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Safety and Efficacy of Inpatient Pulmonary Rehabilitation for Patients Hospitalized with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-analyses. Ann Am Thorac Soc 2023; 20:307-319. [PMID: 36191273 DOI: 10.1513/annalsats.202206-545oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Rationale: Pulmonary rehabilitation (PR) during hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) occurs during a period of disease instability for the patient, and the safety and efficacy of PR, specifically during the hospitalization period, have not been established. Objective: The purpose of this review is to determine the safety and efficacy of PR during the hospitalization phase for individuals with AECOPD. Methods: Scientific databases were searched up to August 2022 for randomized controlled trials that compared in-hospital PR with usual care. PR programs commenced during the hospitalization and included a minimum of two sessions. Titles and abstracts followed by full-text screening and data extraction were conducted independently by two reviewers. The intervention effect estimates were calculated through meta-analysis using a random-effect model. Results: A total of 27 studies were included (n = 1,317). The meta-analysis showed that inpatient PR improved the 6-minute-walk distance by 105 m (P < 0.001). Inpatient PR improved the performance on the five-repetition sit-to-stand test by -7.02 seconds (P = 0.03). Quality of life (QOL), as measured by the 5-level EuroQoL Group-5 dimension version (EQ-ED-5L) and the St. George's Respiratory Questionnaire, was significantly improved by the intervention. Inpatient PR increased lower limb muscle strength by 33.35 N (P < 0.001). There was no change in the length of stay. Only one serious adverse event related to the intervention was reported. Conclusions: This review suggests that it is safe and effective to provide PR during hospitalization for individuals with AECOPD. In-hospital PR improves functional exercise capacity, QOL, and lower limb strength without prolonging the hospital length of stay.
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Moecke DP, Zhu K, Gill J, Brar S, Petlitsyna P, Kirkham A, Girt M, Chen J, Peters H, Denson-Camp H, Crosbie S, Camp PG. A systematic review of exercise studies for individuals hospitalized with an acute exacerbation of chronic obstructive pulmonary disease: Focus on the principles of exercise training. Chron Respir Dis 2023; 20:14799731231215363. [PMID: 37967847 PMCID: PMC10655651 DOI: 10.1177/14799731231215363] [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: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND For exercise interventions to be effectively reproduced or applied in a "real world" clinical setting, clinical trials must thoroughly document all components of the exercise prescription and ensure that participants adhere to each component. However, previous reviews have not critically examined the quality of exercise prescription of inpatient Pulmonary Rehabilitation (PR) programs. OBJECTIVE The objectives of this review were to evaluate the (a) application of the principles of exercise training, (b) reporting of the frequency, intensity, time and type (FITT) components of exercise prescription, and (c) reporting of patient's adherence to the FITT components in intervention studies for patients admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS Relevant scientific databases were searched for randomized controlled trials (RCTs) that compared in-hospital PR with usual care for people hospitalized with AECOPD. Title and abstract followed by full-text screening were conducted independently by two reviewers. Data were extracted and synthesized to evaluate the application of the principles of exercise training and the reporting/adherence of the FITT components. RESULTS Twenty-seven RCTs were included. Only two applied all principles of exercise training. Specificity was applied by 70%, progression by 48%, overload by 37%, initial values by 89% and diminishing returns and reversibility by 37% of trials. Ten trials adequately reported all FITT components. Frequency and type were the components most reported (85% and 81%, respectively), while intensity was less frequently reported (52%). Only three trials reported on the patient's adherence to all four components. CONCLUSIONS Studies have not adequately reported the exercise prescription in accordance with the principles of exercise training nor reported all the FITT components of the exercise prescription and patient's adherence to them. Therefore, interpretation of the current literature is limited and information for developing exercise prescriptions to individuals hospitalized with an AECOPD is lacking.
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Affiliation(s)
- Débora Petry Moecke
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kai Zhu
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jagdeep Gill
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shanjot Brar
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Mirha Girt
- University of Queensland, Brisbane, QLD, Australia
| | - Joel Chen
- University of Calgary, Calgary, AB, Canada
| | - Hannah Peters
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Pat G Camp
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Pan Y, Yang H, Quan L, Wang S, Xu Y, Chen Y. Effects of full-body exercise-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e064212. [PMID: 36564122 PMCID: PMC9791421 DOI: 10.1136/bmjopen-2022-064212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterised by progressive and irreversible fibrosis of the lung parenchyma, resulting in reduced lung function. Since conventional medicines can be associated with low effective rates and adverse events, pulmonary rehabilitation may be a promising non-pharmacological therapy for IPF. Thus, we aimed to evaluate the effects of full-body exercise-based pulmonary rehabilitation on patients with IPF by conducting a systematic review and meta-analysis of randomised controlled trials (RCTs). METHODS AND ANALYSIS This systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). From inception to 31 August 2022, electronic databases in English and Chinese were searched, including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials among the English databases. China National Knowledge Infrastructure, Chinese Biomedical Literature, VIP Chinese Science and Technology Periodical, and Wan Fang Data were among the Chinese databases. Two independent reviewers then screened the potential RCT studies, which were analysed according to the Cochrane Handbook criteria. The efficacy and safety of full-body exercise pulmonary rehabilitation for IPF were evaluated based on outcomes, including exercise capacity measured by 6 min walking distance and quality of life measured by St. George's Respiratory Questionnaire. Lung function was measured based on the forced vital capacity, total lung capacity, diffusing capacity of the lungs for carbon monoxide and dyspnoea assessed by the modified Medical Research Council scale. ETHICS AND DISSEMINATION Ethical approval was not required for this systematic review and meta-analysis. Results will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42021284293.
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Affiliation(s)
- Yi Pan
- Chengdu Second People's Hospital, Chengdu, China
| | - Han Yang
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Luo Quan
- Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Shurong Wang
- Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Youli Xu
- Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Yu Chen
- Chengdu Second People's Hospital, Chengdu, Sichuan, China
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KARADEDE Ö, KARADEDE H, ŞEREMET H, TARAKTAŞLI GO, ALTIPARMAKOĞLU YA, ÖZALP E, GÜNDOĞDU E, DALKILIÇ F, EROĞLU MN, KÜRKAN M, HARMAN M, ÇAKICI S, KARAALİ R. Determination of Daily Life Activity Levels of Hospitalized Individuals Due to COVID-19 Disease. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1085389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Amaç: Araştırma, COVID-19 hastalığı nedeniyle hastanede yatarak tedavi olan hastaların taburculuk sonrasındaki günlük yaşam aktivite düzeylerini belirlemek amacıyla yapılmıştır.Yöntem: Çalışma, COVID-19 hastalığı nedeniyle hastanede yatmış, taburculuğundan itibaren en az bir ay geçmiş 230 hasta üzerinde yapılmıştır. Veriler Temmuz 2021-Eylül 2021 tarihleri arasında telefon ile görüşme yöntemiyle toplanmıştır. Araştırmanın verileri Tanıtıcı Özellikler Formu ve Katz Günlük Yaşam Aktiviteleri Ölçeği kullanılarak toplanmıştır. Araştırma verileri, normal dağılmayan değişkenler için ortanca ve çeyrekler arası aralık kullanılarak verilmiştir. Verilerilerin karşılaştırılmasında Wilcoxon Sıralı İşaretler testi ile kullanılmıştır.Bulgular: Katılımcıların yaş ortalaması 57,28±14,6, %47,8’i kadın, %16,1’i aşısız olup COVID-19 hastalığı öncesi günlük yaşam aktivitesi puan ortalaması 17,5±2,7, COVID-19 hastalığından sonraki günlük yaşam aktivitesi puan ortalaması 17,3±3,3 olarak tespit edilmiştir. Araştırmada hastalık öncesi ve sonrasındaki günlük yaşam aktiviteleri puan ortalamaları arasında anlamlı fark saptanmamıştır.Sonuçlar: COVID-19 hastalığı nedeniyle hastanede yatmış bireylerin taburculuk sonrasındaki sürecinin sağlık profesyonelleri tarafından takip edilmesi, yaşam aktivitelerinin değerlendirilmesi, bakım ihtiyaçlarının belirlenmesi ve buna yönelik olarak bireyselleştirilmiş sağlık hizmetinin hastane dışında da sürdürülmesi önerilmektedir.
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Affiliation(s)
- Özkan KARADEDE
- İstanbul Üniversitesi-Cerrahpaşa Cerrahpaşa Tıp Fakültesi
| | | | - Hatice ŞEREMET
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | | | | | - Ebru ÖZALP
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Ebru GÜNDOĞDU
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Fatma DALKILIÇ
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | | | - Merve KÜRKAN
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Mehmet HARMAN
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Senem ÇAKICI
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Rıdvan KARAALİ
- İstanbul Üniversitesi-Cerrahpaşa Cerrahpaşa Tıp Fakültesi
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Pérez-Zepeda MU, Martínez-Velilla N, Kehler DS, Izquierdo M, Rockwood K, Theou O. The impact of an exercise intervention on frailty levels in hospitalised older adults: secondary analysis of a randomised controlled trial. Age Ageing 2022; 51:6530461. [PMID: 35180287 DOI: 10.1093/ageing/afac028] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/12/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND physical activity reduces frailty in community-dwelling older adults. How exercise influences frailty in hospitalised older adults requires additional investigation. OBJECTIVES (i) to examine the impact of an exercise intervention on frailty in older adults admitted to an acute care ward, and (ii) to determine the impact of baseline frailty on the effectiveness of this intervention. SETTING/PARTICIPANTS this is a secondary analysis of a randomised controlled clinical trial that tested an intensive exercise intervention in ≥75-year-old adults admitted to an acute care ward. METHODS the intervention included two daily sessions of moderate-intensity exercises (control received usual care). A 63-item Frailty Index (FI) was constructed, and three groups were formed: <0.2, 0.2-0.29 and ≥0.3. Other outcomes included Short Physical Performance Battery (SPPB) and Barthel Index (BI). RESULTS a total of 323 individuals were included. The mean age was 87.1 years (± 4.8 standard deviation [SD]) and 56.3% were females. The intervention group improved FI from 0.26 (± 0.10 SD) to 0.20 (± 0.10 SD), whereas the control group FI worsened from 0.25 (± 0.1 SD) to 0.27 (± 0.10 SD). After stratifying by baseline FI, SPPB and depression improved in the intervention group across all levels of frailty; FI, BI and quality of life only improved in individuals with a baseline FI ≥ 0.2. CONCLUSIONS frailty improves with an intensive individualised exercise intervention, especially in those with high baseline levels of frailty. In addition, frailty is a useful outcome when examining the impact of an intervention of hospitalised older adults.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
- Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Dustin Scott Kehler
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Olga Theou
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
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Blancafort Alias S, Cuevas-Lara C, Martínez-Velilla N, Zambom-Ferraresi F, Soto ME, Tavassoli N, Mathieu C, Heras Muxella E, Garibaldi P, Anglada M, Amblàs J, Santaeugènia S, Contel JC, Domingo À, Salvà Casanovas A. A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Older People with Losses in Intrinsic Capacity: AMICOPE Development Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5979. [PMID: 34199566 PMCID: PMC8199683 DOI: 10.3390/ijerph18115979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as "the composite of all physical and mental attributes on which an individual can draw". Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability since adapted physical activity is the preventive intervention that has shown the most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED). The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. The intervention consists of 12 face-to-face sessions held weekly for 2.5 h over three months and facilitated by a pair of health and social care professionals. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention and, at a later stage, assessing the effectiveness in a randomized controlled trial.
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Affiliation(s)
- Sergi Blancafort Alias
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
| | - César Cuevas-Lara
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Geriatrics Department, Hospital Complex of Navarra (CHN)—Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), 31008 Pamplona, Spain; (C.C.-L.); (N.M.-V.); (F.Z.-F.)
| | - Maria Eugenia Soto
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Neda Tavassoli
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Céline Mathieu
- Equipe Régional Vieillissement et Prévention de la Dépendance, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (M.E.S.); (N.T.); (C.M.)
| | - Eva Heras Muxella
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Pablo Garibaldi
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Maria Anglada
- Ageing and Health Department in the Andorran Healthcare System, Servei Andorrà d’Atenció Sanitaria, AD700 Escaldes-Engordany, Andorra; (E.H.M.); (P.G.); (M.A.)
| | - Jordi Amblàs
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Sebastià Santaeugènia
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Joan Carles Contel
- Chronic Care Program, Department of Health, Generalitat de Catalunya, 08028 Barcelona, Spain; (J.A.); (S.S.); (J.C.C.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic/Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | - Àlex Domingo
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
| | - Antoni Salvà Casanovas
- Fundació Salut i Envelliment (Foundation on Health and Ageing)—UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (À.D.); (A.S.C.)
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Valenzuela PL, Saco-Ledo G, Rivas-Baeza B, Martínez-Velilla N, Izquierdo M, Lucia A. Safety of in-hospital early rehabilitation in chronic obstructive pulmonary disease exacerbations: a systematic review and meta-analysis. Ann Phys Rehabil Med 2021; 65:101528. [PMID: 33940246 DOI: 10.1016/j.rehab.2021.101528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/21/2021] [Accepted: 03/08/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | - Gonzalo Saco-Ledo
- Bioenergy and Motion Analysis Laboratory, National Research Center on Human Evolution (CENIEH), Burgos, Spain
| | | | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre ('imas12'), Madrid, Spain.
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Effects of Exercise Interventions on Inflammatory Parameters in Acutely Hospitalized Older Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:jcm10020290. [PMID: 33466835 PMCID: PMC7830051 DOI: 10.3390/jcm10020290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
The purpose of this systematic review and meta-analysis was to appraise the acute effects of exercise training on inflammatory parameters in hospitalized older adults. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Medline and PubMed were searched for studies published until August 2020. The review included all randomized controlled trials (RCTs) that evaluated and compared the effect of exercise versus usual care on inflammatory parameters in acutely hospitalized older adults. Two reviewers independently assessed the studies. The quality of all the included studies was assessed using the DerSimonian-Laird random-effects inverse-variance model. Five studies (275 participants) met the inclusion criteria. The exercise interventions included resistance or multicomponent intervention programs. The results indicate that, compared with usual care, exercise interventions have a positive impact on overall inflammatory parameters, including C-reactive protein (CRP) and insulin-like growth factor-I (IGF-1) (Hedge's g = -0.19, 95% confidence interval [CI] -0.33 to -0.04, p = 0.011, I2 = 0%). However, analyses of individual inflammatory parameters revealed a non-significant trend for reductions in CRP (Hedge's g = -0.20, 95% CI -0.47 to 0.07, p = 0.151, I2 = 31.2%) and IGF-I (Hedge's g = -0.34, 95% CI -0.79 to 0.11, p = 0.138, I2 = 0%). On the basis of this review, we conclude that exercise during acute hospitalization offers a mild improvement in the inflammatory profile over usual care in older patients. Nevertheless, due to limited number of RCTs, our findings must be interpreted with caution and confirmed in future studies.
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 338] [Impact Index Per Article: 112.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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10
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Neunhäuserer D, Reich B, Mayr B, Kaiser B, Lamprecht B, Niederseer D, Ermolao A, Studnicka M, Niebauer J. Impact of exercise training and supplemental oxygen on submaximal exercise performance in patients with COPD. Scand J Med Sci Sports 2020; 31:710-719. [PMID: 33155295 PMCID: PMC7984048 DOI: 10.1111/sms.13870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/30/2022]
Abstract
Functional impairment caused by chronic obstructive pulmonary disease (COPD) impacts on activities of daily living and quality of life. Indeed, patients' submaximal exercise capacity is of crucial importance. It was the aim of this study to investigate the effects of an exercise training intervention with and without supplemental oxygen on submaximal exercise performance. This is a secondary analysis of a randomized, controlled, double-blind, crossover trial. 29 COPD patients (63.5 ± 5.9 years; FEV1 46.4 ± 8.6%) completed two consecutive 6-week periods of high-intensity interval cycling and strength training, which was performed three times/week with either supplemental oxygen or medical air (10 L/min). Submaximal exercise capacity as well as the cardiocirculatory, ventilatory, and metabolic response were evaluated at isotime (point of termination in the shortest cardiopulmonary exercise test), at physical work capacity at 110 bpm of heart rate (PWC 110), at the anaerobic threshold (AT), and at the lactate-2 mmol/L threshold. After 12 weeks of exercise training, patients improved in exercise tolerance, shown by decreased cardiocirculatory (heart rate, blood pressure) and metabolic (respiratory exchange ratio, lactate) effort at isotime; ventilatory response was not affected. Submaximal exercise capacity was improved at PWC 110, AT and the lactate-2 mmol/L threshold, respectively. Although supplemental oxygen seems to affect patients' work rate at AT and the lactate-2 mmol/L threshold, no other significant effects were found. The improved submaximal exercise capacity and tolerance might counteract patients' functional impairment. Although cardiovascular and metabolic training adaptations were shown, ventilatory efficiency remained essentially unchanged. The impact of supplemental oxygen seems less important on submaximal training effects.
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Affiliation(s)
- Daniel Neunhäuserer
- Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria.,Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Bernhard Reich
- Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Barbara Mayr
- Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bernhard Kaiser
- University Clinic of Pneumology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bernd Lamprecht
- University Clinic of Pneumology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Pulmonary Medicine, Faculty of Medicine, Kepler-University-Hospital, Johannes-Kepler-University, Linz, Austria
| | - David Niederseer
- Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria.,Division of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Michael Studnicka
- University Clinic of Pneumology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
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11
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Belli S, Balbi B, Prince I, Cattaneo D, Masocco F, Zaccaria S, Bertalli L, Cattini F, Lomazzo A, Dal Negro F, Giardini M, Franssen FME, Janssen DJA, Spruit MA. Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalisation. Eur Respir J 2020; 56:13993003.02096-2020. [PMID: 32764112 PMCID: PMC7411272 DOI: 10.1183/13993003.02096-2020] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/23/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Stefano Belli
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Bruno Balbi
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Ilaria Prince
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Davide Cattaneo
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Francesca Masocco
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Sergio Zaccaria
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Luca Bertalli
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Francesco Cattini
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Arianna Lomazzo
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Francesca Dal Negro
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Marica Giardini
- Pulmonary Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Frits M E Franssen
- Dept of Research and Development, CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Daisy J A Janssen
- Dept of Research and Development, CIRO+, Horn, The Netherlands.,Dept of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martijn A Spruit
- Dept of Research and Development, CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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