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Sherwood A, Blumenthal JA, Mentz RJ, Koch GG, Rogers JG, Chang PP, Chien C, Adams KF, Rose-Jones LJ, Jensen BC, Donahue M, Johnson KS, Hinderliter AL. Depressive symptoms are associated with clinical outcomes in heart failure with reduced ejection fraction. ESC Heart Fail 2024; 11:2627-2636. [PMID: 38715254 PMCID: PMC11424307 DOI: 10.1002/ehf2.14758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 09/27/2024] Open
Abstract
AIMS The objective of this study was to examine associations between elevated depressive symptoms and increased risk of adverse clinical events patients with heart failure and reduced ejection fraction (HFrEF), as well as the potential contribution of health behaviours. METHODS AND RESULTS One hundred forty-two men and women with HFrEF were enrolled through heart failure (HF) clinics and followed over time. At baseline and 6 months, depressive symptoms were assessed by the Beck Depression Inventory-II (BDI-II) and HFrEF disease activity by B-type natriuretic peptide (BNP). The Self-Care of Heart Failure Index (SCHFI) was used to assess HF self-care behaviours. Proportional hazards regression models assessed the contribution of depressive symptoms and HFrEF disease biomarkers on death or cardiovascular hospitalization. Over a median follow-up period of 4 years, 42 patients (30%) died, and 84 (60%) had cardiovascular hospitalizations. A 10-point higher baseline BDI-II score was associated with a 35% greater risk of death or cardiovascular hospitalization. Higher baseline BDI-II scores were associated with poorer HF self-care maintenance behaviours (R = -0.30, P < 0.001) and fewer daily steps (R = -0.19, P = 0.04), suggesting that elevated depressive symptoms may diminish important health behaviours. Increases in plasma BNP over 6 months were associated with worse outcomes. Changes in BDI-II and plasma BNP over 6 months were positively related (R = 0.25, P = 0.004). CONCLUSIONS This study confirms that elevated depressive symptoms are associated with an increased likelihood of adverse clinical outcomes in patients with HFrEF. Poor health behaviours may contribute to the adverse association of elevated depressive symptoms with the increased hazard of adverse clinical outcomes.
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Affiliation(s)
- Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Robert J Mentz
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Gary G Koch
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph G Rogers
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Department of Cardiology, The Texas Heart Institute, Houston, TX, USA
| | - Patricia P Chang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher Chien
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Rex Healthcare, Raleigh, NC, USA
| | - Kirkwood F Adams
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa J Rose-Jones
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian C Jensen
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark Donahue
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Kristy S Johnson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Van Der Donckt J, Vandenbussche N, Van Der Donckt J, Chen S, Stojchevska M, De Brouwer M, Steenwinckel B, Paemeleire K, Ongenae F, Van Hoecke S. Mitigating data quality challenges in ambulatory wrist-worn wearable monitoring through analytical and practical approaches. Sci Rep 2024; 14:17545. [PMID: 39079945 PMCID: PMC11289092 DOI: 10.1038/s41598-024-67767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
Chronic disease management and follow-up are vital for realizing sustained patient well-being and optimal health outcomes. Recent advancements in wearable technologies, particularly wrist-worn devices, offer promising solutions for longitudinal patient monitoring, replacing subjective, intermittent self-reporting with objective, continuous monitoring. However, collecting and analyzing data from wearables presents several challenges, such as data entry errors, non-wear periods, missing data, and wearable artifacts. In this work, we explore these data analysis challenges using two real-world datasets (mBrain21 and ETRI lifelog2020). We introduce practical countermeasures, including participant compliance visualizations, interaction-triggered questionnaires to assess personal bias, and an optimized pipeline for detecting non-wear periods. Additionally, we propose a visualization-oriented approach to validate processing pipelines using scalable tools such as tsflex and Plotly-Resampler. Lastly, we present a bootstrapping methodology to evaluate the variability of wearable-derived features in the presence of partially missing data segments. Prioritizing transparency and reproducibility, we provide open access to our detailed code examples, facilitating adaptation in future wearable research. In conclusion, our contributions provide actionable approaches for improving wearable data collection and analysis.
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Affiliation(s)
- Jonas Van Der Donckt
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium.
| | - Nicolas Vandenbussche
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Stephanie Chen
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Marija Stojchevska
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Mathias De Brouwer
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Bram Steenwinckel
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Femke Ongenae
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Sofie Van Hoecke
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
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3
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Josa-Culleré A, Basagaña X, Koch S, Arbillaga-Etxarri A, Balcells E, Bosch de Basea M, Celorrio N, Foraster M, Rodriguez-Roisin R, Marin A, Peralta GP, Rodríguez-Chiaradia DA, Simonet P, Torán-Monserrat P, Vall-Casas P, Garcia-Aymerich J. Short-term effects of air pollution and weather on physical activity in patients with chronic obstructive pulmonary disease (COPD). ENVIRONMENTAL RESEARCH 2024; 247:118195. [PMID: 38237751 DOI: 10.1016/j.envres.2024.118195] [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: 11/08/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) accumulate low levels of physical activity. How environmental factors affect their physical activity in the short-term is uncertain. AIM to assess the short-term effects of air pollution and weather on physical activity levels in COPD patients. METHODS This multi-center panel study assessed 408 COPD patients from Catalonia (Spain). Daily physical activity (i.e., steps, time in moderate-to-vigorous physical activity (MVPA), locomotion intensity, and sedentary time) was recorded in two 7-day periods, one year apart, using the Dynaport MoveMonitor. Air pollution (nitrogen dioxide (NO2), particulate matter below 10 μm (PM10) and a marker of black carbon (absorbance of PM2.5: PM2.5ABS), and weather (average and maximum temperature, and rainfall) were estimated the same day (lag zero) and up to 5 days prior to each assessment (lags 1-5). Mixed-effect distributed lag linear regression models were adjusted for age, sex, weekday, public holidays, greenness, season, and social class, with patient and city as random effects. RESULTS Patients (85% male) were on average (mean ± SD) 68 ± 9 years old with a post-bronchodilator forced expiratory volume in 1 s (FEV1) of 57 ± 18% predicted. Higher NO2, PM10 and PM2.5ABS levels at lag four were associated with fewer steps, less time in MVPA, reduced locomotion intensity, and longer sedentary time (e.g., coefficient (95% CI) of -60 (-105, -15) steps per 10 μg/m3 increase in NO2). Higher average and maximum temperatures at lag zero were related to more steps and time in MVPA, and less sedentary time (e.g., +85 (15, 154) steps per degree Celsius). Higher rainfall at lag zero was related to fewer steps and more sedentary time. CONCLUSION Air pollution affects the amount and intensity of physical activity performed on the following days in COPD patients, whereas weather affects the amount of physical activity performed on the same day.
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Affiliation(s)
- Alícia Josa-Culleré
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Sarah Koch
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ane Arbillaga-Etxarri
- Deusto Physical TherapIker, Physical Therapy Department, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastián, Spain
| | - Eva Balcells
- Universitat Pompeu Fabra (UPF), Barcelona, Spain; Respiratory Medicine Department, Hospital del Mar, Barcelona, Spain; CIBER Respiratory Disease (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Magda Bosch de Basea
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Nuria Celorrio
- Clinical pneumologist, Department of Respiratory Medicine Hospital de Viladecans, Barcelona, Spain
| | - Maria Foraster
- PHAGEX Research Group, Blanquerna School of Health Science, Universitat Ramon Llull (URL), Barcelona, Spain
| | - Robert Rodriguez-Roisin
- CIBER Respiratory Disease (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marin
- Department of Respiratory Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Germans Trias i Pujol Research Institute - IGTP, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriela P Peralta
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Diego A Rodríguez-Chiaradia
- Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Respiratory Disease (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Pulmonary Medicine, Hospital del Mar, Spain
| | - Pere Simonet
- EAP Viladecans-2. Gerencia Metropolitana Sud, ICS, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mare de Déu de Guadalupe, 08303 Mataró, Spain; Multidisciplinary Research Group in Health and Society (GREMSAS) (2021 SGR 01484), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain; Department of Medicine, Faculty of Medicine, Universitat de Girona, 17001 Girona, Spain
| | | | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
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Silva H, Mantoani LC, Aguiar WF, Gonçalves AFL, da Silva TG, Zamboti CL, Ribeiro M, Probst VS, Pitta F, Camillo CA. The impact of sleep duration on physical activity in daily life in patients with idiopathic pulmonary fibrosis. Physiother Theory Pract 2024; 40:736-745. [PMID: 36622293 DOI: 10.1080/09593985.2022.2160679] [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: 06/04/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite the high prevalence of sleep disturbances in idiopathic pulmonary fibrosis (IPF), the relationship between physical activity in daily life (PADL) and sleep in this population remains unclear. OBJECTIVES Investigate the impact of sleep on different domains of PADL in IPF and characterize their PADL profile. METHODS Sixty-seven participants (thirty-three with IPF and thirty-four healthy subjects [control group]) were included. The subjects underwent assessments of pulmonary function, exercise capacity, respiratory and peripheral muscle strength, PADL, sleep, dyspnea, and health-related quality of life. PADL and sleep measures were assessed using an activity monitor (Actigraph®, wGT3x-BT). Associations between sleep and PADL were done using correlation and regression models. RESULTS In the IPF, sleep duration at night associated significantly with step counts, sedentary, light, and moderate-to-vigorous physical activity (MVPA) (-0.82 ≤ R ≤ 0.43; p < .05 for all). Lung function and sleep partially explained PADL variables (0.19 ≤ R2 ≤ 0.65, p < .05 for all). Compared to controls, the IPF subjects presented lower step counts, less time spent in MVPA, standing position, and more time spent in lying position (p < .05, for all). CONCLUSIONS Sleep duration is associated with PADL in IPF. The PADL profile of patients is worse than in control subjects.
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Affiliation(s)
- Humberto Silva
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
- Post-Graduation Programme in Rehabilitation Sciences, Centre of Research and Post-Graduation, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Leandro C Mantoani
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
- Post-Graduation Programme in Rehabilitation Sciences, Centre of Research and Post-Graduation, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Wagner F Aguiar
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
- Post-Graduation Programme in Rehabilitation Sciences, Centre of Research and Post-Graduation, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Aline F L Gonçalves
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
- Post-Graduation Programme in Rehabilitation Sciences, Centre of Research and Post-Graduation, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Thatielle G da Silva
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
- Post-Graduation Programme in Rehabilitation Sciences, Centre of Research and Post-Graduation, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Camile L Zamboti
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
- Post-Graduation Programme in Rehabilitation Sciences, Centre of Research and Post-Graduation, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Marcos Ribeiro
- Department of Pneumology, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Vanessa S Probst
- Post-Graduation Programme in Rehabilitation Sciences, Centre of Research and Post-Graduation, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
- Post-Graduation Programme in Rehabilitation Sciences, Centre of Research and Post-Graduation, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
| | - Carlos A Camillo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University, Av. Robert Koch, 60, Operária 86038-350, Londrina, Brazil
- Department of Rehabilitation Sciences, University Pitágoras UNOPAR, Rua Marselha, 519 - Parque Residencial Joaquim Toledo Piza 86041-140, Londrina, Brazil
- Department of Physiotherapy, Faculty of Science and Technology, São Paulo State University (UNESP), Rua Roberto Simonsen, 305 19060-900, Presidente Prudente, Brazil
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Simón-Vicente L, Rodríguez-Fernández A, Rivadeneyra-Posadas J, Soto-Célix M, Raya-González J, Castillo-Alvira D, Calvo S, Mariscal N, García-Bustillo Á, Aguado L, Cubo E. Validation of ActiGraph and Fitbit in the assessment of energy expenditure in Huntington's disease. Gait Posture 2024; 109:89-94. [PMID: 38286064 DOI: 10.1016/j.gaitpost.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Consumer and research activity monitors have become popular because of their ability to quantify energy expenditure (EE) in free-living conditions. However, the accuracy of activity trackers in determining EE in people with Huntington's Disease (HD) is unknown. RESEARCH QUESTION Can the ActiGraph wGT3X-B or the Fitbit Charge 4 accurately measure energy expenditure during physical activity, in people with HD compared to Indirect Calorimetry (IC) (Medisoft Ergo Card)? METHODS We conducted a cross-sectional, observational study with fourteen participants with mild-moderate HD (mean age 55.7 ± 11.4 years). All participants wore an ActiGraph and Fitbit during an incremental test, running on a treadmill at 3.2 km/h and 5.2 km/h for three minutes at each speed. We analysed and compared the accuracy of EE estimates obtained by Fitbit and ActiGraph against the EE estimates obtained by a metabolic cart, using with Intra-class correlation (ICC), Bland-Altman analysis and correlation tests. RESULTS A significant correlation and a moderate reliability was found between ActiGraph and IC for the incremental test (r = 0.667)(ICC=0.633). There was a significant correlation between Fitbit and IC during the incremental test (r = 0.701), but the reliability was poor at all tested speeds in the treadmill walk. Fitbit significantly overestimated EE, and ActiGraph underestimated EE compared to IC, but ActiGraph estimates were more accurate than Fitbit in all tests. SIGNIFICANCE Compared to IC, Fitbit Charge 4 and ActiGraph wGT3X-BT have reduced accuracy in estimating EE at slower walking speeds. These findings highlight the need for population-specific algorithms and validation of activity trackers.
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Affiliation(s)
| | - Alejandro Rodríguez-Fernández
- VALFIS Research Group, Institute of Biomedicine (IBIOMED), Faculty of Sciences of Physical Activity and Sports. University of Leon, León, Spain
| | | | - María Soto-Célix
- Faculty of Health Sciences, Universidad Isabel I, Burgos, Spain,; Endocrinología y Nutrición. Servicio Medicina Interna. Hospital Reina Sofía. Área de Salud de Tudela, Servicio Navarro de Salud - Osasunbidea
| | | | | | | | | | | | | | - Esther Cubo
- University of Burgos, Spain; Hospital Universitario de Burgos, Spain
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Wullems JA, Verschueren SMP, Degens H, Morse CI, Onambélé-Pearson GL. Concurrent Validity of Four Activity Monitors in Older Adults. SENSORS (BASEL, SWITZERLAND) 2024; 24:895. [PMID: 38339613 PMCID: PMC10856911 DOI: 10.3390/s24030895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
Sedentary behaviour (SB) and physical activity (PA) have been shown to be independent modulators of healthy ageing. We thus investigated the impact of activity monitor placement on the accuracy of detecting SB and PA in older adults, as well as a novel random forest algorithm trained on data from older persons. Four monitor types (ActiGraph wGT3X-BT, ActivPAL3c VT, GENEActiv Original, and DynaPort MM+) were simultaneously worn on five anatomical sites during ten different activities by a sample of twenty older adults (70.0 (12.0) years; 10 women). The results indicated that collecting metabolic equivalent (MET) data for 60 s provided the most representative results, minimising variability. In addition, thigh-worn monitors, including ActivPAL, Random Forest, and Sedentary Sphere-Thigh, exhibited superior performance in classifying SB, with balanced accuracies ≥ 94.2%. Other monitors, such as ActiGraph, DynaPort MM+, and GENEActiv Sedentary Sphere-Wrist, demonstrated lower performance. ActivPAL and GENEActiv Random Forest outperformed other monitors in participant-specific balanced accuracies for SB classification. Only thigh-worn monitors achieved acceptable overall balanced accuracies (≥80.0%) for SB, standing, and medium-to-vigorous PA classifications. In conclusion, it is advisable to position accelerometers on the thigh, collect MET data for ≥60 s, and ideally utilise population-specific trained algorithms.
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Affiliation(s)
- Jorgen A. Wullems
- Department of Sport and Exercise Sciences, Institute of Sport, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 7EL, UK; (J.A.W.); (C.I.M.)
| | - Sabine M. P. Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium;
| | - Hans Degens
- Department of Life Sciences, Institute of Sport, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK;
- Institute of Sport Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Christopher I. Morse
- Department of Sport and Exercise Sciences, Institute of Sport, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 7EL, UK; (J.A.W.); (C.I.M.)
| | - Gladys L. Onambélé-Pearson
- Department of Sport and Exercise Sciences, Institute of Sport, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 7EL, UK; (J.A.W.); (C.I.M.)
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7
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Mellaerts P, Demeyer H, Blondeel A, Vanhoutte T, Breuls S, Wuyts M, Coosemans I, Claes L, Vandenbergh N, Beckers K, Bossche LV, Stylemans D, Janssens W, Everaerts S, Troosters T. The one-minute sit-to-stand test: A practical tool for assessing functional exercise capacity in patients with COPD in routine clinical practice. Chron Respir Dis 2024; 21:14799731241291530. [PMID: 39400070 PMCID: PMC11483694 DOI: 10.1177/14799731241291530] [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: 05/30/2024] [Revised: 09/12/2024] [Accepted: 09/24/2024] [Indexed: 10/15/2024] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is associated with a reduced exercise capacity. Although several field tests for exercise capacity have been modified for non-standard settings, i.e. outside the hospital clinic or pulmonary rehabilitation center, their uptake remains limited. Objectives: To assess the test-retest reliability, constuct validity and responsiveness of the one-minute sit-to-stand test (1'STST) adopted in clinical practice among patients with COPD and to confirm the earlier established minimal important difference (MID) of three repetitions. Methods: Patients with COPD performed two 1'STSTs, two 6-minute walk tests (6MWT), an isometric quadriceps force (QF) measurement, a cardiopulmonary exercise test (CPET), and a seven-day physical activity (PA) measurement before and after three months of pulmonary rehabilitation (PR). An Intraclass Correlation Coefficient (ICC) evaluated the agreement between two 1'STSTs. Pearson Correlation examined the association between the 1'STST and other physical measurements, and their changes following PR. A receiver operating characteristic (ROC) curve was constructed using a 30-meter increment in the 6MWT as cut-off to identify responders. Results: The 1'STST demonstrated good reliability (Δ0.9 ± 4.0 repetitions, p = .13; ICC = 0.79). The 1'STST was moderately correlated with the 6MWT (r = 0.57, p < .0001), VO2max (r = 0.50, p = .0006) and maximal work rate (r = 0.52, p = .0003). Weak correlations were observed with QF (r = 0.33, p = .03) and step count (r = 0.38, p = .013). The 1'STST improved after PR (∆ = 3.6 ± 6.4 repetitions, p = .0013) and changes correlated moderately with changes in the 6MWT (r = 0.57, p = .002), QF (r = 0.48, p = .003) and VO2max (r = 0.41, p = .014). A cut-off of three repetitions demonstrated a 71% accuracy in identifying responders to a rehabilitation program. Conclusion: The 1'STST is a valuable alternative to evaluate exercise capacity in patients with COPD when more expensive and time-consuming tests are unavailable.
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Affiliation(s)
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- IS Global, Barcelona, Spain
| | - Tim Vanhoutte
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Iris Coosemans
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
| | - Lode Claes
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
| | - Nele Vandenbergh
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Beckers
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Wim Janssens
- Clinical department of Respiratory diseases, UZ Leuven- BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Stephanie Everaerts
- Clinical department of Respiratory diseases, UZ Leuven- BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
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8
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Breuls S, Zlamalova T, Raisova K, Blondeel A, Wuyts M, Dvoracek M, Zurkova M, Yserbyt J, Janssens W, Wuyts W, Troosters T, Demeyer H. Physical activity coaching in patients with interstitial lung diseases: A randomized controlled trial. Chron Respir Dis 2024; 21:14799731241235231. [PMID: 38511242 PMCID: PMC10956148 DOI: 10.1177/14799731241235231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/13/2023] [Accepted: 01/31/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Physical activity is reduced in patients with interstitial lung disease (ILD) and physical inactivity is related to poor health outcomes. We investigated the effect of a telecoaching intervention to improve physical activity in patients with ILD. METHODS Eighty patients with ILD were randomized into the intervention or control group. Patients in the intervention group received a 12-week telecoaching program including a step counter, a patient-tailored smartphone application, and coaching calls. Patients in the control group received usual care. Physical activity (primary outcome), physical fitness and quality of life were measured at baseline and 12 weeks later with an accelerometer, 6-min walking test and quadriceps muscle force and the King's Brief Interstitial Lung Disease questionnaire (K-BILD). RESULTS Participation in telecoaching did not improve physical activity: between-group differences for step count: 386 ± 590 steps/day, p = .52; sedentary time: 4 ± 18 min/day, p = .81; movement intensity: 0.04 ± 0.05 m/s2, p = .45). Between-group differences for the 6-min walking test, quadriceps muscle force and K-BILD were 14 ± 10 m, p = .16; 2 ± 3% predicted, p = .61; 0.8 ± 1.7 points, p = .62 respectively. CONCLUSIONS Twelve weeks of telecoaching did not improve physical activity, physical fitness or quality of life in patients with ILD. Future physical or behavioural interventions are needed for these patients to improve physical activity.
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Affiliation(s)
- Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Tamara Zlamalova
- Department of Physiotherapy, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - Katerina Raisova
- Department of Physiotherapy, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Martin Dvoracek
- Department of Physiotherapy, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - Monika Zurkova
- Faculty of Medicine, Palacký University Olomouc, Czech Republic
- Department of Pulmonary Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jonas Yserbyt
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Wim Wuyts
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | | | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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9
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Antão J, Rebelo P, Almeida S, Franssen FME, Spruit MA, Marques A. Effects of ActiGraph's filter, epoch length and non-wearing time algorithm on step counts in people with COPD. J Sports Sci 2024; 42:9-16. [PMID: 38394032 DOI: 10.1080/02640414.2024.2319448] [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: 05/04/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
The influence of the ActiGraph® processing criteria on estimating step counts in chronic obstructive pulmonary disease (COPD) remains uncertain. This study aimed to assess the influence of filters, epoch lengths and non-wearing time (NWT) algorithms on steps/day in people with COPD. ActiGraph GT3X+ was worn on the waist for seven days. Steps were detected using different filters (normal and low-frequency extension [LFE]), epoch lengths (15s and 60s), and NWT algorithms (Choi and Troiano). Linear mixed-effects model was applied to assess the effects of filter, epoch length, NWT algorithm on steps/day. Lin's concordance correlation and Bland-Altman were used to measure agreement. A total of 136 people with COPD (107 male; 69 ± 8 years; FEV1 51 ± 17% predicted) were included. Significant differences were found between filters (p < 0.001), but not between epoch lengths or NWT algorithms. The LFE increased, on average, approximately 7500 steps/day compared to the normal filter (p < 0.001). Agreement was poor (<0.3) and proportional bias was significant when comparing steps/day computed with different filters, regardless of the epoch length and NWT algorithm. Filter choice but not epoch lengths or NWT algorithms seem to impact measurement of steps/day. Future studies are needed to recommend the most accurate technique for measuring steps/day in people with COPD.
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Affiliation(s)
- Joana Antão
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
- Department of Research and Development, Horn, Ciro, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Patrícia Rebelo
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Sara Almeida
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Frits M E Franssen
- Department of Research and Development, Horn, Ciro, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Horn, Ciro, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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10
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Shah AJ, Althobiani MA, Saigal A, Ogbonnaya CE, Hurst JR, Mandal S. Wearable technology interventions in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:222. [PMID: 38012218 PMCID: PMC10682416 DOI: 10.1038/s41746-023-00962-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and is associated with multiple medical and psychological comorbidities. Therefore, future strategies to improve COPD management and outcomes are needed for the betterment of patient care. Wearable technology interventions offer considerable promise in improving outcomes, but prior reviews fall short of assessing their role in the COPD population. In this systematic review and meta-analysis we searched ovid-MEDLINE, ovid-EMBASE, CINAHL, CENTRAL, and IEEE databases from inception to April 2023 to identify studies investigating wearable technology interventions in an adult COPD population with prespecified outcomes of interest including physical activity promotion, increasing exercise capacity, exacerbation detection, and quality-of-life. We identified 7396 studies, of which 37 were included in our review. Meta-analysis showed wearable technology interventions significantly increased: the mean daily step count (mean difference (MD) 850 (494-1205) steps/day) and the six-minute walk distance (MD 5.81 m (1.02-10.61 m). However, the impact was short-lived. Furthermore, wearable technology coupled with another facet (such as health coaching or pulmonary rehabilitation) had a greater impact that wearable technology alone. Wearable technology had little impact on quality-of-life measures and had mixed results for exacerbation avoidance and prediction. It is clear that wearable technology interventions may have the potential to form a core part of future COPD management plans, but further work is required to translate this into meaningful clinical benefit.
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Affiliation(s)
- Amar J Shah
- Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, University College London, London, UK
| | - Malik A Althobiani
- UCL Respiratory, University College London, London, UK
- King Abdulaziz University, Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, Jeddah, Makkah, Saudi Arabia
| | - Anita Saigal
- Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, University College London, London, UK
| | | | - John R Hurst
- Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, University College London, London, UK
| | - Swapna Mandal
- Royal Free London NHS Foundation Trust, London, UK.
- UCL Respiratory, University College London, London, UK.
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11
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Blondeel A, Hermans F, Breuls S, Wuyts M, De Maeyer N, Verniest T, Derom E, Van Calster B, Janssens W, Troosters T, Demeyer H. The association of weather conditions with day-to-day variability in physical activity in patients with COPD. ERJ Open Res 2023; 9:00314-2023. [PMID: 37965232 PMCID: PMC10641577 DOI: 10.1183/23120541.00314-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 11/16/2023] Open
Abstract
Background While patients with COPD often cite weather conditions as a reason for inactivity, little is known about the relationship between physical activity (PA) and weather conditions. The present study investigated the association of day-to-day weather changes on PA in patients with COPD and investigated patient characteristics related to being more or less influenced by weather conditions. Methods In this longitudinal analysis, device-based day-by-day step counts were objectively measured in COPD patients for up to 12 months. Daily meteorological data (temperature, precipitation, wind speed, hours of sunlight and daylight) were linked to the daily step count and individual and multivariable relationships were investigated using mixed-model effects. Individual R2 was calculated for every subject to investigate the estimated influence of weather conditions on a patient level and its relationship with patient characteristics. Results We included 50 patients with a mean±sd follow-up time of 282±93 days, totalling 14 117 patient-days. Daily temperature showed a positive linear pattern up until an inflexion point, after which a negative association with increasing temperature was observed (p<0.0001). Sunshine and daylight time had a positive association with PA (p<0.0001). Precipitation and wind speed were negatively associated with PA (p<0.0001). The median per-patient R2 for overall weather conditions was 0.08, ranging from 0.00 to 0.42. No strong associations between patient characteristics and per-patient R2 were observed. Conclusion Weather conditions are partly associated with PA in patients with COPD, yet the overall explained variance of PA due to weather conditions is rather low and varied strongly between individuals.
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Affiliation(s)
- Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Fien Hermans
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nikolaas De Maeyer
- Clinical Department of Respiratory Diseases, Regional Hospital Heilig Hart Leuven, Leuven, Belgium
| | - Thessa Verniest
- Clinical Department of Respiratory Diseases, Regional Hospital Heilig Hart Leuven, Leuven, Belgium
| | - Eric Derom
- Clinical Department of Respiratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Department of Chronic Diseases, Metabolism and Aging (CHROMETA) – BREATHE, KU Leuven, Leuven, Belgium
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- These authors contributed equally
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- These authors contributed equally
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12
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Blondeel A, Hermans F, Breuls S, Wuyts M, Everaerts S, Gyselinck I, De Maeyer N, Verniest T, Derom E, Janssens W, Troosters T, Demeyer H. Factors associated to physical activity in patients with COPD: An ecological approach. Respir Med 2023; 219:107424. [PMID: 37820971 DOI: 10.1016/j.rmed.2023.107424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Physical activity (PA) is low in patients with Chronic Obstructive Pulmonary Disease (COPD). Identifying modifiable and non-modifiable correlates of PA give understanding of the individual behavior and provide future directions for PA enhancing interventions. As PA is complex and multidimensional, it should be embedded within a thorough framework. OBJECTIVE To identify correlates of PA in a comprehensive COPD population based on a broad ecological model, including physiological, psychological, socio-demographic and environmental dimensions. METHODS PA was objectively measured using the Dynaport Movemonitor and a comprehensive data collection of physiological, psychological, socio-demographic and environmental factors were collected. Bivariable and multivariable regression analyses (including principle component analysis) were executed. RESULTS For this cross-sectional analysis, we included 148 patients with COPD and valid PA data (mean (SD) age 68 (7) years, FEV1 57 (17) % predicted, 5613 (3596) steps per day). Significant bivariable associations were found for physiological (exercise capacity, muscle force, lung function, symptoms, comorbidities), psychological (e.g. fatigue, motivation, perceived difficulty with PA), socio-demographic (dog owning, use of activity tracker) and environmental (season, daylight, temperature) factors. Based on the multivariable regression model, exercise capacity, beliefs on motivation, importance and self-confidence regarding PA and weather conditions were independent correlates of mean steps per day (R2 = 0.35). Movement intensity during walking was only independently associated with exercise capacity and age (R2 = 0.41). CONCLUSION Although a wide range of potential influence factors were evaluated, variance in PA was only partly explained, supporting that PA is a complex behavior which is difficult to predict.
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Affiliation(s)
- Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Fien Hermans
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Stephanie Everaerts
- Department of Chronic Diseases, Metabolism and Aging (CHROMETA) - BREATHE, KU Leuven, Leuven, Belgium; Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Iwein Gyselinck
- Department of Chronic Diseases, Metabolism and Aging (CHROMETA) - BREATHE, KU Leuven, Leuven, Belgium
| | - Nikolaas De Maeyer
- Clinical Department of Respiratory Diseases, Regional Hospital Heilig Hart Leuven, Leuven, Belgium
| | - Thessa Verniest
- Clinical Department of Respiratory Diseases, Regional Hospital Heilig Hart Leuven, Leuven, Belgium
| | - Eric Derom
- Clinical Department of Respiratory Medicine, University Hospital Gent, Gent, Belgium
| | - Wim Janssens
- Department of Chronic Diseases, Metabolism and Aging (CHROMETA) - BREATHE, KU Leuven, Leuven, Belgium; Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Gent, Belgium.
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13
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Mantoani LC, Furlanetto KC, Camillo CA, de Oliveira JM, Polastri C, Schneider LP, Zamboti CL, Hernandes NA, Pitta F. Comparison of Physical Activity Patterns among Three Major Chronic Respiratory Diseases. J Clin Med 2023; 12:6832. [PMID: 37959297 PMCID: PMC10650693 DOI: 10.3390/jcm12216832] [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: 09/19/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Although the level of physical activity in daily life (PADL) plays a vital role concerning the health of subjects with chronic lung diseases, it remains uncertain how PADL patterns compare among different conditions. This study's objective was to compare the PADL levels of subjects with COPD, asthma and idiopathic pulmonary fibrosis (IPF); and to investigate PADL behaviour in different diseases' severity. Stable subjects who had not undergone pulmonary rehabilitation in the previous year were included. Subjects were divided into two subgroups according to disease severity: mild/moderate and severe/very severe. The primary outcome was time spent in moderate-to-vigorous physical activities (MVPA) (Actigraph GT3x) measured during one week over 12 h/day; other assessments included pulmonary function, peripheral muscle strength and exercise capacity. Comparisons among subgroups were corrected for age, BMI and sex. The analysis involved 119 subjects (47 asthma, 48 COPD and 24 IPF). Subjects with asthma had higher PADL levels than those with COPD and IPF (MVPA 18(14-22) vs. 8(4-12) vs. 7(1-12) min/day, respectively; p ancova = 0.002). Subjects with severe/very severe IPF had the lowest PADL level among all subgroups. Adult subjects with asthma have higher PADL levels than those with COPD and IPF, whereas patients with severe and very severe IPF are the most physically inactive subjects.
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Affiliation(s)
- Leandro Cruz Mantoani
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
- Department of Physiotherapy, Faculty of Science and Technology, São Paulo State University (UNESP), Presidente Prudente 19060-080, Brazil
- Graduate Associated Program in Rehabilitation Sciences, University Pitagoras UNOPAR / UEL, Londrina 86041-140, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
- Graduate Associated Program in Rehabilitation Sciences, University Pitagoras UNOPAR / UEL, Londrina 86041-140, Brazil
| | - Carlos Augusto Camillo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
- Department of Physiotherapy, Faculty of Science and Technology, São Paulo State University (UNESP), Presidente Prudente 19060-080, Brazil
- Graduate Associated Program in Rehabilitation Sciences, University Pitagoras UNOPAR / UEL, Londrina 86041-140, Brazil
| | - Joice Mara de Oliveira
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
| | - Cláudia Polastri
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
| | - Lorena Paltanin Schneider
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
| | - Camile Ludovico Zamboti
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
- Department of Physiotherapy, Faculty of Science and Technology, São Paulo State University (UNESP), Presidente Prudente 19060-080, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina 86047-970, Brazil; (K.C.F.); (C.A.C.); (J.M.d.O.); (C.P.); (L.P.S.); (C.L.Z.); (N.A.H.)
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14
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Huang SC, Lee CH, Hsu CC, Chang SY, Chen YA, Chiu CH, Hsiao CC, Su HR. Prediction for blood lactate during exercise using an artificial intelligence-Enabled electrocardiogram: a feasibility study. Front Physiol 2023; 14:1253598. [PMID: 37954448 PMCID: PMC10634516 DOI: 10.3389/fphys.2023.1253598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction: The acquisition of blood lactate concentration (BLC) during exercise is beneficial for endurance training, yet a convenient method to measure it remains unavailable. BLC and electrocardiogram (ECG) both exhibit variations with changes in exercise intensity and duration. In this study, we hypothesized that BLC during exercise can be predicted using ECG data. Methods: Thirty-one healthy participants underwent four cardiopulmonary exercise tests, including one incremental test and three constant work rate (CWR) tests at low, moderate, and high intensity. Venous blood samples were obtained immediately after each CWR test to measure BLC. A mathematical model was constructed using 31 trios of CWR tests, which utilized a residual network combined with long short-term memory to analyze every beat of lead II ECG waveform as 2D images. An artificial neural network was used to analyze variables such as the RR interval, age, sex, and body mass index. Results: The standard deviation of the fitting error was 0.12 mmol/L for low and moderate intensities, and 0.19 mmol/L for high intensity. Weighting analysis demonstrated that ECG data, including every beat of ECG waveform and RR interval, contribute predominantly. Conclusion: By employing 2D convolution and artificial neural network-based methods, BLC during exercise can be accurately estimated non-invasively using ECG data, which has potential applications in exercise training.
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Affiliation(s)
- Shu-Chun Huang
- Department of Physical Medicine and Rehabilitation, New Taipei Municipal Tucheng Hospital, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Hung Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chin Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Sing-Ya Chang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-An Chen
- Taipei Private Tsai Hsing Senior High School, Taipei, Taiwan
| | - Chien-Hung Chiu
- Department of Surgery, Thoracic and Cardiovascular Surgery Division, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Chung Hsiao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, New Taipei Municipal TuCheng Hospital, Taipei, Taiwan
| | - Hong-Ren Su
- Super Genius Aitak Co., LTD., Taipei, Taiwan
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15
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Loeckx M, Rodrigues FM, Blondeel A, Everaerts S, Janssens W, Demeyer H, Troosters T. Sustaining training effects through physical activity coaching (STEP): a randomized controlled trial. Int J Behav Nutr Phys Act 2023; 20:121. [PMID: 37814266 PMCID: PMC10563200 DOI: 10.1186/s12966-023-01519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) programs improve physical fitness, symptoms and quality of life (QoL) of patients with COPD. However, improved physical activity (PA) is not guaranteed after PR and the clinical benefits fade off after PR discharge. We aimed to investigate whether a 9 months PA-telecoaching program is able to improve PA of patients with COPD, after 3 months of PR and if this leads to maintenance of PR-acquired benefits. METHODS Patients with COPD enrolled in a 6-month PR program were randomized to a (semi-automated) PA-telecoaching program or usual care, 3 months after PR initiation. The intervention consisted of a smartphone application with individual targets and feedback (for 6 months) and self-monitoring with a step counter (for 9 months). Patients were followed up for 9 months after randomization. Primary outcome was PA (daily step count by accelerometery), secondary outcomes were exercise tolerance, quadriceps force, dyspnea and QoL. RESULTS Seventy-three patients were included (mean ± SD: 65 ± 7 years, FEV1 49 ± 19%, 6MWD 506 ± 75 m, PA 5225 ± 2646 steps/day). The intervention group presented a significant improvement in steps/day at every visit compared to usual care (between-group differences mean ± SE: 1431 ± 555 steps/day at 9 months after randomization, p = 0.01). Secondary outcomes did not differ between the groups. CONCLUSION The semi-automated PA-telecoaching program implemented after 3 months of PR was effective to improve the amount of PA (steps/day) during PR and after follow-up. However, this was not accompanied by the maintenance of other PR-acquired benefits. TRIAL REGISTRATION ClinicalTrials.gov. Identifier: NCT02702791. Retrospectively registered on March 9, 2016. Start study October 2015. https://clinicaltrials.gov/ct2/show/NCT02702791?term=NCT02702791&draw=2&rank=1 .
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Affiliation(s)
- Matthias Loeckx
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
| | - Fernanda M Rodrigues
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
- Department of Medicine, Western of Sao Paulo University (UNOESTE), Guarujá, Brazil
| | - Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Everaerts
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Respiratory division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
- Respiratory division, University Hospitals Leuven, Leuven, Belgium.
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16
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Iwakura M, Kawagoshi A, Tamaki A, Oki Y, Oshima Y, Spruit MA. Physical activity measurements in individuals with interstitial lung disease: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:220165. [PMID: 37437911 DOI: 10.1183/16000617.0165-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/11/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Physical activity (PA) measurements are becoming common in interstitial lung disease (ILD); however, standardisation has not been achieved. We aimed to systematically review PA measurement methods, present PA levels and provide practical recommendations on PA measurement in ILD. METHODS We searched four databases up to November 2022 for studies assessing PA in ILD. We collected information about the studies and participants, the methods used to measure PA, and the PA metrics. Studies were scored using 12 items regarding PA measurements to evaluate the reporting quality of activity monitor use. RESULTS In 40 of the included studies, PA was measured using various devices or questionnaires with numerous metrics. Of the 33 studies that utilised activity monitors, a median of five out of 12 items were not reported, with the definition of nonwear time being the most frequently omitted. The meta-analyses showed that the pooled means (95% CI) of steps, time spent in moderate to vigorous PA, total energy expenditure and sedentary time were 5215 (4640-5791) steps·day-1, 82 (58-106) min·day-1, 2130 (1847-2412) kcal·day-1 and 605 (323-887) min·day-1, respectively, with considerable heterogeneity. CONCLUSION The use of activity monitors and questionnaires in ILD lacks consistency. Improvement is required in the reporting quality of PA measurement methods using activity monitors.
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Affiliation(s)
- Masahiro Iwakura
- Department of Rehabilitation, Akita City Hospital, Akita City, Japan
| | | | - Akira Tamaki
- School of Rehabilitation, Hyogo Medical University, Hyogo, Japan
| | - Yutaro Oki
- Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Yohei Oshima
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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17
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De Groef A, Asnong A, Blondeel A, Ginis P, Nieuwboer A, De Vrieze T, Devoogdt N, Troosters T, Demeyer H, Geraerts I. Accuracy of consumer-based activity trackers as measuring tool and coaching device in breast and colorectal cancer survivors. Support Care Cancer 2023; 31:596. [PMID: 37768403 DOI: 10.1007/s00520-023-08061-2] [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: 12/08/2022] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Consumer-based activity trackers are used to measure and promote PA. We studied the accuracy of a wrist- and waist-worn activity tracker in cancer survivors and compared these results to a healthy age-matched control group. METHODS Twenty-two cancer survivors and 35 healthy subjects wore an activity tracker at the waist and at the wrist combined with a reference activity monitor at the waist (Dynaport Movemonitor). The devices were worn for 14 consecutive days. The mean daily step count from both activity trackers was compared with the reference activity monitor to investigate accuracy and agreement (paired t-test, intraclass correlation, Bland-Altman plots). To evaluate the accuracy as a coaching tool, day-by-day differences within patients were calculated. The Kendall correlation coefficient was used to test the consistency of ranking daily steps between the activity trackers and the reference activity monitor. RESULTS The wrist-worn wearable significantly overestimated the daily step count in the cancer group (mean ± SDΔ: + 1305 (2685) steps per day; p = 0.033) and in the healthy control group (mean ± SDΔ: + 1598 (2927) steps per day; p = 0.003). The waist-worn wearable underestimated the step count in both groups, although this was not statistically significant. As a coaching device, moderate (r = 0.642-0.670) and strong (r = 0.733-0.738) accuracy was found for the wrist- and waist-worn tracker, respectively, for detecting day-by-day variability in both populations. CONCLUSION Our results show that wrist-worn activity trackers significantly overestimate daily step count in both cancer survivors and healthy control subjects. Based on the accuracy, in particular, the waist-worn activity tracker could possibly be used as a coaching tool.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium.
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Antwerp, Belgium.
| | - Anne Asnong
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
| | - Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
- Pulmonary Rehabilitation, Respiratory Department, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Pieter Ginis
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Antwerp, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
- Department of Vascular Surgery, Department of Physical Medicine and Rehabilitation, Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
- Pulmonary Rehabilitation, Respiratory Department, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Louvain, Belgium
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18
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Sherwood A, Blumenthal JA, Mentz RJ, Koch GG, Rogers JG, Chang PP, Chien C, Adams KF, Rose-Jones LJ, Jensen BC, Johnson KS, Hinderliter AL. Association of Depression Symptoms and Biomarkers of Risk on Clinical Outcomes in HFrEF. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.26.23296194. [PMID: 37808654 PMCID: PMC10557801 DOI: 10.1101/2023.09.26.23296194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Prior studies have demonstrated an association of depression with adverse clinical outcomes in patients with HFrEF, but the possible mechanisms responsible for the association are not unserstood. METHODS 142 men and women with HFrEF were enrolled through HF clinics and followed over time. At baseline and 6-months, depression was assessed by the Beck Depression Inventory (BDI-II) and disease activity by B-type natriuretic peptide (BNP). Proportional Hazards Regression Models assessed the contribution of depressive symptoms and HFrEF disease biomarkers on death or cardiovascular hospitalization. RESULTS Over a median follow-up period of 4 years, 42 patients (30%) died, and 84 (60%) had cardiovascular hospitalizations. A 10-point higher baseline BDI-II score was associated with a 35% higher hazard of death or cardiovascular hospitalization. Greater baseline BDI-II scores were associated with poorer HF self-care maintenance (R=-0.30, p<0.001) and fewer daily steps (R=-0.19, p=0.04), suggesting that depression may adversely affect important health behaviors. Increases in plasma BNP over 6 months were associated with worse outcomes. Changes in BDI-II score and plasma BNP over 6 months were positively correlated (R=0.25, p=0.004). CONCLUSIONS This study underscores the importance of elevated depression symptoms and their association with an increased likelihood of adverse clinical outcomes in patients with HFrEF. Health behaviors may play a greater role than direct biobehavioral pathways in the adverse effects of depression on the HF disease trajectory and resultant clinical outcomes.
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Affiliation(s)
- Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | - Gary G. Koch
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Joseph G. Rogers
- Department of Medicine, Duke University Medical Center
- Department of Cardiology, The Texas Heart Institute
| | | | - Christopher Chien
- Department of Medicine, University of North Carolina at Chapel Hill
- UNC Rex Healthcare, Raleigh, NC, USA
| | | | | | - Brian C. Jensen
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Kristy S. Johnson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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19
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Armstrong M, Hume E, McNeillie L, Chambers F, Wakenshaw L, Burns G, Heslop Marshall K, Vogiatzis I. Cognitive behavioural therapy combined with physical activity behavioural modification strategies during pulmonary rehabilitation in patients with COPD. ERJ Open Res 2023; 9:00074-2023. [PMID: 37701362 PMCID: PMC10493712 DOI: 10.1183/23120541.00074-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction Patients with COPD who exhibit elevated levels of anxiety and/or depression are typically less able to improve symptoms and physical activity levels following a programme of pulmonary rehabilitation (PR). The objective of the present study was to provide proof of concept that offering an intervention comprising cognitive behavioural therapy (CBT) alongside physical activity behavioural modification strategies (BPA) during PR is more effective in improving physical activity outcomes compared to PR and CBT alone. Methods 32 patients with COPD (mean±sd forced expiratory volume in 1 s 42±14% predicted) were assigned 1:1 to receive PR+CBT+BPA or PR+CBT. BPA comprised motivational interviews, step-count monitoring, feedback using a pedometer and goal setting. Assessments included accelerometer-derived steps per day, movement intensity, 6-min walk distance (6MWD) and Hospital Anxiety and Depression Scale (HADS) scores. Results The magnitude of improvement across physical activity outcomes was greater for the PR+CBT+BPA compared to the PR+CBT intervention (by 829 steps per day (p=0.029) and by 80±39 vector magnitude units (p=0.042), respectively). Compared to PR and CBT alone, the PR+CBT+BPA intervention induced greater clinically meaningful improvements in HADS anxiety scores (by -2 units, 95% CI -4-1 units) and 6MWD (by 33±20 m). Conclusions Providing anxious and/or depressed patients with COPD with a combined intervention of CBT and BPA during PR presents more favourable improvements in physical activity outcome measures compared to CBT alone during PR.
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Affiliation(s)
- Matthew Armstrong
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Laura McNeillie
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Francesca Chambers
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Lynsey Wakenshaw
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Graham Burns
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
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20
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Rebelo P, Antão J, Brooks D, Marques A. Effect of Data Reduction Techniques on Daily Moderate to Vigorous Physical Activity Collected with ActiGraph ® in People with COPD. J Clin Med 2023; 12:5340. [PMID: 37629381 PMCID: PMC10455487 DOI: 10.3390/jcm12165340] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
ActiGraph® is a valid, frequently used, accelerometer to quantify moderate to vigorous physical activities (MVPA) in people with COPD. The impact of ActiGraph processing techniques on this population is unknown. This study aimed to explore the effect of data reduction techniques on MVPA in people with COPD. MVPA/day, through ActiGraph GT3X+, was estimated using: Troiano, Freedson 98 and FreedsonVM3 cutoffs, 15-s and 60-s epochs, and normal and low-frequency extension (LFE) filters. Cutoff, epoch, and filter effects were explored with Aligned Rank Transform-ANOVA. Lin's concordance correlation coefficients and Bland-Altman plots were used to evaluate agreement and bias between different techniques. The analysis included 136 people with COPD (79% male; 68 ± 8 years; FEV1 51 ± 17% predicted). MVPA/day differed according to cutoff, filter, and epoch selection (p-value < 0.001). FreedsonVM3 cutoff, 15-s epochs, and LFE yielded the highest MVPA (45 min/day, 68% of physically active participants). Troiano cutoff, 60-s epochs, and normal filter yielded the lowest MVPA (8 min/day, 20% of physically active participants). Only comparisons between Troiano and Freedson98 cutoffs presented an almost perfect agreement. ActiGraph data reduction techniques affected MVPA/day estimates and their interpretation at the individual and group level. Studies using different processing criteria should not be compared in people with COPD. Future studies with a gold standard are required to ascertain which processing technique produces the most accurate MVPA estimates in COPD. Meanwhile, future trials employing the ActiGraph GT3X+ may consider estimating MVPA based on Freedson VM3 cutofffs, 60-s epochs, and normal filter.
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Affiliation(s)
- Patrícia Rebelo
- Lab3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (P.R.); (J.A.)
- iBiMED—Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal
- Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Joana Antão
- Lab3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (P.R.); (J.A.)
- iBiMED—Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal
- Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Dina Brooks
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
- West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada
| | - Alda Marques
- Lab3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (P.R.); (J.A.)
- iBiMED—Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal
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21
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Byron C, Osadnik CR. Physical Activity Profiles among Patients Admitted with Acute Exacerbations of Chronic Obstructive Pulmonary Disease. J Clin Med 2023; 12:4914. [PMID: 37568317 PMCID: PMC10419862 DOI: 10.3390/jcm12154914] [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: 06/08/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
People with hospitalised acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exhibit low levels of physical activity (PA) and increased risks of future exacerbations. While methods to objectively measure and express PA are established for people with stable COPD, less clarity exists for people during AECOPD. Further, the relationship between PA during AECOPD and clinically relevant outcomes remains uncertain. The purpose of the study was to evaluate how much PA (step count and intensity) people accumulate during hospitalised AECOPDs, and the effect of accumulated inpatient PA (expressed via differing metrics) on length of stay (LOS), PA recovery, and readmission risk. This study was a secondary analysis of prospective observational cohort data collected with Actigraph wActiSleep-BT devices from patients with AECOPD in a Melbourne hospital from 2016 to 2018. Step counts and PA intensity throughout the hospital admission and at one-month follow-up were collected and analysed. Sixty-eight participants were recruited for inpatient measurement, and 51 were retained for follow-up. There were no significant changes in step count or intensity across the inpatient days, but 33/51 (65%) of participants demonstrated a clinically meaningful improvement in steps per day from 3817.0 to 6173.7 at follow-up. Participants spent most time sedentary and in light PA, with both PA metrics demonstrating significant influences on LOS and follow-up PA intensity, but with generally low explanatory power (R2 value range 7-22%). Those who had LOS < 5 days spent significantly less time sedentary and more time in light PA than those with LOS ≥ 5 days (p < 0.001 for both). Time spent sedentary or in light PA appears to be the most promising metric to associate with clinically relevant outcomes related to recovery following AECOPD. These findings can inform future clinical practice for the evaluation of inpatient PA to better establish its role in the clinical management of patients with AECOPD.
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Affiliation(s)
- Christopher Byron
- Department of Physiotherapy, Monash University, Melbourne 3199, Australia;
| | - Christian R. Osadnik
- Department of Physiotherapy, Monash University, Melbourne 3199, Australia;
- Monash Lung Sleep Allergy Immunology, Monash Health, Melbourne 3168, Australia
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22
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Kamperman RG, Bogaards JA, Evers SW, Walter HAW, de Visser M, de Borgie C, Colen-de Koning JCA, Verhamme C, Maas M, Eftimov F, van Schaik IN, van der Kooi AJ, Raaphorst J. Treatment with add-on IVIg in Myositis Early In the diSease course May be sUperior to Steroids alone for reaching CLinical improvEment (TIME IS MUSCLE): study protocol of a phase-2 double-blind placebo-controlled randomised trial. BMJ Open 2023; 13:e067435. [PMID: 37429682 DOI: 10.1136/bmjopen-2022-067435] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION For idiopathic inflammatory myopathies (IIM) ('myositis') standard initial treatment is high-dosed glucocorticoids, which results in relatively slow improvement of muscle strength. Early immunosuppression or modulation by intensive treatment ('hit-early, hit-hard') may induce faster reduction of disease activity and prevent chronic disability due to disease-induced structural muscle damage. Intravenous immunoglobulin (IVIg) in addition to standard glucocorticoid treatment may be promising in this regard as was shown in various studies: add-on IVIg improved symptoms and muscle strength in refractory myositis patients and monotherapy IVIg improved outcomes after 9 weeks, in about half of treatment-naive patients. HYPOTHESIS We hypothesise that early add-on IVIg leads to a greater clinical response after 12 weeks in patients with newly diagnosed myositis, in comparison to prednisone monotherapy. Second, we expect that early treatment with add-on IVIg leads to a faster time to improvement and sustained positive effects on multiple secondary outcomes. METHODS The Time Is Muscle trial is a phase-2 double-blind placebo-controlled randomised trial. Forty-eight patients with IIM will be treated with IVIg or placebo at baseline (within 1 week after diagnosis) and after 4 and 8 weeks, in addition to standard therapy with prednisone. The primary outcome is the Total Improvement Score (TIS) of the myositis response criteria at 12 weeks. At baseline, and after 4, 8, 12, 26 and 52 weeks, relevant secondary outcomes will be assessed, including time to moderate improvement (TIS≥40), mean daily prednisone dosage, physical activity, health-related quality of life, fatigue and MRI muscle imaging parameters. ETHICS AND DISSEMINATION Ethical approval was obtained from the medical ethics committee of the Academic Medical Centre, University of Amsterdam, the Netherlands (2020_180; including a first amendment approval at the 12 April 2023; A2020_180_0001). The results will be distributed through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER EU Clinical trials register (2020-001710-37).
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Affiliation(s)
- Renske G Kamperman
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Bogaards
- Department of Epidemiology and Data Science, Amsterdam UMC - Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne W Evers
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hannah A W Walter
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Corianne de Borgie
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jantine C A Colen-de Koning
- Department of Clinical Pharmacy, Amsterdam UMC - Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Camiel Verhamme
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ivo N van Schaik
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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Bertoche MP, Furlanetto KC, Hirata RP, Sartori L, Schneider LP, Mantoani LC, Brito I, Dala Pola DC, Hernandes NA, Pitta F. Assessment of sedentary behaviour in individuals with COPD: how many days are necessary? ERJ Open Res 2023; 9:00732-2022. [PMID: 37650084 PMCID: PMC10463027 DOI: 10.1183/23120541.00732-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/09/2023] [Indexed: 09/01/2023] Open
Abstract
Objective The objective of the present study was to define the minimum number of monitoring days required for the adequate cross-sectional assessment of sedentary behaviour in individuals with chronic obstructive pulmonary disease (COPD). Methods In this cross-sectional study, the sedentary behaviour of individuals with COPD was assessed using two physical activity monitors during awake time for seven consecutive days. Time spent per day in activities requiring ≤1.5 metabolic equivalents (METs) and in sitting, lying and sitting+lying positions was calculated taking into account the average of 7 days (as a reference in all analyses) and of all 119 possible combinations of 2---6 days. Intraclass correlation coefficients (ICCs) and linear regression analyses were performed for all combinations. Results 91 individuals were analysed (47 female, 66±9 years, forced expiratory volume in 1 s 50±15% predicted). For the variables time spent per day in activities ≤1.5METs and sitting, the average of any combination of at least four assessment days was sufficient to adequately reflect the average of 7 days (adjusted R2≥0.929, ICC≥0.962, p<0.0001 for all). For time spent per day lying and sitting+lying, only two assessment days were enough (adjusted R2≥0.937, ICC≥0.968, p<0.0001 for all). Results were maintained independently of patient sex, disease severity, day of the week, daylight time or daytime naps. Conclusions The average of 4 days of objective monitoring was sufficient to adequately reflect the results of a 1-week assessment of the main outcomes related to sedentary behaviour in individuals with moderate to very severe COPD, regardless of sex, disease severity, day of the week, daylight time and occurrence of daytime naps.
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Affiliation(s)
- Mariana Pereira Bertoche
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
- Biological and Health Sciences Research Center, Stricto Sensu Graduate Program in Rehabilitation Sciences, Universidade Pitagoras – UNOPAR, Londrina, Paraná, Brazil
| | - Raquel Pastrello Hirata
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Larissa Sartori
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Lorena Paltanin Schneider
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Leandro Cruz Mantoani
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Igor Brito
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Daniele Caroline Dala Pola
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
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Jesus LADSD, Pinheiro BV, Lucinda LMF, de Oliveira GBGR, Haddad MFPD, Vidigal ABR, Maciel JM, Watanabe LD, Oliveira CC, Reboredo MM. Factors associated with postural balance in patients with end-stage renal disease on hemodialysis. Clin Biomech (Bristol, Avon) 2023; 107:106033. [PMID: 37352608 DOI: 10.1016/j.clinbiomech.2023.106033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/18/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Patients with end-stage renal disease on hemodialysis have postural balance impairments due to uremic syndrome and hemodialysis complications. This study evaluated the factors associated with postural balance in patients on hemodialysis. METHODS This cross-sectional study included patients on hemodialysis [n = 93, 62.0 (16.0) years]. Postural balance was evaluated using a force plate in a static position with eyes opened and eyes closed on a firm surface and with eyes opened on a foam surface to register the center of pressure path length. Physical function was assessed by isometric handgrip force, the 5-repetition sit-to-stand test, and gait speed. The level of physical activity and quality of life were evaluated by accelerometry and the 36-Item Short Form Health Survey, respectively. FINDINGS After adjustment for potential confounders, the multiple linear regression analysis showed that the presence of diabetes mellitus and neurological disease and gait speed were significantly associated with the center of pressure path length in the eyes opened test (R2 = 0.263; p < 0.001). The center of pressure path length in the eyes closed test was significantly associated with the presence of neurological disease (R2 = 0.177; p = 0.002). The center of pressure path length in the eyes opened on a foam surface test was significantly associated with the presence of diabetes mellitus (R2 = 0.223; p < 0.001). INTERPRETATION Poor postural balance was associated with the presence of diabetes mellitus and neurological disease and a slower gait speed in patients on hemodialysis.
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Affiliation(s)
| | - Bruno Valle Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Leda Marília Fonseca Lucinda
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; Barbacena School of Medicine, Barbacena, Minas Gerais, Brazil; Department of Morphology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | | | | | | | | | - Cristino Carneiro Oliveira
- Department of Physiotherapy, Federal University of Juiz de Fora - Governador Valadares, Governador Valadares, Minas Gerais, Brazil; School of Physical Education, Physical Therapy, and Occupational Therapy. Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maycon Moura Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
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Janssen SMJ, van Helvoort HAC, Tjalma TA, Antons JC, Djamin RS, Simons SO, Spruit MA, van 't Hul AJ. Impact of Treatable Traits on Asthma Control and Quality of Life. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1823-1833.e4. [PMID: 36893847 DOI: 10.1016/j.jaip.2023.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/08/2022] [Accepted: 02/26/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Many adult patients with asthma have uncontrolled disease and impaired quality of life, despite current asthma-specific drug therapies. OBJECTIVE This study aimed to investigate the prevalence of 9 traits in patients with asthma, their associations with disease control and quality of life, and referral rates to nonmedical health care professionals. METHODS Retrospectively, data from patients with asthma were collected in 2 Dutch hospitals (Amphia Breda and RadboudUMC Nijmegen). Adult patients without exacerbation <3 months who were referred for a first-ever elective, outpatient, hospital-based diagnostic pathway were deemed eligible. Nine traits were assessed: dyspnea, fatigue, depression, overweight, exercise intolerance, physical inactivity, smoking, hyperventilation, and frequent exacerbations. To assess the likelihood of having poor disease control or decreased quality of life, the odds ratio (OR) was calculated per trait. Referral rates were assessed by checking patients' files. RESULTS A total of 444 adults with asthma were studied (57% women, age: 48 ± 16 years, forced expiratory volume in 1 second: 88% ± 17% predicted). Most patients (53%) were found to have uncontrolled asthma (Asthma Control Questionnaire ≥1.5 points) and decreased quality of life (Asthma Quality of Life Questionnaire <6 points). Generally, patients had 3.0 ± 1.8 traits. Severe fatigue was most prevalent (60%) and significantly increased the likelihood of having uncontrolled asthma (OR: 3.0, 95% confidence interval [CI]: 1.9-4.7) and decreased quality of life (OR: 4.6, 95% CI: 2.7-7.9). Referrals to nonmedical health care professionals were low; most referrals were to a respiratory-specialized nurse (33%). CONCLUSION Adult patients with asthma with a first-ever referral to a pulmonologist frequently exhibit traits justifying the deployment of nonpharmacological interventions, especially in those with uncontrolled asthma. However, referrals to appropriate interventions appeared infrequent.
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Affiliation(s)
- Steffi M J Janssen
- Basalt Rehabilitation Centre, Department of Pulmonary Rehabilitation, Leiden, the Netherlands; Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.
| | - Hanneke A C van Helvoort
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tjitske A Tjalma
- Department of Pulmonary Diseases, Amphia Hospital, Breda, the Netherlands
| | - Jeanine C Antons
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Remco S Djamin
- Department of Pulmonary Diseases, Amphia Hospital, Breda, the Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Department of Research and Development, CIRO, Horn, the Netherlands
| | - Alex J van 't Hul
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Vendetti ML, Esther Moon SJ, Imes CC, Hergenroeder A, Sciurba F, Lendermon E, Pilewski J, Ren D, Parmanto B, Dewhirst B, Willey B, Jones K, Morrell MR, Sanchez P, DeVito Dabbs A. Design of Lung Transplant Go (LTGO): A randomized controlled trial evaluating the efficacy of a telerehabilitation behavioral exercise intervention to improve physical activity, physical function, and blood pressure control after lung transplantation. Contemp Clin Trials Commun 2023; 33:101097. [PMID: 36911577 PMCID: PMC9999171 DOI: 10.1016/j.conctc.2023.101097] [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: 09/15/2022] [Revised: 01/22/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
Background Lung transplantation is an established treatment option for persons with advanced lung disease. After transplantation, lung function typically returns to near normal levels, however exercise capacity remains low due to chronic deconditioning, limited physical function, and inactive lifestyles which undermine the intended benefits of the highly selective, resource-intensive transplant procedure. Pulmonary rehabilitation is recommended to improve fitness and activity tolerance, however due to multiple barriers, lung transplant recipients either never participate, or fail to complete, pulmonary rehabilitation programs. Purpose To describe the design of Lung Transplant Go (LTGO), a trial modified for the remote environment based on recommendations to preserve trial integrity during COVID. The aims are to evaluate a behavioral exercise intervention to improve physical function, physical activity, and blood pressure control in lung transplant recipients conducted safely and effectively using a telerehabilitation (telerehab) platform, and to explore the role of potential mediators and moderators of the relationship between LTGO and outcomes. Methods Single-site, 2-group randomized controlled trial with lung transplant recipients randomized 1:1 to either the LTGO intervention (a 2-phased, supervised, telerehab behavioral exercise program), or to enhanced usual care (activity tracking and monthly newsletters). All study activities, including intervention delivery, recruitment, consenting, assessment, and data collection, will be performed remotely. Conclusion If efficacious, this fully scalable and replicable telerehab intervention could be efficiently translated to reach large numbers of lung recipients to improve and sustain self-management of exercise habits by overcoming barriers to participation in existing, in-person pulmonary rehabilitation programs.
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Affiliation(s)
- Melissa L. Vendetti
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, Pittsburgh, PA, USA
| | - Seol Ju Esther Moon
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, Pittsburgh, PA, USA
| | - Christopher C. Imes
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, Pittsburgh, PA, USA
| | - Andrea Hergenroeder
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Physical Therapy, Pittsburgh, PA, USA
| | - Frank Sciurba
- University of Pittsburgh, School of Medicine, Department of Medicine, Division of Pulmonary Allergy Critical Care Medicine, Pittsburgh, PA, USA
| | - Elizabeth Lendermon
- University of Pittsburgh, School of Medicine, Department of Medicine, Division of Pulmonary Allergy Critical Care Medicine, Pittsburgh, PA, USA
| | - Joseph Pilewski
- University of Pittsburgh, School of Medicine, Department of Medicine, Division of Pulmonary Allergy Critical Care Medicine, Pittsburgh, PA, USA
| | - Dianxu Ren
- University of Pittsburgh, School of Nursing, Department of Health and Community Systems, Pittsburgh, PA, USA
| | - Bambang Parmanto
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Health Information Management, Pittsburgh, PA, USA
| | - Barbara Dewhirst
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, Pittsburgh, PA, USA
| | - Bryan Willey
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, Pittsburgh, PA, USA
| | - Kristen Jones
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, Pittsburgh, PA, USA
| | - Matthew R. Morrell
- University of Utah Health, Internal Medicine, Division of Pulmonary and Critical Care, Salt Lake City, UT, USA
| | - Pablo Sanchez
- University of Pittsburgh, School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Pittsburgh, PA, USA
| | - Annette DeVito Dabbs
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, Pittsburgh, PA, USA
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Minakata Y, Azuma Y, Sasaki S, Murakami Y. Objective Measurement of Physical Activity and Sedentary Behavior in Patients with Chronic Obstructive Pulmonary Disease: Points to Keep in Mind during Evaluations. J Clin Med 2023; 12:jcm12093254. [PMID: 37176694 PMCID: PMC10179547 DOI: 10.3390/jcm12093254] [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: 03/31/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Objective measurement methods using accelerometers have become the mainstream approach for evaluating physical activity (PA) and sedentary behavior (SB). However, several problems face the objective evaluation of PA and SB in patients with chronic obstructive pulmonary disease (COPD). For example, indicators of PA differ depending on whether the accelerometer detects the kind of activity on the one hand, or its intensity on the other. Measured data are also strongly influenced by environmental factors (weather, season, employment status, etc.) and methodological factors (days with uncommon activities, non-wearing time, minimum required wearing time per day, minimum number of valid days required, etc.). Therefore, adjusting for these factors is required when evaluating PA or SB, especially when evaluating the effects of intervention. The exclusion of sleeping time, unification of total measurement time, and minimization of the required wearing time per day might be more important for the evaluation of ST than for evaluating PA. The lying-down-time-to-sitting-time ratio was shown to be larger in COPD patients than in healthy subjects. In this review, we clarified the problems encountered during objective evaluations of PA and SB in patients with COPD and encouraged investigators to recognize the presence of these problems and the importance of adjusting for them.
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Affiliation(s)
- Yoshiaki Minakata
- National Hospital Organization Wakayama Hospital, 1138 Wada, Mihama-Cho, Hidaka-gun, Wakayama 644-0044, Japan
| | - Yuichiro Azuma
- National Hospital Organization Wakayama Hospital, 1138 Wada, Mihama-Cho, Hidaka-gun, Wakayama 644-0044, Japan
| | - Seigo Sasaki
- National Hospital Organization Wakayama Hospital, 1138 Wada, Mihama-Cho, Hidaka-gun, Wakayama 644-0044, Japan
| | - Yusuke Murakami
- National Hospital Organization Wakayama Hospital, 1138 Wada, Mihama-Cho, Hidaka-gun, Wakayama 644-0044, Japan
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Ababneh A, Finlayson K, Edwards H, Armstrong DG, Najafi B, van Netten JJ, Lazzarini PA. The Validity and Reliability of Self-Reported Adherence to Using Offloading Treatment in People with Diabetes-Related Foot Ulcers. SENSORS (BASEL, SWITZERLAND) 2023; 23:4423. [PMID: 37177627 PMCID: PMC10181495 DOI: 10.3390/s23094423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Adherence to using offloading treatment is crucial to healing diabetes-related foot ulcers (DFUs). Offloading adherence is recommended to be measured using objective monitors. However, self-reported adherence is commonly used and has unknown validity and reliability. This study aimed to assess the validity and reliability of self-reported adherence to using removable cast walker (RCW) offloading treatment among people with DFUs. Fifty-three participants with DFUs using RCWs were included. Each participant self-reported their percentage adherence to using their RCW of total daily steps. Participants also had adherence objectively measured using dual activity monitors. After one week, a subset of 19 participants again self-reported their percentage adherence to investigate test-retest reliability. Validity was tested using Pearson's r and Bland-Altman tests, and reliability using Cohen's kappa. Median (IQR) self-reported adherence was greater than objectively measured adherence (90% (60-100) vs. 35% (19-47), p < 0.01). There was fair agreement (r = 0.46; p < 0.01) and large 95% limits of agreement with significant proportional bias (β = 0.46, p < 0.01) for validity, and minimal agreement for test-retest reliability (K = 0.36; p < 0.01). The validity and reliability of self-reported offloading adherence in people with DFU are fair at best. People with DFU significantly overestimate their offloading adherence. Clinicians and researchers should instead use objective adherence measures.
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Affiliation(s)
- Anas Ababneh
- Faculty of Nursing, Applied Science Private University, Amman 11931, Jordan
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Kathleen Finlayson
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Helen Edwards
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - David G. Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jaap J. van Netten
- Department of Rehabilitation Medicine, 1105 AZ Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation and Development, 1105 AZ Amsterdam, The Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Peter A. Lazzarini
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
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Cakmak A, Kocaaga E, Sonbahar-Ulu H, Inal-Ince D, Vardar-Yagli N, Calik-Kutukcu E, Saglam M, Coplu L. Upper Extremity Exercise Capacity and Activities of Daily Living in Individuals With Bronchiectasis Versus Healthy Controls. Phys Ther 2023; 103:pzad012. [PMID: 37086209 PMCID: PMC10155809 DOI: 10.1093/ptj/pzad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/11/2022] [Accepted: 12/04/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the upper extremity exercise capacity and activities of daily living (ADL) in individuals with bronchiectasis and controls. METHODS Twenty-four individuals with bronchiectasis and 24 healthy controls were assessed for upper extremity exercise capacity (6-minute pegboard and ring test [6PBRT]) and ADL (Glittre ADL test). Energy expenditure was measured using a wearable metabolic monitor during the Glittre ADL test. RESULTS The mean [SD] 6PBRT score of individuals with bronchiectasis was significantly lower than the mean score of controls (196.50 [51.75] vs 243.00 [29.76] number of rings). The Glittre ADL test duration was significantly higher in individuals with bronchiectasis compared with controls (3.54 [1.53] vs 2.36 [0.18] minutes), despite similar energy expenditure during the Glittre ADL test between the groups (17.67 [5.28] kcal in individuals with bronchiectasis vs 18.13 [5.71] kcal in controls). The 6PBRT score and the Glittre ADL test duration were negatively correlated in individuals with bronchiectasis (r = -0.694). CONCLUSION The individuals with bronchiectasis had reduced upper extremity exercise capacity compared with healthy controls. Energy expenditure during ADL was similar between individuals with bronchiectasis and healthy controls, despite lower ADL performance in individuals with bronchiectasis. The upper extremity exercise capacity and ADL are related in individuals with bronchiectasis. Given this relationship, inclusion of upper extremity exercise training in pulmonary rehabilitation programs should be considered. IMPACT Considering the impairment of upper extremity exercise capacity and ADL in individuals with bronchiectasis highlights the need to tailor preventive strategies and preclude further unfavorable effects. LAY SUMMARY Bronchiectasis may reduce exercise capacity in your arms and reduce your ability to perform daily living activities. Physical therapists can evaluate your condition and create rehabilitation programs to help manage these impairments.
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Affiliation(s)
- Aslihan Cakmak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Elif Kocaaga
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hazal Sonbahar-Ulu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Lutfi Coplu
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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30
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Hergenroeder AL, Willey B, Vendetti M, Dabbs AD. Exercise Progression Protocol for Lung Transplant GO: A Multicomponent Telerehab Exercise Intervention for Patients After Lung Transplantation. Cardiopulm Phys Ther J 2023; 34:2-12. [PMID: 36644217 PMCID: PMC9838685 DOI: 10.1097/cpt.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lung transplantation is one of the fastest growing solid organ transplant procedures in the United States. After transplantation, lung function typically returns to near normal levels; however, reduced physical function and an inactive lifestyle compromise this benefit. To promote rehabilitation goals, lung transplant recipients (LTRs) are advised to participate in pulmonary rehab, but participation is low due to barriers related to scheduling, travel requirements, lack of insurance coverage, and the concern about exposure to infection. Telerehabilitation offers a flexible alternative with the potential to promote self-management of exercise in LTRs. The purpose of this report was to describe the exercise progression protocol for the Lung Transplant GO multicomponent telerehab exercise intervention for patients after lung transplantation. The progression protocol is an evidence-informed exercise protocol designed to improve physical function and physical activity in LTRs safely and effectively in a remote environment. The protocol standardizes the prescription of exercise while permitting adaptation of the program to meet the needs of the individual. Using this model, the decisions about program progression are systematic, transparent, and replicable to other LTRs.
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Shingai K, Matsuda T, Kondoh Y, Kimura T, Kataoka K, Yokoyama T, Yamano Y, Ogawa T, Watanabe F, Hirasawa J, Reid WD, Kozu R. Physical activity in idiopathic pulmonary fibrosis: Longitudinal change and minimal clinically important difference. Chron Respir Dis 2023; 20:14799731231221818. [PMID: 38108832 DOI: 10.1177/14799731231221818] [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] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Reference values of physical activity to interpret longitudinal changes are not available in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to define the minimal clinical important difference (MCID) of longitudinal changes in physical activity in patients with IPF. METHODS Using accelerometry, physical activity (steps per day) was measured and compared at baseline and 6-months follow-up in patients with IPF. We calculated MCID of daily step count using multiple anchor-based and distribution-based methods. Forced vital capacity and 6-minute walk distance were applied as anchors in anchor-based methods. Effect size and standard error of measurement were used to calculate MCID in distribution-based methods. RESULTS One-hundred and five patients were enrolled in the study (mean age: 68.5 ± 7.5 years). Step count significantly decreased from baseline to 6-months follow-up (-461 ± 2402, p = .031). MCID calculated by anchor-based and distribution-based methods ranged from 570-1358 steps. CONCLUSION Daily step count significantly declined over 6-months in patients with IPF. MCID calculated by multiple anchor-based and distribution-based methods was 570 to 1358 steps/day. These findings contribute to interpretation of the longitudinal changes of physical activity that will assist its use as a clinical and research outcome in patients with IPF.
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Affiliation(s)
- Kazuya Shingai
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Tomoya Ogawa
- Department of Rehabilitation, Tosei General Hospital, Seto, Japan
| | - Fumiko Watanabe
- Department of Rehabilitation, Tosei General Hospital, Seto, Japan
| | - Jun Hirasawa
- Department of Rehabilitation, Tosei General Hospital, Seto, Japan
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Ryo Kozu
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Ramon MA, Esteban C, Ortega F, Cebollero P, Carrascosa I, Martinez-González C, Sobradillo P, Soler-Cataluña JJ, Miravitlles M, García-Río F. Discriminant Validity of a Single Clinical Question for the Screening of Inactivity in Individuals Living with COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:3033-3044. [PMID: 36483675 PMCID: PMC9725925 DOI: 10.2147/copd.s378758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Quantifying physical activity in chronic obstructive pulmonary disease (COPD) with questionnaires and activity monitors in clinical practice is challenging. The aim of the present study was to analyse the discriminant validity of a single clinical question for the screening of inactive individuals living with COPD. Methods A multicentre study was carried out in stable COPD individuals both in primary and tertiary care. Patients wore the Dynaport accelerometer for 8 days and then answered 5 physical activity questions developed for the study, referring to the week in which their physical activity was monitored. Receiver operating characteristic (ROC) curve analysis with physical activity level (PAL) as the gold standard reference was used to determine the best cut-off point for each of the 5 clinical physical activity questions tested. Results A total of 86 COPD participants were analysed (males 68.6%; mean (SD) age 66.6 (8.5) years; FEV1 50.9 (17.3)% predicted; mean of 7305 (3906) steps/day). Forty-two (48.8%) participants were considered physically inactive (PAL ≤1.69). Answers to 4 out of 5 questions significantly differed in active vs inactive patients. The Kappa index and ROC curves showed that the answer to the question "On average, how many minutes per day do you walk briskly?" had the best discriminative capacity for inactivity, with an area under the curve (AUC) (95% Confidence interval (CI)) of 0.73 (0.63-0.84) and 30 min/day was identified as the best cut-off value (sensitivity (95% CI): 0.75 (0.60-0.87); specificity: 0.76 (0.61-0.88)). Conclusion The present results indicate that self-reported brisk walk time lower than 30 min/day may be a valid tool for the screening of inactivity in individuals living with COPD in routine care, if more detailed physical activity measures are not feasible.
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Affiliation(s)
- Maria Antonia Ramon
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus; Physical Therapy Department, Universitat Internacional de Catalunya and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Cristóbal Esteban
- Respiratory Department, Hospital Galdakao; Health Services Research on Chronic Patients Network (REDISSEC) and BioCrues-Bizkaia Health Research Institute, Baracaldo, Spain
| | - Francisco Ortega
- Pneumology Department, Hospital Universitario Virgen del Rocío; Instituto de Biomedicina de Sevilla (IBiS), and CIBER de Enfermedades Respiratorias (CIBERES), Sevilla, Spain
| | - Pilar Cebollero
- Pneumology Department, Hospital CH de Navarra, Pamplona, Spain
| | - Inés Carrascosa
- Pneumology Department, Hospital Urduliz, Urduliz, Bizkaia, Spain
| | | | | | | | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain,Correspondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d´Hebron Barcelona Hospital Campus, P. Vall d’Hebron 119-129, Barcelona, 08035, Spain, Tel +34 934893000, Fax +34 93 274 82 08, Email
| | - Francisco García-Río
- Pneumology Department, Hospital Universitario La Paz-IdiPAZ, and CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Breuls S, Pereira de Araujo C, Blondeel A, Yserbyt J, Janssens W, Wuyts W, Troosters T, Demeyer H. Physical activity pattern of patients with interstitial lung disease compared to patients with COPD: A propensity-matched study. PLoS One 2022; 17:e0277973. [PMID: 36409724 PMCID: PMC9678311 DOI: 10.1371/journal.pone.0277973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Physical activity (PA) is reduced in patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). Evidence about the PA pattern of patients with ILD is scarce. If PA of patients with ILD would be comparable to COPD, it is tempting to speculate that existing interventions focusing on enhancing PA could be as effective in ILD as already shown in COPD. Therefore, we aimed to compare PA and the correlates with PA in matched patients with ILD, COPD, and healthy subjects. MATERIALS AND METHODS Patients with ILD (n = 45), COPD (n = 45) and healthy subjects (n = 30) were propensity matched. PA level, pattern, and PA correlations with lung function and physical performance (6-minute walking distance and quadriceps force) were compared between groups. RESULTS Daily number of steps was similar in both patient groups (mean±SE: 5631±459 for ILD, 5544±547 for COPD, p = 0.900), but significantly lower compared to healthy subjects (10031±536, p<0.001 for both). Mean intensity of PA tended to be lower in the ILD group (mean±SE metabolic equivalents of task per day: 1.41±0.04) compared to COPD (1.52±0.05, p = 0.074) and healthy individuals (1.67±0.04, p<0.001). The pattern of PA over one day was found to be similar between the three groups. Lastly, the correlation between PA and 6-minute walking distance was significantly weaker in patients with ILD compared to patients with COPD (respectively r = 0.348 and r = 0.739; p<0.05 for both). CONCLUSIONS For a given functional reserve, patients with ILD perform an equal amount of steps but perform PA at lower intensity compared to patients with COPD. Both groups are less active compared to healthy control subjects. Functional exercise capacity was shown to be only moderately related to PA. This can potentially influence the effectiveness of PA interventions that can be expected.
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Affiliation(s)
- Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Cintia Pereira de Araujo
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Wim Wuyts
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | | | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- * E-mail:
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Koreny M, Arbillaga-Etxarri A, Bosch de Basea M, Foraster M, Carsin AE, Cirach M, Gimeno-Santos E, Barberan-Garcia A, Nieuwenhuijsen M, Vall-Casas P, Rodriguez-Roisín R, Garcia-Aymerich J. Urban environment and physical activity and capacity in patients with chronic obstructive pulmonary disease. ENVIRONMENTAL RESEARCH 2022; 214:113956. [PMID: 35872322 DOI: 10.1016/j.envres.2022.113956] [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: 03/09/2022] [Revised: 07/09/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Physical activity and exercise capacity are key prognostic factors in chronic obstructive pulmonary disease (COPD) but their environmental determinants are unknown. OBJECTIVES To test the association between urban environment and objective physical activity, physical activity experience and exercise capacity in COPD. METHODS We studied 404 patients with mild-to-very severe COPD from a multi-city study in Catalonia, Spain. We measured objective physical activity (step count and sedentary time) by the Dynaport MoveMonitor, physical activity experience (difficulty with physical activity) by the Clinical visit-PROactive (C-PPAC) instrument, and exercise capacity by the 6-min walk distance (6MWD). We estimated individually (geocoded to the residential address) population density, pedestrian street length, slope of terrain, and long-term (i.e., annual) exposure to road traffic noise, nitrogen dioxide (NO2) and particulate matter (PM2.5). We built single- and multi-exposure mixed-effects linear regressions with a random intercept for city, adjusting for confounders. RESULTS Patients were 85% male, had mean (SD) age 69 (9) years and walked 7524 (4045) steps/day. In multi-exposure models, higher population density was associated with fewer steps, more sedentary time and worse exercise capacity (-507 [95% CI: 1135, 121] steps, +0.2 [0.0, 0.4] h/day and -13 [-25, 0] m per IQR). Pedestrian street length related with more steps and less sedentary time (156 [9, 304] steps and -0.1 [-0.1, 0.0] h/day per IQR). Steeper slope was associated with better exercise capacity (15 [3, 27] m per IQR). Higher NO2 levels related with more sedentary time and more difficulty in physical activity. PM2.5 and noise were not associated with physical activity or exercise capacity. DISCUSSION Population density, pedestrian street length, slope and NO2 exposure relate to physical activity and capacity of COPD patients living in highly populated areas. These findings support the consideration of neighbourhood environmental factors during COPD management and the attention to patients with chronic diseases when developing urban and transport planning policies.
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Affiliation(s)
- Maria Koreny
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Ane Arbillaga-Etxarri
- Physiotherapy Department, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastián, Spain.
| | - Magda Bosch de Basea
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Maria Foraster
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; PHAGEX Research Group, Blanquerna School of Health Science, Universitat Ramon Llull (URL), Barcelona, Spain.
| | - Anne-Elie Carsin
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital Del Mar Medical Research Institute), Spain.
| | - Marta Cirach
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Elena Gimeno-Santos
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
| | - Anael Barberan-Garcia
- University of Barcelona, Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), CIBER Enfermedades Respiratorias (CIBERES), Hospital Clínic, Barcelona, Spain.
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Pere Vall-Casas
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
| | - Robert Rodriguez-Roisín
- University of Barcelona, Institut D'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), CIBER Enfermedades Respiratorias (CIBERES), Hospital Clínic, Barcelona, Spain.
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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Matlary RED, Holme PA, Glosli H, Rueegg CS, Grydeland M. Comparison of free-living physical activity measurements between ActiGraph GT3X-BT and Fitbit Charge 3 in young people with haemophilia. Haemophilia 2022; 28:e172-e180. [PMID: 35830613 PMCID: PMC9796296 DOI: 10.1111/hae.14624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Measurement of physical activity (PA) using commercial activity trackers such as Fitbit devices has become increasingly popular, also for people with haemophilia (PWH). The accuracy of the Fitbit model Charge 3 has not yet been examined. AIMS To compare the Fitbit Charge 3 against the research-grade accelerometer ActiGraph GT3X-BT in measuring average daily steps and minutes spent in different PA intensities. METHODS Twenty-four young PWH wore a wrist-worn Fitbit Charge 3 and hip-worn ActiGraph GT3X-BT simultaneously for seven consecutive days in free-living conditions. Correlation of and differences between the devices for daily averages of PA parameters were assessed using Pearson's correlation coefficient and paired t-test, respectively. Agreement between devices was assessed using Bland-Altman plots. RESULTS Twenty participants (mean age 21.8) were included in the analyses. We found moderate to high correlations between Fitbit and ActiGraph measured daily averages for all PA variables, but statistically significant differences between devices for all variables except daily minutes of moderate PA. Fitbit overestimated average daily steps, minutes of light, vigorous and moderate-to-vigorous PA. Bland-Altman plots showed a measurement bias between devices for all parameters with increasing overestimation by the Fitbit for higher volumes of PA. CONCLUSION The Fitbit Charge 3 overestimated steps and minutes of light, moderate and moderate-to-vigorous PA as compared to the ActiGraph GT3X-BT, and this bias increased with PA volume. The Fitbit should therefore be used with caution in research, and we advise users of the device to be cognizant of this overestimation.
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Affiliation(s)
- Ruth Elise D. Matlary
- Department of HaematologyOslo University HospitalOsloNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Pål André Holme
- Department of HaematologyOslo University HospitalOsloNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Heidi Glosli
- Centre for Rare DisordersOslo University HospitalOsloNorway,Department of Paediatric ResearchOslo University HospitalOsloNorway
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and EpidemiologyOslo University HospitalOsloNorway
| | - May Grydeland
- Department of Physical PerformanceNorwegian School of Sport SciencesOsloNorway
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Daily Physical Activity in Asthma and the Effect of Mepolizumab Therapy. J Pers Med 2022; 12:jpm12101692. [PMID: 36294831 PMCID: PMC9605576 DOI: 10.3390/jpm12101692] [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: 08/16/2022] [Revised: 09/15/2022] [Accepted: 10/08/2022] [Indexed: 01/24/2023] Open
Abstract
For the various asthma-specific beneficial effects of physical activity, daily physical activity (DPA) and the potential of asthma therapies on DPA require better characterization. Hence, we aimed to determine (a) the DPA of asthma patients, and (b) the effect of add-on mepolizumab on the DPA of severe asthma patients. Methods: Adult outpatients with mild-to-moderate or severe asthma had accelerometer assessment of DPA. Severe asthma patients who were commenced on mepolizumab had their DPA reassessed after 12 months. Results: For the total cohort (n = 36), daily step count, time in moderate-to-vigorous physical activity (MVPA), MVPA volume and Movement Intensity (MI) were 7806 ± 3823 steps, 123 (interquartile range, 63) min, 657 ± 255 MET·min and 1.96 (0.45) m/s2, respectively. All patients met at least one recommendation for DPA but less than half met recommendations for vigorous DPA. Patients on mepolizumab therapy increased daily step count (646 steps; 9%), time in MVPA (20 min; 21%), MVPA volume (87 MET·min; 17%) and MI (0.11 m/s2; 6%) for the same amount of moving time; lung function, asthma control and health-related quality of life also improved. Conclusions: Analysis of the first national data on DPA in asthma and novel comparison against current applicable guidelines and identified beneficial thresholds showed borderline levels of DPA with room for improvement especially for severe asthma patients. In a non-sedentary cohort of severe asthma patients, mepolizumab conferred significant and meaningful improvements in DPA.
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37
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Xiang X, Huang L, Fang Y, Cai S, Zhang M. Physical activity and chronic obstructive pulmonary disease: a scoping review. BMC Pulm Med 2022; 22:301. [PMID: 35932050 PMCID: PMC9354440 DOI: 10.1186/s12890-022-02099-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Reduced physical activity (PA) was the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease (COPD). This scoping review aimed to map the evidence on the current landscape of physical activity, barriers and facilitators, and assessment tools across COPD patients. Methods Arksey and O’Malley’s scoping review methodology framework guided the conduct of this review. An electronic search was conducted on five English databases (PubMed, Cochrane Library, PsycINFO, CINAHL and Web of Science) and three Chinese databases (CNKI, CQVIP and WAN-FANG) in January 2022. Two authors independently screened the literature, extracted the studies characteristics. Results The initial search yielded 4389 results, of which 1954 were duplicates. Of the remaining 135 articles, 42 studies met the inclusion criteria. Among the reviewed articles, there were 14 (33.3%) cross-sectional study, 9 (21.4%) cohort study, 4 (9.5%) longitudinal study, 3 qualitative study, 12 (28.7%) randomized control trials. The main barriers identified were older age, women, lung function, comorbidities, COPD symptoms (fear of breathlessness and injury, severe fatigue, anxiety and depression), GOLD stage, frequency of exacerbation, oxygen use, lack of motivation and environment-related (e.g., season and weather). Twelve studies have evaluated the effects of physical exercise (e.g., walking training, pulmonary rehabilitation (PR), pedometer, self-efficacy enhancing intervention and behavioral modification intervention) on PA and showed significant positive effects on the prognosis of patients. However, in real life it is difficult to maintain PA in people with COPD. Conclusions Changing PA behavior in patients with COPD requires multidisciplinary collaboration. Future studies need to identify the best instruments to measure physical activity in clinical practice. Future studies should focus on the effects of different types, time and intensity of PA in people with COPD and conduct randomized, adequately-powered, controlled trials to evaluate the long-term effectiveness of behavioral change interventions in PA. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02099-4.
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Affiliation(s)
- Xinyue Xiang
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
| | - Yong Fang
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shasha Cai
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mingyue Zhang
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Kuhn M, Kohlbrenner D, Sievi NA, Clarenbach CF. Increasing Daily Physical Activity and Its Effects on QTc Time in Severe to Very Severe COPD: A Secondary Analysis of a Randomised Controlled Trial. COPD 2022; 19:339-344. [PMID: 36166273 DOI: 10.1080/15412555.2022.2101992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Approximately, half of COPD patients die from cardiovascular diseases. A prolongation of cardiac repolarization (measured as QTc interval) is associated with cardiovascular events or cardiovascular deaths in populations of older adults and COPD. One way to reduce the QTc could be to increase physical activity (PA). We investigated whether QTc can be reduced by an increase in PA in patients with severe COPD. This is a secondary outcome analysis from a randomized controlled trial investigating the effects of a 3 months pedometer based program to improve PA. 12-lead ECG was assessed at baseline and after 3 months. We measured PA using a validated triaxial accelerometer. Data were analyzed from 59 participants. Multiple regression modeling, including adjustment for baseline QTc, sex, QT prolonging medications, BMI, smoking status and FEV1%, showed no evidence for an association between an improvement of ≥15% PA and QTc reduction. A 15% improvement in PA according to step counts over 3 months seems not to reduce QTc interval by its MCID of 20 ms in patients with severe to very severe COPD.
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Affiliation(s)
- Manuel Kuhn
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Dario Kohlbrenner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Souto-Miranda S, van ‘t Hul AJ, Vaes AW, Antons JC, Djamin RS, Janssen DJA, Franssen FME, Marques A, Spruit MA. Differences in Pulmonary and Extra-Pulmonary Traits between Women and Men with Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11133680. [PMID: 35806965 PMCID: PMC9267757 DOI: 10.3390/jcm11133680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Evidence suggests sex-related differences in chronic obstructive pulmonary disease (COPD). Whether these differences are reflected in the prevalence of treatable traits remains unknown. Methods: Two samples of patients referred to secondary (n = 530) or tertiary care (n = 2012) were analyzed. Men and women were matched for age, forced expiratory volume in 1 s and body mass index. Sex-related differences were tested using t-tests, Mann-Whitney U, or chi-square tests. Results: Frequent exacerbations (30.5 vs. 19.7%), high cardiovascular risk (88.1 vs. 66.2%) and activity-related severe dyspnea (50.9 vs. 34.8%) were more prevalent in women in secondary care (p < 0.05). Severe hyperinflation (43.0 vs. 25.4%), limited diffusing capacity (79.6 vs. 70.1%), impaired mobility (44.0 vs. 28.7%), frequent exacerbations (66.8 vs. 57.4%), frequent hospitalizations (47.5 vs. 41.6%), severe activity-related dyspnea (89.1 vs. 85.0%), symptoms of anxiety (56.3 vs. 42.0%) and depression (50.3 vs. 44.8%), and poor health status (79.9 vs. 71.0%) were more prevalent in women in tertiary care (p < 0.05). Severe inspiratory muscle weakness (14.6 vs. 8.2%) and impaired exercise capacity (69.1 vs. 59.6%) were more prevalent among men (p < 0.05) in tertiary care. Conclusions: Sex-related differences were found, with most traits more prevalent and severe among women. Care providers should be aware of these differences to adjust treatment.
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Affiliation(s)
- Sara Souto-Miranda
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Respiratory Research and Rehabilitation Laboratory (Lab3R) and Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal;
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Correspondence:
| | - Alex J. van ‘t Hul
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.J.v.‘t.H.); (J.C.A.)
| | - Anouk W. Vaes
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
| | - Jeanine C. Antons
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.J.v.‘t.H.); (J.C.A.)
| | - Remco S. Djamin
- Department of Respiratory Diseases, Amphia Hospital, 4818 CK Breda, The Netherlands;
| | - Daisy J. A. Janssen
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, 6226 NB Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R) and Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
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Antoniou V, Xanthopoulos A, Giamouzis G, Davos C, Batalik L, Stavrou V, Gourgoulianis KI, Kapreli E, Skoularigis J, Pepera G. Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol. BMJ Open 2022; 12:e059945. [PMID: 35738643 PMCID: PMC9226468 DOI: 10.1136/bmjopen-2021-059945] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness. METHODS AND ANALYSIS A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20 min plus 20 min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6 min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks). ETHICS AND DISSEMINATION The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05019157.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
| | | | - Gregory Giamouzis
- Cardiology, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Constantinos Davos
- Cardiovascular Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Masaryk University Brno, Brno, Czech Republic
| | - Vasileios Stavrou
- Laboratory of Cardio-Pulmonary Testing, Department of Respiratory Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Laboratory of Cardio-Pulmonary Testing, Department of Respiratory Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
| | - John Skoularigis
- Cardiology, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
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Vaes AW, Spruit MA, Koolen EH, Antons JC, de Man M, Djamin RS, van Hees HWH, van 't Hul AJ. "Can Do, Do Do" Quadrants and 6-Year All-Cause Mortality in Patients With COPD. Chest 2022; 161:1494-1504. [PMID: 35026297 DOI: 10.1016/j.chest.2021.12.657] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Physical capacity (PC; "can do") and physical activity (PA; "do do") are prognostic indicators in COPD and can be used to subdivide patients with COPD into four exclusive subgroups (the so-called "can do, do do" quadrants). This concept may be useful to understand better the impact of PC and PA on all-cause mortality in patients with COPD. RESEARCH QUESTION What is the 6-year all-cause mortality risk of the "can do, do do" quadrants of patients with COPD? STUDY DESIGN AND METHODS This retrospective study used data from patients with COPD who underwent a comprehensive assessment at their first-ever outpatient consultation. PC was assessed using the 6-min walk distance and physical activity was assessed using an accelerometer (steps per day). All-cause mortality data were obtained from the Municipal Personal Records Database. Receiver operating characteristic curves were used to determine threshold values for PC and PA to predict 6-year all-cause mortality. Using the derived threshold values, male and female patients were divided into the four "can do, do do" quadrants. RESULTS Data from 829 patients were used for analyses. Best discriminatory values for 6-year mortality were 404 m and 4,125 steps/day for men and 394 m and 4,005 steps/day for women. During a median follow-up of 55 months (interquartile range, 37-71 months), 129 patients (15.6%) died. After controlling for established prognostic factors, patients in the "can do, don't do" quadrant and "can do, do do" quadrant showed significantly lower mortality risk compared with patients in the "can't do, don't do" quadrant: hazard ratios of 0.36 (95% CI, 0.14-0.93) and 0.24 (95% CI, 0.09-0.61) for men and 0.37 (95% CI, 0.38-0.99) and 0.29 (95% CI, 0.10-0.87) for women, respectively. No significant differences were found between the "can't do, do do" and "can't do, don't do" quadrants. INTERPRETATION Patients with COPD with a preserved PC seem to have a significantly lower 6-year mortality risk compared with patients with a decreased PC, regardless of physical activity level.
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Affiliation(s)
- Anouk W Vaes
- Department of Research and Education, Ciro, Horn, The Netherlands.
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Eleonore H Koolen
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeanine C Antons
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marianne de Man
- Department of Pulmonary Diseases, Bernhoven, Uden, The Netherlands
| | - Remco S Djamin
- Department of Pulmonary Diseases, Amphia Hospital, Breda, The Netherlands
| | - Hieronymus W H van Hees
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alex J van 't Hul
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Chen CK, Cheng LY, Hsu SW, Liao MT, Ku PW, Liu YB. Comparative Analysis of Physical Activity Detected via an External Accelerometer and Cardiac Implantable Electronic Devices. Front Cardiovasc Med 2022; 9:898086. [PMID: 35694655 PMCID: PMC9184442 DOI: 10.3389/fcvm.2022.898086] [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: 03/16/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPhysical activity (PA) has become an important health issue for decades. Cardiovascular implantable electronic devices (CIEDs) have built-in PA-recording functions. We aimed to compare PA measurements using an external accelerometer (ActiGraph GT3X+) and internal accelerometers (Abbott, Biotronik, and Medtronic CIEDs).MethodsThis was a prospective, single-center observational study. The device-measured 7-day average PA was collected, and GT3X+ -measured 7-day average PA was used as the gold-standard, including all daily observations of activity. Pearson’s correlation coefficients were used to compare the correlations between GT3X+ -measured and CIED-measured PA. Bland-Altman plots were used to analyze measurement agreement, and intraclass correlation coefficients were used to analyze reliability.ResultsIn total, 720 patients treated with CIEDs were surveyed between November 2020 and April 2021, 60 of them were analyzed after patient screening by our protocol. Each manufacturer included 20 patients for the final analysis. The CIED-measured PAs of Abbott, Biotronik, and Medtronic were 3.0 ± 1.5, 2.6 ± 1.8, and 3.8 ± 2.5 h per day, respectively; the GT3X+ -measured PAs were 6.9 ± 2.8, 6.0 ± 2.4, and 6.4 ± 2.5 h per day, respectively. Moderate and significant correlations were found in patients using Abbott, Biotronik, and Medtronic CIEDs (r = 0.534, p = 0.015; r = 0.465, p = 0.039; r = 0.677, p = 0.001, respectively). Bland-Altman plots and intraclass correlation coefficients both showed a significant correlation and reliability between the average PA measured by GT3X+ and CIEDs (hours per day).ConclusionAlthough the PA recording function of CIEDs includes a single-axis accelerometer, it has a moderate correlation compared with the triaxial accelerometer of the GT3X+. However, CIEDs seem to underestimate PA for 3–4 h compared to the GT3X+.
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Affiliation(s)
- Chun-Kai Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Li-Ying Cheng
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shan-Wei Hsu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- *Correspondence: Min-Tsun Liao,
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, Taichung, Taiwan
| | - Yen-Bin Liu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Holland AE, Jones AW, Mahal A, Lannin NA, Cox N, Hepworth G, O'Halloran P, McDonald CF. Implementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e057311. [PMID: 35410931 PMCID: PMC9003613 DOI: 10.1136/bmjopen-2021-057311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model. METHOD AND ANALYSIS This is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial. ETHICS AND DISSEMINATION Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies. TRIAL REGISTRATION NUMBER NCT04217330.
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Affiliation(s)
- Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ajay Mahal
- The Nossal Global Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Natasha A Lannin
- Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Allied Health (Occupational Therapy), Alfred Health, Melbourne, Victoria, Australia
| | - Narelle Cox
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul O'Halloran
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Daniel CR, Yazbek P, Santos ACA, Battistella LR. Validity study of a triaxial accelerometer for measuring energy expenditure in stroke inpatients of a physical medicine and rehabilitation center. Top Stroke Rehabil 2022; 30:402-409. [PMID: 35383539 DOI: 10.1080/10749357.2022.2058292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital. METHODS This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement. RESULTS An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer. CONCLUSION Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise.
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Affiliation(s)
- Christiane Riedi Daniel
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.,Departamento de Fisioterapia, Universidade Estadual do Centro Oeste, Gruarapuava, Brazil
| | - Paulo Yazbek
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Artur Cesar Aquino Santos
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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Blondeel A, Demeyer H, Ceulemans LJ, Coolen J, Everaerts S, Geysen H, Verleden GM, Van Raemdonck D, Dooms C, Troosters T, Janssens W. The impact of endoscopic lung volume reduction on physical activity coaching in patients with severe emphysema. ERJ Open Res 2022; 8:00150-2022. [PMID: 35769416 PMCID: PMC9234426 DOI: 10.1183/23120541.00150-2022] [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: 12/23/2021] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Endoscopic lung volume reduction (ELVR) aims to improve pulmonary function in severe emphysema. Physical activity (PA) coaching is expected to improve daily life PA. When improving ventilatory constrains in severe COPD, a better response to PA coaching is expected. The present study investigated the impact of PA coaching in addition to ELVR in severe emphysema. Methods Patients allocated, based on fissure integrity, in the ELVR or no-ELVR cohort, received the PA coaching intervention with a step counter and smartphone application from 3 to 6 months follow-up. The primary end-point of this research question was the change in daily step count from baseline to 6 months follow-up compared between the ELVR and no-ELVR cohort. The secondary end-points were time spent in moderate to vigorous PA, movement intensity and patient-reported experience with PA between ELVR and no-ELVR. Results At 6 months, PA in both ELVR+coaching (1479±460 steps·day-1; p=0.001) and no-ELVR+coaching (1910±663 steps·day-1; p=0.004) improved within group, without significant between-group differences (-405±781 steps·day-1; p=0.60). Patients in the ELVR group tended to experience less difficulty with PA compared to no-ELVR+coaching (7±4 points, p=0.08). Conclusion We found that PA coaching is feasible and can help to enhance PA in patients with severe emphysema. Improving the ventilatory capacity through ELVR is not a prerequisite for a successful coaching intervention to increase objectively measured PA, although it alleviates patients' experienced difficulty with PA in those with severe COPD.
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Affiliation(s)
| | - Heleen Demeyer
- Dept of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Dept of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Laurens J. Ceulemans
- Clinical Dept of Thoracic Surgery, University Hospitals Leuven, BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Johan Coolen
- Clinical Dept of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Everaerts
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE Dept CHROMETA, KU Leuven, Leuven, Belgium
| | - Hannelore Geysen
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE Dept CHROMETA, KU Leuven, Leuven, Belgium
| | - Geert M. Verleden
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE Dept CHROMETA, KU Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Clinical Dept of Thoracic Surgery, University Hospitals Leuven, BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Christophe Dooms
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE Dept CHROMETA, KU Leuven, Leuven, Belgium
| | | | - Wim Janssens
- Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE Dept CHROMETA, KU Leuven, Leuven, Belgium
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Chaplin E, Barnes A, Newby C, Houchen-Wolloff L, Singh SJ. Comparison of the Impact of Conventional and Web-Based Pulmonary Rehabilitation on Physical Activity in Patients With Chronic Obstructive Pulmonary Disease: Exploratory Feasibility Study. JMIR Rehabil Assist Technol 2022; 9:e28875. [PMID: 35266871 PMCID: PMC8949713 DOI: 10.2196/28875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/24/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Pulmonary Rehabilitation (PR) increases exercise capacity, with less clear evidence regarding physical activity (PA). The World Health Organization recommends at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA per week to reduce the risks of chronic disease. Objective The objective of this study was to assess the effectiveness of conventional PR versus web-based PR with respect to changes in PA. Methods Patients with COPD were randomized to either conventional PR classes (n=51) or a web-based PR program (n=52) for 7 weeks in a feasibility study. Accelerometers (Sensewear) were worn before and after the intervention, and PA was measured as steps per day and mean bouts of moderate activity for ≥2, ≥5, ≥10, and ≥20 minutes. Measures were derived for patients with ≥8 hours of data per day for ≥4 days, using the R package for statistical analysis. Variables were explored to examine their relationships with bouts of activity. Results Baseline characteristics did not differ significantly between groups. Complete PA data were available for the groups receiving web-based (n=20) and conventional (n=34) PR interventions. The web-based PR group demonstrated a nonsignificant increase in the number of steps per day, which mainly comprised short bouts of moderate to vigorous intensity PA when compared to the conventional PR group (P=.20). The conventional PR group demonstrated increased 20-minute bouts of PA by 49.1%, although this was not significant (P=.07). At baseline, age (r=–0.21, P=.04), BMI (r=–0.311, P=.004), and FEV1 (forced expiratory volume in 1 second; % predicted; r=–0.248, P=.048) were significantly correlated with 10-minute bouts of PA; however, this was not observed post intervention. Conclusions The analysis revealed a nonsignificant difference in the pattern of PA between groups receiving conventional vs web-based PR—the former being associated with an increase in 20-minute bouts, while the latter having demonstrated an increase in the number of steps per day. There appears to be a differing response emerging between the two interventions. Trial Registration International Clinical Trials Registry ISRCTN03142263; https://tinyurl.com/y4dmfyrb
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Affiliation(s)
- Emma Chaplin
- Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre- Respiratory, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Amy Barnes
- Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre- Respiratory, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Chris Newby
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre- Respiratory, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom.,Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre- Respiratory, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom.,Respiratory Sciences, University of Leicester, Leicester, United Kingdom
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Thyregod M, Løkke A, Skou ST, Larsen J, Bodtger U. Changes in systemic inflammation after pulmonary rehabilitation in patients with COPD and severe physical inactivity - an exploratory study. Chron Respir Dis 2022; 19:14799731221112439. [PMID: 36113167 PMCID: PMC9483968 DOI: 10.1177/14799731221112439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Severe physical inactivity (SPI) in patients with COPD is associated
with a poor prognosis. It is unknown whether there is a link between SPI and
systemic inflammation, and if systemic inflammation in SPI changes following
pulmonary rehabilitation (PR). Methods: A prospective, observational study of patients referred for at least
7 weeks of PR comprising 2 h of exercise therapy and education twice weekly. At
baseline and after PR, daily physical activity level (PAL) was measured with a
validated activity monitor, SenseWear® as well as systemic
inflammation: b-eosinophils, p-fibrinogen, p-CRP, s-IL-6 and s-CD 163. SPI was
defined as PAL <1.4. Results: At baseline, SPI was present in 31 of the 57 patients included, and 23%
(7/31) improved to non-SPI after PR. We observed no differences between patients
with SPI and non-SPI, except baseline plasma fibrinogen level was slightly yet
significantly higher in patients with SPI (median 13.3 [6.2–23.6] vs 11.2
[6.5–16.7] µmol/l) but change in fibrinogen levels differed insignificantly
between patients who improved to non-SPI at follow-up compared to patients with
persistent SPI (−0.6 [−16.9–9.9] vs −0.4 [−11.2–1.2] µmol/l). Conclusion: SPI in COPD appears not to be associated with a distinct inflammatory
profile compared to less sedentary COPD patients attending pulmonary
rehabilitation. Currently biomarkers have no role in the detection of SPI in
COPD.
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Affiliation(s)
- Mimi Thyregod
- Department of Respiratory Medicine, 91907Naestved Hospital, Nastved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, 4321Little Belt Hospital University, Vejle, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, 573169University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Jacob Larsen
- Department of Pathology, 53140Zealand University Hospital, Roskilde, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, 91907Naestved Hospital, Nastved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
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Motivational regulations and lifestyle in muscle-wasted COPD patients undergoing pulmonary rehabilitation. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Pimenta S, Silva CG, Flora S, Hipólito N, Burtin C, Oliveira A, Morais N, Brites-Pereira M, Carreira BP, Januário F, Andrade L, Martins V, Rodrigues F, Brooks D, Marques A, Cruz J. What Motivates Patients with COPD to Be Physically Active? A Cross-Sectional Study. J Clin Med 2021; 10:5631. [PMID: 34884333 PMCID: PMC8658241 DOI: 10.3390/jcm10235631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 01/03/2023] Open
Abstract
Motivation can be broadly defined as what moves people to act. Low motivation is a frequently reported factor for the reduced physical activity (PA) levels observed in patients with chronic obstructive pulmonary disease (COPD). This study assessed patients' motives to be physically active, according to three pulmonary rehabilitation (PR) participation groups (Never PR, Previous PR and Current PR) and explored whether these motives were related to the PA levels and clinical characteristics. The motives to be physically active were assessed with the Exercise Motivation Inventory-2 (EMI-2, 14 motivational factors, five dimensions) and PA with accelerometry (PA groups: <5000 steps/day vs. ≥5000 steps/day). The clinical variables included symptoms, impact of the disease, exercise capacity and comorbidities. Ninety-two patients (67.4 ± 8.1 years, 82.6% male, forced expiratory volume in 1s (FEV1) 48.3 ± 18.9% predicted; 30.4% Never PR, 51% Previous PR and 18.5% Current PR) participated. The motivational dimensions related to health/fitness presented the highest scores (3.8 ± 1.1; 3.4 ± 1.3). The motives to be active were not significantly different between PA groups (p > 0.05) but having less symptoms and ≥two comorbidities were associated with higher scores in psychological/health and body-related motives, respectively (p < 0.05). The findings may encourage health professionals to actively explore with patients their motives to be physically active to individualise PA promotion.
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Affiliation(s)
- Sara Pimenta
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal; (S.P.); (C.G.S.); (S.F.); (N.H.); (N.M.); (M.B.-P.); (B.P.C.)
- School of Health Sciences (ESSLei), Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Cândida G. Silva
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal; (S.P.); (C.G.S.); (S.F.); (N.H.); (N.M.); (M.B.-P.); (B.P.C.)
- School of Health Sciences (ESSLei), Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Coimbra Chemistry Centre, Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal
| | - Sofia Flora
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal; (S.P.); (C.G.S.); (S.F.); (N.H.); (N.M.); (M.B.-P.); (B.P.C.)
| | - Nádia Hipólito
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal; (S.P.); (C.G.S.); (S.F.); (N.H.); (N.M.); (M.B.-P.); (B.P.C.)
| | - Chris Burtin
- REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium;
- BIOMED—Biomedical Research Institute, Hasselt University, B-3590 Diepenbeek, Belgium
| | - Ana Oliveira
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.O.); (D.B.)
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada
- Lab 3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Nuno Morais
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal; (S.P.); (C.G.S.); (S.F.); (N.H.); (N.M.); (M.B.-P.); (B.P.C.)
- School of Health Sciences (ESSLei), Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Centre for Rapid and Sustainable Product Development (CDRSP), Polytechnic of Leiria, 2430-028 Leiria, Portugal
| | - Marcelo Brites-Pereira
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal; (S.P.); (C.G.S.); (S.F.); (N.H.); (N.M.); (M.B.-P.); (B.P.C.)
| | - Bruno P. Carreira
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal; (S.P.); (C.G.S.); (S.F.); (N.H.); (N.M.); (M.B.-P.); (B.P.C.)
- School of Health Sciences (ESSLei), Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Unidade de Saúde Familiar Pedro e Inês, ACeS Oeste Norte, 2460-492 Alcobaça, Portugal
| | - Filipa Januário
- Physical Medicine and Rehabilitation Department, Leiria Hospital Center, 2410-197 Leiria, Portugal;
| | - Lília Andrade
- Pulmonology Department, Baixo Vouga Hospital Center, 3810-501 Aveiro, Portugal;
| | - Vitória Martins
- Pulmonology Department, District Hospital of Figueira da Foz, 3094-001 Figueira da Foz, Portugal;
| | - Fátima Rodrigues
- Pulmonology Department, Northern Lisbon University Hospital Centre (CHULN), 1769-001 Lisboa, Portugal;
- Environmental Health Behaviour Lab, Faculty of Medicine, University of Lisbon (ISAMB/FMUL), 1649-028 Lisboa, Portugal
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.O.); (D.B.)
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada
| | - Alda Marques
- Lab 3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal; (S.P.); (C.G.S.); (S.F.); (N.H.); (N.M.); (M.B.-P.); (B.P.C.)
- School of Health Sciences (ESSLei), Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Lab 3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
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Han X, Li P, Yang Y, Liu X, Xia J, Wu W. An Exploration of the Application of Step Counter-Based Physical Activity Promotion Programs in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review. Front Public Health 2021; 9:691554. [PMID: 34631641 PMCID: PMC8495070 DOI: 10.3389/fpubh.2021.691554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This paper aimed to systematically review the application methods and components of step counter-based physical activity (PA) promotion programs in patients with chronic obstructive pulmonary disease (COPD). The effects of longer-duration (≥12 weeks) programs on PA, exercise capacity, quality of life, and dyspnea were discussed. Methods: This review was performed in accordance with the preferred reporting items for systematic reviews and meta-analysis. Online data resources PubMed, Web of Science, Embase, and EBSCO were searched. The publication year was limited between January 2000 to August 2020. All randomized controlled trials with ≥12-week duration of step counter-based PA promotion programs of COPD were included. Two researchers independently assessed the quality of the included studies and extracted their characteristics. Results: Nine studies involving 1,450 participants were included. Step counters, counseling, exercise goals, diaries, and tele-communicational approaches were common components of these programs. The PA feedback tools were mostly pedometers (n = 8), whereas accelerometers were often used as assessment tools of PA (n = 5). All studies implemented counseling: five applied behavioral change theories, and three reported motivational interview techniques simultaneously. Six studies reported detailed exercise goals. The usual exercise goal was to reach a total of 8,000–10,000 steps/day. Three research studies used diaries, and five applied tele-communication approaches to deliver interventions. The programs could be implemented alone (n = 4), in combination with exercise training (n = 2), or with pulmonary rehabilitation (n = 2). All studies showed a significant increase in the PA (≥793 steps/day). Three studies observed a significant improvement in exercise capacity (≥13.4 m), and two reported a significant increase in the quality of life (p < 0.05). No study showed significant between-group differences in dyspnea. Conclusion: There are a few studies assessing the impact of long-duration (≥12 weeks) step counter-based interventions in COPD, with different methodologies, although all studies included counseling and exercise goal setting. These interventions seem to have a positive effect on PA. A few studies also showed benefit on exercise capacity and quality of life.
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Affiliation(s)
- Xiaoyu Han
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yahui Yang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Xia
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
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