24:S2173-5115(17)30151-3. [PMID: 29191775 DOI: 10.1016/j.rppnen.2017.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/22/2017] [Accepted: 08/31/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Interpretation of the six-minute walk distance (6MWD) is enhanced by using recommended reference equations. Whenever possible, the choice of equation should be region-specific. A potential problem is that different equations for the 6MWD may have been developed for the same population, and it may be complicated to choose the most suitable. OBJECTIVE To verify the agreement of different reference equations in classifying patients with Chronic Obstructive Pulmonary Disease (COPD) as having reduced or preserved 6MWD. METHODS 159 patients with COPD performed the six-minute walk test according to international standardization. They were classified as having reduced 6MWD if it was below the lower limit of normal. Five Brazilian equations (Iwama; Britto1; Britto2; Dourado; Soares) and the two non-Brazilian equations most cited worldwide (Troosters; Enright) were used. The agreement for patients classified as reduced or preserved 6MWD was verified by Cohen's Kappa (pair-to-pair) analysis. The proportion of patients classified as having reduced walked distance was compared by the Chi-squared test. RESULTS Agreement between equations varied largely in classifying subjects as having reduced or preserved 6MWD (Kappa: 0.10-0.82). Brazilian equations with the highest agreement were Iwama, Britto1 and Britto2 (Kappa>0.75). The proportion of patients classified as having reduced 6MWD was statistically similar only between equations in which the agreement was higher than 0.70. CONCLUSION Even reference equations from the same country vary considerably in the classification of reduced or preserved 6MWD, and it is recommended that the region-specific ones be used as they give with higher agreement for similar and comparable interpretation of the patients' functional exercise capacity.
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Affiliation(s)
- F V C Machado
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - G W Bisca
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil; Centro Universitário Filadélfia (UniFil), Av. Juscelino Kubitscheck, 1626, 86020-000 Londrina, Paraná, Brazil
| | - A A Morita
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - A Rodrigues
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - V S Probst
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - K C Furlanetto
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil; Research Centre in Health Sciences (CPCS), University of Northern Paraná (UNOPAR), Londrina, Paraná, Brazil
| | - F Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - N A Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil.
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Lalmolda C, Coll-Fernández R, Martínez N, Baré M, Teixidó Colet M, Epelde F, Monsó E. Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns. Int J Chron Obstruct Pulmon Dis 2017; 12:2531-2538. [PMID: 28883720 PMCID: PMC5574698 DOI: 10.2147/copd.s138451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. Aims The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. Materials and methods COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. Results Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0–1] vs 1 [0–2.5]; P=0.022) and in days of admission (0 [0–7] vs 7 [0–12]; P=0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient −0.785, P=0.014, and R2=0.219). Conclusion A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.
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Affiliation(s)
- C Lalmolda
- Respiratory Diseases Department, Hospital Universitari Parc Tauli.,Ciber de Enfermedades Respiratorias - Ciberes.,Universitat Autònoma de Barcelona - UAB
| | | | - N Martínez
- Respiratory Diseases Department, Hospital Universitari Parc Tauli
| | - M Baré
- Primary Care Unit Vallés Occidental, Institut Català de la Salut
| | - M Teixidó Colet
- Primary Care Unit Vallés Occidental, Institut Català de la Salut
| | - F Epelde
- Short Stay Unit, Emergency Service, Hospital Universitari Parc Taulí, Barcelona, Spain
| | - E Monsó
- Respiratory Diseases Department, Hospital Universitari Parc Tauli.,Ciber de Enfermedades Respiratorias - Ciberes.,Universitat Autònoma de Barcelona - UAB
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De Brandt J, Spruit MA, Hansen D, Franssen FM, Derave W, Sillen MJ, Burtin C. 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. Chron Respir Dis 2017; 15:182-219. [PMID: 28580854 PMCID: PMC5958462 DOI: 10.1177/1479972317709642] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Jana De Brandt
- 1 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Martijn A Spruit
- 1 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,2 Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands.,3 Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Dominique Hansen
- 1 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frits Me Franssen
- 2 Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Wim Derave
- 4 Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Maurice Jh Sillen
- 2 Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Chris Burtin
- 1 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Loprinzi PD, Sng E, Walker JF. Muscle strengthening activity associates with reduced all-cause mortality in COPD. Chronic Illn 2017; 13:140-147. [PMID: 27358285 DOI: 10.1177/1742395316657399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Emerging research suggests that aerobic-based physical activity may help to promote survival among chronic obstructive pulmonary disease patients. However, the extent to which engagement in resistance training on survival among chronic obstructive pulmonary disease patients is relatively unknown. Therefore, the purpose of this study was to examine the independent associations of muscle strengthening activities on all-cause mortality among a national sample of U.S. adults with chronic obstructive pulmonary disease. We hypothesize that muscle strengthening activities will be inversely associated with all-cause mortality. Methods Data from the 2003-2006 NHANES were employed, with follow-up through 2011. Aerobic-based physical activity was objectively measured via accelerometry, muscle strengthening activities engagement was assessed via self-report, and chronic obstructive pulmonary disease was assessed via physician-diagnosis. Results Analysis included 385 adults (20 + yrs) with chronic obstructive pulmonary disease, who represent 13.3 million chronic obstructive pulmonary disease patients in the USA. The median follow-up period was 78 months (IQR=64-90), with 82 chronic obstructive pulmonary disease patients dying during this period. For a two muscle strengthening activity sessions/week increase (consistent with national guidelines), chronic obstructive pulmonary disease patients had a 29% reduced risk of all-cause mortality (HR=0.71; 95% CI: 0.51-0.99; P = 0.04). Conclusion Participation in muscle strengthening activities, independent of aerobic-based physical activity and other potential confounders, is associated with greater survival among chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Paul D Loprinzi
- 1 Department of Health, Exercise Science and Recreation Management, Center for Health Behavior Research, The University of Mississippi, University, MS, USA
| | | | - Jerome F Walker
- 2 Department of Respiratory Therapy, Bellarmine University, Louisville, KY, USA
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