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Turner J, Maiwald K, Winter A, Simms A, Bendall C, Camp PG. Photovoice exploration of physical activity norms and values among rural and remote pulmonary rehabilitation participants in British Columbia, Canada. Disabil Rehabil 2022; 44:8400-8411. [PMID: 35138962 DOI: 10.1080/09638288.2021.2018052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Individuals with chronic obstructive pulmonary disease (COPD) engage in less physical activity compared to the general population, which can lead to worsened symptoms. In pulmonary rehabilitation (PR) programs, participants learn strategies to complete activities more easily. For such strategies to be effective, however, PR clinicians must understand their clients' activity values and practices within their geocultural contexts. In this qualitative study, our aim was to explore physical activity norms and values among people with COPD living in remote and rural locations, using Photovoice methodology. MATERIALS AND METHODS We recruited 12 participants from rural PR sites in British Columbia, Canada. During two distinct seasons (winter and summer), participants photographed meaningful activities then completed semi-structured interviews. We analyzed transcripts using a three-step hermeneutic method, which revealed three themes. RESULTS Participants discussed feeling conflicted regarding their COPD symptoms and physical activity, as difficulties in activity engagement cause stress, but remaining active also fosters a sense of purpose and well-being. Meanwhile, participants' activities are inextricably linked to their rural, remote, and seasonal environment. CONCLUSIONS Our study provides insight into how people with COPD resiliently engage in activities in a rural environment with distinct weather variations. Findings highlight the importance of considering individual factors when recommending activities in PR programs.Implications for rehabilitationAlthough people with chronic lung disease often encounter difficulty and stress in completing their daily activities, they both recognize the importance of and derive great personal meaning from remaining active.The unique social, geographical, physical, and climatic environments of rural and remote dwelling people with chronic lung disease can both enable and challenge their activity engagement.Pulmonary rehabilitation (PR) programs and clinicians must situate their activity recommendations within the geographic contexts of their clients - which can vary across the seasons.Support for participants' mental health is a vital aspect of PR.
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Affiliation(s)
- Justin Turner
- Centre for Heart Lung Innovation, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Karin Maiwald
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ashley Winter
- Centre for Heart Lung Innovation, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Pat G Camp
- Centre for Heart Lung Innovation, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Bone Metabolism Impairment in Heart Transplant: Results From a Prospective Cohort Study. Transplantation 2020; 104:873-880. [DOI: 10.1097/tp.0000000000002906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paneroni M, Ambrosino N, Simonelli C, Bertacchini L, Venturelli M, Vitacca M. Physical Activity in Patients with Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy: A Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2019; 14:2815-2823. [PMID: 31824146 PMCID: PMC6901041 DOI: 10.2147/copd.s228465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022] Open
Abstract
Background and aim There are few studies evaluating physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). Aim To assess PA in hypoxemic COPD patients on LTOT. Methods In this cross-sectional study, we compared lung function, arterial blood gases, respiratory and peripheral muscle strength, 6-min walking distance (6MWD), daily energy expenditure and steps, and health-related quality of life (HRQL) in COPD patients on LTOT (LTOT group) versus two groups of control patients not needing LTOT: with (HYPOX) and without (COPD) exercise-induced desaturations. Results Groups did not differ as regards demographics, anthropometrics, peripheral or respiratory muscle strength. Compared to the other groups, LTOT patients had more severe airway obstruction and lung hyperinflation, greater number and severity of comorbidities, shorter 6MWD, as well as lower mean SpO2 during 6MWD and worse quality of life. LTOT patients had a lower daily energy expenditure, shorter time spent > 3.0 METs and longer sedentary time compared to the COPD group, and less daily steps compared to the other groups. No significant difference in any parameter of PA was found between COPD and HYPOX. In LTOT patients, daily steps showed a strong correlation with 6MWD, and a moderate correlation with airway obstruction, level of oxygenation, comorbidities and quality of life but not with peripheral and respiratory muscle strength. In COPD and HYPOX patients, daily steps were strongly correlated with 6MWD and level of oxygenation as assessed by PaO2/FiO2. There was no significant correlation between mean SpO2 and 6MWD in any group. Conclusion COPD patients on LTOT perform less physical activity than patients not needing LTOT, both with and without exercise-induced desaturations. Patients with exercise-induced desaturations do not perform less physical activity than those without.
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Affiliation(s)
- Mara Paneroni
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Lumezzane, IRCCS, Brescia, Italy
| | - Nicolino Ambrosino
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Montescano, IRCCS, Pavia, Italy
| | - Carla Simonelli
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Lumezzane, IRCCS, Brescia, Italy
| | - Laura Bertacchini
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Lumezzane, IRCCS, Brescia, Italy
| | - Massimo Venturelli
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Vitacca
- Respiratory Rehabilitation Division, ICS Maugeri SPA SB, Institute of Lumezzane, IRCCS, Brescia, Italy
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Patients with Chronic Musculoskeletal Pain of 3-6-Month Duration Already Have Low Levels of Health-Related Quality of Life and Physical Activity. Curr Pain Headache Rep 2019; 23:81. [PMID: 31456081 DOI: 10.1007/s11916-019-0817-6] [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] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW To determine the level of physical activity and health-related quality of life in patients with chronic musculoskeletal pain of 3-6-month duration who have not been diagnosed or treated before. RECENT FINDINGS Low levels of quality of life and physical activity have been reported for patients with musculoskeletal pain with a duration of longer than 6 months. This study assessed the levels of quality of life and physical activity at the beginning stage of chronic musculuskeletal pain. Prospective cross-sectional study carried out at a musculoskeletal and sports medicine clinic. Eighty-five consecutive patients with muskuloskeletal (i.e., spine, peripheral joint, muscle, tendon) pain of 3-6-month duration, not diagnosed before, age 14 and older, and from either gender were recruited. Short Form-36 Health Survey and International Physical Activity Questionnaire long were administered during assessments. Scores on subscales of Short Form-36 Health Survey and total scores of International Physical Activity Questionnaire were used as outcome measures. A total of 85 patients with an age range of 15-86 (51.22 ± 15.99) were enrolled. There were 23 male (27.06%) and 62 (72.94%) female subjects. Forty-six (54.11%) patients had three or less painful regions; 39 (45.88%) had more than three painful regions. Majority of the patients had low scores on both Short Form-36 Health Survey subscales and International Physical Activity Questionnaire. Forty-nine patients had low, 32 patients had moderate, and 4 patients had high level of physical activity. Overall, females had lower level of physical activity in all age groups. All patients had less than optimal scores on all subscales of Physical Health and Mental Health scales of the Short Form-36. The female patients had lower scores in role physical and bodily pain subscales of physical health. Patients with musculoskeletal pain duration of 3-6 months have low levels of physical activity and health-related quality of life at the time of their first evaluation.
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Lewthwaite H, Olds T, Williams MT, Effing TW, Dumuid D. Use of time in chronic obstructive pulmonary disease: Longitudinal associations with symptoms and quality of life using a compositional analysis approach. PLoS One 2019; 14:e0214058. [PMID: 30897134 PMCID: PMC6428329 DOI: 10.1371/journal.pone.0214058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/28/2019] [Indexed: 12/01/2022] Open
Abstract
Background and objectives This study explored whether, for people with chronic obstructive pulmonary disease (COPD), changes to the 24-hour composition of physical activity (PA), sedentary behaviour (SB) and sleep were associated with changes in symptoms and health-related quality of life (HRQoL); and how time re-allocations between these behaviours were associated with changes in outcomes. Methods This study pools data on people with COPD drawn from two previous studies: a randomised controlled trial of cognitive behavioural therapy and pulmonary rehabilitation and a usual care cohort. Participants recalled behaviours and completed symptom and HRQoL assessments at baseline (T0) and four months (T1). Linear mixed-effects models (pooled control/intervention samples) predicted changes in outcomes from T0 to T1 with a change to the 24-hour behaviour composition; compositional isotemporal substitution predicted change in outcomes when re-allocating time between behaviours. Results Valid data were obtained for 95 participants (forced expiratory volume in one second %predicted = 49.6±15.3) at T0 and T1. A change in the 24-hour behaviour composition was associated with a change in anxiety (p<0.01) and mastery (p<0.01), but not breathlessness, depression or fatigue. When modelling time re-allocation with compositional isotemporal substitution, more time re-allocated to higher intensity PA or sleep was associated with favourable changes in outcomes; re-allocating time to SB or light PA was associated with unfavourable changes in outcomes. The direction of association, however, could not be determined. Conclusion To improve the overall health and wellbeing of people with COPD, intervention approaches that optimise the composition of PA, SB and sleep may be beneficial.
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Affiliation(s)
- Hayley Lewthwaite
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- * E-mail:
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Marie T. Williams
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Tanja W. Effing
- College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
- Department of Respiratory Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Capparelli I, Fernandez M, Saadia Otero M, Steimberg J, Brassesco M, Campobasso A, Palacios S, Caro F, Alberti ML, Rabinovich RA, Paulin F. Traducción al español y validación del cuestionario Saint George específico para fibrosis pulmonar idiopática. Arch Bronconeumol 2018; 54:68-73. [DOI: 10.1016/j.arbres.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/12/2017] [Accepted: 09/18/2017] [Indexed: 01/17/2023]
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Blumenthal JA, Smith PJ, Durheim M, Mabe S, Emery CF, Martinu T, Diaz PT, Babyak M, Welty-Wolf K, Palmer S. Biobehavioral Prognostic Factors in Chronic Obstructive Pulmonary Disease: Results From the INSPIRE-II Trial. Psychosom Med 2016; 78:153-62. [PMID: 26780299 PMCID: PMC4737990 DOI: 10.1097/psy.0000000000000260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine the prognostic value of select biobehavioral factors in patients with chronic obstructive pulmonary disease (COPD) in a secondary analysis of participants from the INSPIRE-II trial. METHODS Three hundred twenty-six outpatients with COPD underwent assessments of pulmonary function, physical activity, body mass index, inflammation, pulmonary symptoms, depression, and pulmonary quality of life and were followed up for up to 5.4 years for subsequent clinical events. The prognostic value of each biobehavioral factor, considered individually and combined, also was examined in the context of existing Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 risk stratification. RESULTS Sixty-nine individuals experienced a hospitalization or died over a mean follow-up period of 2.4 (interquartile range = 1.6) years. GOLD classification was associated with an increased risk of clinical events (hazard ratio [HR] = 2.72 [95% confidence interval = 1.63-4.54], per stage); 6-minute walk (HR = 0.50 [0.34-0.73] per 500 ft), total steps (HR = 0.82 [0.71-0.94] per 1000 steps), high-sensitivity C-reactive protein (HR = 1.44 [1.01-2.06] per 4.5 mg/l), depression (HR = 1.12 [1.01-1.25] per 4 points), and pulmonary quality of life (HR = 1.73 [1.14-2.63] per 25 points) were each predictive over and above the GOLD assessment. However, only GOLD group and 6-minute walk were predictive of all-cause mortality and COPD hospitalization when all biobehavioral variables were included together in a multivariable model. CONCLUSIONS Biobehavioral factors provide added prognostic information over and above measures of COPD severity in predicting adverse events in patients with COPD.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Michael Durheim
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | | | - Tereza Martinu
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Philip T. Diaz
- Department of Medicine, Ohio State University, Columbus, OH
| | - Michael Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Karen Welty-Wolf
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Scott Palmer
- Department of Medicine, Duke University Medical Center, Durham, NC
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Six-minute-walk distance and accelerometry predict outcomes in chronic obstructive pulmonary disease independent of Global Initiative for Chronic Obstructive Lung Disease 2011 Group. Ann Am Thorac Soc 2015; 12:349-56. [PMID: 25568929 DOI: 10.1513/annalsats.201408-365oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
RATIONALE The 2011 combined Global Initiative for Chronic Obstructive Lung Disease (GOLD) assessment incorporates symptoms, exacerbation history, and spirometry in discriminating risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Six-minute-walk distance (6MWD) and accelerometry also have been used to assess disease severity in COPD. The association between these measures and the risks of hospitalization and mortality in the context of GOLD 2011 is unknown. OBJECTIVES To describe changes in exercise tolerance and physical activity over time in patients with COPD and to test the hypothesis that lower baseline 6MWD or accelerometry step count is associated with increased risk of COPD-related hospitalization or all-cause mortality, independent of GOLD 2011 group. METHODS Physical function and medical outcomes were prospectively assessed in 326 patients with moderate to severe COPD in INSPIRE-II, a randomized controlled trial of a coping skills training intervention. Cox models were used to determine if GOLD 2011 group, 6MWD, or accelerometry steps were associated with risk of COPD-related hospitalization or all-cause mortality. MEASUREMENTS AND MAIN RESULTS Physical function declined over time in GOLD group D but remained stable in groups A, B, and C. GOLD classification was associated with time to death or first COPD-related hospitalization. Baseline 6MWD was more strongly associated with time to death or first COPD-related hospitalization (hazard ratio, 0.50 [95% confidence interval, 0.34, 0.73] per 150 m, P=0.0003) than GOLD 2011 classification. A similar relationship was observed for accelerometry steps (hazard ratio, 0.80 [95% confidence interval, 0.70, 0.92] per 1,000 steps, P=0.002). CONCLUSIONS Exercise tolerance and daily physical activity are important predictors of hospitalization and mortality in COPD, independent of GOLD 2011 classification. Physical function may represent a modifiable risk factor that warrants increased attention as a target for interventions to improve clinically meaningful outcomes in COPD.
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Spruit MA, Pitta F, McAuley E, ZuWallack RL, Nici L. Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2015; 192:924-33. [DOI: 10.1164/rccm.201505-0929ci] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Frederix I, Hansen D, Coninx K, Vandervoort P, Van Craenenbroeck EM, Vrints C, Dendale P. Telerehab III: a multi-center randomized, controlled trial investigating the long-term effectiveness of a comprehensive cardiac telerehabilitation program--rationale and study design. BMC Cardiovasc Disord 2015; 15:29. [PMID: 25948479 PMCID: PMC4432995 DOI: 10.1186/s12872-015-0021-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/15/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Telerehabilitation has been proposed as an adjunct/alternative to standard center-based cardiac rehabilitation. Two recent systematic reviews showed non-inferiority and/or superiority of this remote approach for cardiac rehabilitation. However, these trials focused only on one core component of cardiac rehabilitation and telemonitoring, rather than implementing a more comprehensive approach. The aim of Telerehab III is to investigate the long-term effectiveness of the addition of a patient-tailored, internet-based telerehabilitation program implementing multiple cardiac rehabilitation core components and using both telemonitoring and telecoaching strategies to standard cardiac rehabilitation. METHODS/DESIGN In this prospective, multi-center randomized, controlled trial 140 patients with coronary artery disease and/or chronic heart failure patients will be recruited between February 2013 and February 2015. Patients will be randomized 1:1 to an intervention group (receiving an internet-based telerehabilitation program in addition to standard cardiac rehabilitation) or to standard cardiac rehabilitation alone. The mean follow-up is at least 6 months. The primary endpoint is peak oxygen consumption (VO2 peak). Secondary endpoints include measured and self-reported daily physical activity, cardiovascular risk factor control, health-related quality of life, days lost due to (non)cardiovascular rehospitalizations and time to first (non)cardiovascular rehospitalization. A clinical event committee blinded to treatment allocation assesses causes of rehospitalizations. DISCUSSION Telerehab III will be one of the first studies to examine the added value of a more comprehensive cardiac telerehabilitation program, focusing on multiple cardiac rehabilitation core components. It has the potential to augment current standard center-based cardiac rehabilitation practices and to be used as a model for other disease prevention programs. TRIAL REGISTRATION Current controlled trials ISRCTN29243064. Registration date 21 January 2015.
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Affiliation(s)
- Ines Frederix
- Department of Cardiology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.
- Faculty of Medicine & Life Sciences, Hasselt University, Agoralaan gebouw D, 3590, Diepenbeek, Belgium.
| | - Dominique Hansen
- Department of Cardiology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.
| | - Karin Coninx
- Faculty of Sciences, Expertise Center for Digital Media, Hasselt University, Wetenschapspark 2, 3590, Diepenbeek, Belgium.
| | - Pieter Vandervoort
- Faculty of Medicine & Life Sciences, Hasselt University, Agoralaan gebouw D, 3590, Diepenbeek, Belgium.
- Department of Cardiology, Hospital East-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | | | - Christiaan Vrints
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Paul Dendale
- Department of Cardiology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.
- Faculty of Medicine & Life Sciences, Hasselt University, Agoralaan gebouw D, 3590, Diepenbeek, Belgium.
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Shiue I. Heart murmur and dysrhythmia are associated with accidents leading to poor mental health and cognition: Scottish Health Survey, 2013. Int J Cardiol 2015; 187:322-4. [PMID: 25839636 DOI: 10.1016/j.ijcard.2015.03.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ivy Shiue
- School of Energy, Geoscience, Infrastructure & Society, Heriot-Watt University, UK.
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12
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Daily walking >10 min could improve mental health in people with historical cardiovascular disease or COPD: Scottish Health Survey, 2012. Int J Cardiol 2015; 179:375-7. [PMID: 25464490 DOI: 10.1016/j.ijcard.2014.11.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/05/2014] [Indexed: 11/21/2022]
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Hunt T, Madigan S, Williams MT, Olds TS. Use of time in people with chronic obstructive pulmonary disease--a systematic review. Int J Chron Obstruct Pulmon Dis 2014; 9:1377-88. [PMID: 25548519 PMCID: PMC4271726 DOI: 10.2147/copd.s74298] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
“Physical inactivity” and “sedentary lifestyles” are phrases often used when describing lifestyles of people with chronic obstructive pulmonary disease (COPD). Evidence suggests activity types, independent of energy expenditure, influence health outcomes, so understanding patterns of time use is important, particularly in chronic disease. We aimed to identify reports of time use in people with COPD. Predefined search strategies were used with six electronic databases to identify individual activity reports (including frequencies and/or durations) in which community-dwelling people with COPD engaged. Eligible studies were assessed independently against predefined criteria and data were extracted by two reviewers. Data synthesis was achieved by aggregating activity reports into activity domains (sports/exercise, screen time, transport, quiet time, self-care, sociocultural, work/study, chores, and sleep). Twenty-six publications reported 37 specific daily activities. People with COPD were found to spend extended periods in sedentary behaviors (eg, standing [194 min/day]; sitting [359 min/day]; lying [88 min/day]), have limited engagement in physical activity (eg, walking [51 min/day]; exercising [1.2 episodes per week {ep/w}, 13 min/day]), have high health care needs (medical appointments [1.0 ep/w]), and experience difficulties associated with activities of daily living (eg, showering [2.5 ep/w, 60 minutes per episode]; preparing meals [4.7 ep/w]). Little data could be found describing how people with COPD use their time, and data synthesis was problematic because of variations in methodologies, population differences, and research emphases. Identified data largely referred to posture and were skewed according to country, assessment methods, and disease severity. Comparisons with age-matched population data showed people with COPD spent less time engaged in personal-care activities (self-care and sleeping) and chores than people in similar age groups. The incorporation of time-use outcomes in future research designs should be encouraged. Ideally, these tools should use consistent frameworks and comparable outcome measures in order to provide clearer descriptions of time use in chronic disease.
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Affiliation(s)
- Toby Hunt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, City East Campus, Adelaide, SA, Australia ; Respiratory Clinical Research Unit, Repatriation General Hospital, Daw Park, SA, Australia
| | - Sarah Madigan
- Respiratory Clinical Research Unit, Repatriation General Hospital, Daw Park, SA, Australia
| | - Marie T Williams
- School of Population Health, University of South Australia, City East Campus, Adelaide, SA, Australia
| | - Tim S Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, City East Campus, Adelaide, SA, Australia
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14
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Watz H, Pitta F, Rochester CL, Garcia-Aymerich J, ZuWallack R, Troosters T, Vaes AW, Puhan MA, Jehn M, Polkey MI, Vogiatzis I, Clini EM, Toth M, Gimeno-Santos E, Waschki B, Esteban C, Hayot M, Casaburi R, Porszasz J, McAuley E, Singh SJ, Langer D, Wouters EFM, Magnussen H, Spruit MA. An official European Respiratory Society statement on physical activity in COPD. Eur Respir J 2014; 44:1521-37. [PMID: 25359358 DOI: 10.1183/09031936.00046814] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This European Respiratory Society (ERS) statement provides a comprehensive overview on physical activity in patients with chronic obstructive pulmonary disease (COPD). A multidisciplinary Task Force of experts representing the ERS Scientific Group 01.02 "Rehabilitation and Chronic Care" determined the overall scope of this statement through consensus. Focused literature reviews were conducted in key topic areas and the final content of this Statement was agreed upon by all members. The current knowledge regarding physical activity in COPD is presented, including the definition of physical activity, the consequences of physical inactivity on lung function decline and COPD incidence, physical activity assessment, prevalence of physical inactivity in COPD, clinical correlates of physical activity, effects of physical inactivity on hospitalisations and mortality, and treatment strategies to improve physical activity in patients with COPD. This Task Force identified multiple major areas of research that need to be addressed further in the coming years. These include, but are not limited to, the disease-modifying potential of increased physical activity, and to further understand how improvements in exercise capacity, dyspnoea and self-efficacy following interventions may translate into increased physical activity. The Task Force recommends that this ERS statement should be reviewed periodically (e.g. every 5-8 years).
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Affiliation(s)
| | - Fabio Pitta
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Carolyn L Rochester
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Judith Garcia-Aymerich
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Richard ZuWallack
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Thierry Troosters
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Anouk W Vaes
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Milo A Puhan
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Melissa Jehn
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Michael I Polkey
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Ioannis Vogiatzis
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Enrico M Clini
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Michael Toth
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Elena Gimeno-Santos
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Benjamin Waschki
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Cristobal Esteban
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Maurice Hayot
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Richard Casaburi
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Janos Porszasz
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Edward McAuley
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Sally J Singh
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Daniel Langer
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Emiel F M Wouters
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
| | - Helgo Magnussen
- For a full list of the authors' affiliations please refer to the Acknowledgements. Task Force co-chairs
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15
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Demeyer H, Burtin C, Van Remoortel H, Hornikx M, Langer D, Decramer M, Gosselink R, Janssens W, Troosters T. Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program. Chest 2014; 146:318-327. [PMID: 24603844 PMCID: PMC4122275 DOI: 10.1378/chest.13-1968] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 02/01/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is a wide variability in measurement methodology of physical activity. This study investigated the effect of different analysis techniques on the statistical power of physical activity outcomes after pulmonary rehabilitation. METHODS Physical activity was measured with an activity monitor armband in 57 patients with COPD (mean ± SD age, 66 ± 7 years; FEV1, 46 ± 17% predicted) before and after 3 months of pulmonary rehabilitation. The choice of the outcome (daily number of steps [STEPS], time spent in at least moderate physical activity [TMA], mean metabolic equivalents of task level [METS], and activity time [ACT]), impact of weekends, number of days of assessment, postprocessing techniques, and influence of duration of daylight time (DT) on the sample size to achieve a power of 0.8 were investigated. RESULTS The STEPS and ACT (1.6-2.3 metabolic equivalents of task) were the most sensitive outcomes. Excluding weekends decreased the sample size for STEPS (83 vs 56), TMA (160 vs 148), and METS (251 vs 207). Using 4 weekdays (STEPS and TMA) or 5 weekdays (METS) rendered the lowest sample size. Excluding days with < 8 h wearing time reduced the sample size for STEPS (56 vs 51). Differences in DT were an important confounder. CONCLUSIONS Changes in physical activity following pulmonary rehabilitation are best measured for 4 weekdays, including only days with at least 8 h of wearing time (during waking hours) and considering the difference in DT as a covariate in the analysis. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00948623; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Heleen Demeyer
- Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Chris Burtin
- Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium; Department of Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Hans Van Remoortel
- Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Miek Hornikx
- Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Daniel Langer
- Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Marc Decramer
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Rik Gosselink
- Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Thierry Troosters
- Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium.
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16
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Dürr S, Zogg S, Miedinger D, Steveling EH, Maier S, Leuppi JD. Daily physical activity, functional capacity and quality of life in patients with COPD. COPD 2014; 11:689-96. [PMID: 24945972 DOI: 10.3109/15412555.2014.898050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In the therapy of chronic obstructive pulmonary disease (COPD), it is a major goal to improve health-related quality of life (HRQOL). Patients with COPD often suffer from exertional dyspnea and adopt a sedentary lifestyle, which could be associated with poorer HRQOL. The aim of this study was to investigate the independent association of objectively measured daily physical activity and functional capacity with HRQOL in patients with COPD. METHODS In this cross-sectional study conducted at the University Hospital Basel, Switzerland, 87 stable patients (58.6% male, mean age: 67.3 ± 9.6 yrs) with COPD in GOLD grades I (n = 23), II (n = 46), III (n = 12) and IV (n = 6) were investigated. To assess HRQOL, the COPD assessment test (CAT) was completed. Patients performed spirometry and 6-min walk test. Physical activity was measured by the SenseWear Mini Armband on 7 consecutive days. By performing a multiple linear regression analysis, independent predictors of CAT score were identified. RESULTS Age (β = -0.39, p = 0.001), average daily steps (β = -0.31, p = 0.033) and 6-min walk distance (β = -0.32, p = 0.019) were found to be independent predictors of CAT score, whereas physical activity duration above 3 METs (p = 0.498) and forced expiratory volume in 1 s in% of predicted (p = 0.364) showed no significant association. CONCLUSIONS This study showed that average daily steps and functional capacity are independent determinants of HRQOL in patients with COPD. This emphasizes the importance to remain active and mobile, which is associated with better HRQOL.
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Affiliation(s)
- Selina Dürr
- 1Medical University Clinic, Cantonal Hospital Baselland , Liestal, Switzerland and Medical Faculty, University of Basel, Basel , Switzerland
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17
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Wilke S, Spruit MA, Wouters EFM, Schols JMGA, Franssen FME, Janssen DJA. Determinants of 1-year changes in disease-specific health status in patients with advanced chronic obstructive pulmonary disease: A 1-year observational study. Int J Nurs Pract 2014; 21:239-48. [PMID: 24666609 DOI: 10.1111/ijn.12265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We aimed to identify baseline and longitudinal determinants of change in disease-specific health status in patients with advanced chronic obstructive pulmonary disease (COPD). Demographic and clinical characteristics as well as disease-specific health status (St George's Respiratory Questionnaire, SGRQ) were assessed in 105 outpatients with advanced COPD at baseline and at 4, 8 and 12 months. Eighty-five patients (81.0%) had complete SGRQ data at baseline and 12 months and were included in analyses. Stepwise multiple regression analysis revealed that lower SGRQ total score, higher depression scores and longer time needed to complete the Timed Up and Go (TUG) test at baseline, as well as increase in time needed to complete the TUG test and increase in dyspnoea during the 1-year follow-up period, were predictors of deterioration in disease-specific health status. The current study reinforces the stimulation of physical mobility and the targeting of dyspnoea as components for treatment programs to optimize disease-specific health status in patients with advanced COPD.
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Affiliation(s)
- Sarah Wilke
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
| | - Martijn A Spruit
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
| | - Emiel F M Wouters
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of General Practice and Department of Health Services Research, Faculty of Health, Medicine and Life Sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Frits M E Franssen
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
| | - Daisy J A Janssen
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
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18
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Chronic obstructive pulmonary disease (COPD) patients' disease-related preferences : a study using conjoint analysis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 6:93-101. [PMID: 23526399 DOI: 10.1007/s40271-013-0007-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the management of chronic obstructive pulmonary disease (COPD), knowledge of disease attributes and preferences that are important to patients is crucial. This knowledge may support drug development and optimization of COPD management strategies. OBJECTIVE To assess patient preferences in COPD and to use the conjoint methodology in order to propose a self-assessment tool based on patients' preferences gained from this conjoint analysis. This tool might then be used in future observational study settings. METHODS A two-step procedure was applied: an initial qualitative research module consisting of interviews with eight COPD patients served to assess COPD patients' health state in-depth, their attitudes towards COPD and their information sources regarding the disease, symptomatology, unmet needs, and their preferences for future COPD medications. In the main quantitative research part of the study, 300 patients (with an average age of 55 years) from across Germany suffering from COPD (n = 225 with stage II and n = 75 with stage III COPD) participated. Each participant was presented with 15 different scenarios during the conjoint exercise. Additionally, the Clinical COPD Questionnaire (CCQ) had to be completed and attitudes towards COPD were assessed. RESULTS According to the participants, the three COPD attributes of the highest relative importance were dyspnea, performance capability, and sleep quality. Frequency of administration of the medication, onset of medication, and emotional state due to COPD base medication played only a minor role. COPD symptoms were reported to have the highest impact on quality of life, according to the CCQ. CONCLUSIONS Our study proposes an alternative utility-based approach of a self-reported health state concept, utilizing the fact that patients with moderate to severe COPD would trade, e.g., ease of administration and onset of medication for relief from dyspnea.
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Almagro P, Castro A. Helping COPD patients change health behavior in order to improve their quality of life. Int J Chron Obstruct Pulmon Dis 2013; 8:335-45. [PMID: 23901267 PMCID: PMC3726303 DOI: 10.2147/copd.s34211] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and debilitating diseases in adults worldwide and is associated with a deleterious effect on the quality of life of affected patients. Although it remains one of the leading causes of global mortality, the prognosis seems to have improved in recent years. Even so, the number of patients with COPD and multiple comorbidities has risen, hindering their management and highlighting the need for futures changes in the model of care. Together with standard medical treatment and therapy adherence--essential to optimizing disease control--several nonpharmacological therapies have proven useful in the management of these patients, improving their health-related quality of life (HRQoL) regardless of lung function parameters. Among these are improved diagnosis and treatment of comorbidities, prevention of COPD exacerbations, and greater attention to physical disability related to hospitalization. Pulmonary rehabilitation reduces symptoms, optimizes functional status, improves activity and daily function, and restores the highest level of independent physical function in these patients, thereby improving HRQoL even more than pharmacological treatment. Greater physical activity is significantly correlated with improvement of dyspnea, HRQoL, and mobility, along with a decrease in the loss of lung function. Nutritional support in malnourished COPD patients improves exercise capacity, while smoking cessation slows disease progression and increases HRQoL. Other treatments such as psychological and behavioral therapies have proven useful in the treatment of depression and anxiety, both of which are frequent in these patients. More recently, telehealthcare has been associated with improved quality of life and a reduction in exacerbations in some patients. A more multidisciplinary approach and individualization of interventions will be essential in the near future.
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Affiliation(s)
- Pere Almagro
- Acute Geriatric Care Unit, Internal Medicine Department, University Hospital Mútua de Terrassa, Barcelona, Spain.
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20
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Lahaije AJ, van Helvoort HA, Dekhuijzen PR, Vercoulen JH, Heijdra YF. Resting and ADL-induced dynamic hyperinflation explain physical inactivity in COPD better than FEV1. Respir Med 2013; 107:834-40. [DOI: 10.1016/j.rmed.2013.02.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/19/2013] [Accepted: 02/22/2013] [Indexed: 11/27/2022]
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21
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Jehn M, Schindler C, Meyer A, Tamm M, Koehler F, Witt C, Schmidt-Trucksäss A, Stolz D. Associations of Daily Walking Activity with Biomarkers Related to Cardiac Distress in Patients with Chronic Obstructive Pulmonary Disease. Respiration 2013; 85:195-202. [DOI: 10.1159/000345218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/02/2012] [Indexed: 11/19/2022] Open
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22
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Wee YC, Tan KL, Kuldip K, Tai KS, George E, Tan PC, Chia P, Subramaniam R, Yap SF, Tan JAMA. Alpha-thalassaemia in association with beta-thalassaemia patients in Malaysia: a study on the co-inheritance of both disorders. Public Health Genomics 2008; 11:129-34. [PMID: 18376108 DOI: 10.1159/000113874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Individuals with double heterozygosity for alpha- and beta-thalassaemia and heterozygous beta-thalassaemia show a similar haematological picture. Co-inheritance of alpha- and beta-thalassaemia in both partners may result in pregnancies with either Hb Bart's hydrops foetalis or beta-thalassaemia major, or pregnancies with both disorders. METHODS The co-inheritance of alpha-thalassaemia in 322 beta-thalassaemia carriers in Malaysia was studied. RESULTS The frequency of alpha-thalassaemia in the beta-thalassaemia carriers was 12.7% (41/322), with a carrier frequency of 7.8% for the SEA deletion, 3.7% for the -alpha(3.7) deletion, 0.9% for Hb Constant Spring and 0.3% for the -alpha(4.2) deletion. CONCLUSION Double heterozygosity for alpha- and beta-thalassaemia was confirmed in 5 out of the 41 couples and the risk of the fatal condition Hb Bart's hydrops foetalis was confirmed in two of these couples. Detection of the Southeast Asian (SEA) deletion in the Malaysian Malays in this study confirms that Hb Bart's hydrops foetalis can occur in this ethnic group. Results of this study have provided new information on the frequency and different types of alpha-thalassaemia (--(SEA), -alpha(3.7) and -alpha(4.2) deletions, Hb Constant Spring) in Malaysian beta-thalassaemia carriers.
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Affiliation(s)
- Y C Wee
- Department of Molecular Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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