1
|
Daros Dos Santos T, Pasqualoto AS, Cardoso DM, Da Cruz IBM, Moresco RN, Ferreira da Silveira A, Martins de Albuquerque I. Effects of multimodal exercise program on postural balance in patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial. Trials 2023; 24:532. [PMID: 37580800 PMCID: PMC10426202 DOI: 10.1186/s13063-023-07558-9] [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: 09/28/2022] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Evidence has shown that patients with chronic obstructive pulmonary disease present significant deficits in the control of postural balance when compared to healthy subjects. In view of this, it is pertinent to investigate the effects of different therapeutic strategies used alone or in association with pulmonary rehabilitation with the potential to improve postural balance and other outcomes with clinical significance in patients with chronic obstructive pulmonary disease. This study will investigate the effects of an 8-week (short-term) multimodal exercise program [inspiratory muscle training (IMT) plus neuromuscular electrical stimulation (NMES)] on postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program compared to individualized addition of IMT or NMES to pulmonary rehabilitation or standard pulmonary rehabilitation. METHODS This is a randomized, single-blind, 4-parallel-group trial. Forty patients with chronic obstructive pulmonary disease will be included prospectively to this study during a pulmonary rehabilitation program. Patients will be randomly assigned to one of four groups: multimodal exercise program (IMT + NMES + pulmonary rehabilitation group) or (IMT + pulmonary rehabilitation group) or (NMES + pulmonary rehabilitation group) or standard pulmonary rehabilitation group. Patients will receive two sessions per week for 8 weeks. The primary outcome will be static postural balance and secondary outcomes will include as follows: static and dynamic postural balance, fear of falling, muscle strength and endurance (peripheral and respiratory), functional capacity, health-related quality of life, muscle architecture (quadriceps femoris and diaphragm), and laboratory biomarkers. DISCUSSION This randomized clinical trial will investigate the effects of adding of short-term multimodal exercise program, in addition to pulmonary rehabilitation program, in postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation. Furthermore, this randomized control trial will enable important directions regarding the effectiveness of short-term intervention as part of the need to expand the focus of pulmonary rehabilitation to include balance management in chronic obstructive pulmonary disease patients which will be generated. TRIAL REGISTRATION ClinicalTrials.gov NCT04387318. Registered on May 13, 2020.
Collapse
Affiliation(s)
- Tamires Daros Dos Santos
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria (UFSM), Avenida Roraima, 1000, Santa Maria, 97105-900, Brazil
| | - Adriane Schmidt Pasqualoto
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria (UFSM), Avenida Roraima, 1000, Santa Maria, 97105-900, Brazil
| | - Dannuey Machado Cardoso
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, 90010-150, Brazil
- Centro de Ensino Superior Dom Alberto, Santa Cruz do Sul, Brazil
| | - Ivana Beatrice Mânica Da Cruz
- Programa de Pós-Graduação em Farmacologia e Programa de Pós-Graduação em Gerontologia, Universidade Federal de Santa Maria (UFSM), Avenida Roraima, 1000, Santa Maria, 97105-900, Brazil
| | - Rafael Noal Moresco
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal de Santa Maria (UFSM), Avenida Roraima, 1000, Santa Maria, 97105-900, Brazil
| | - Aron Ferreira da Silveira
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria (UFSM), Avenida Roraima, 1000, Santa Maria, 97105-900, Brazil
| | - Isabella Martins de Albuquerque
- Programa de Pós-Graduação em Ciências do Movimento e Reabilitação, Universidade Federal de Santa Maria (UFSM), Avenida Roraima, 1000, Santa Maria, 97105-9000, Brazil.
| |
Collapse
|
2
|
Rassam P, Pazzianotto-Forti EM, Matsumura U, Orchanian-Cheff A, Aliabadi S, Kulkarni M, Fat Fur RL, Rodrigues A, Langer D, Rozenberg D, Reid WD. Impact of cognitive capacity on physical performance in chronic obstructive pulmonary disease patients: A scoping review. Chron Respir Dis 2023; 20:14799731231163874. [PMID: 37029090 PMCID: PMC10087654 DOI: 10.1177/14799731231163874] [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: 04/09/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by impaired cognitive and physical function. However, the role of cognitive function on motor control and purposeful movement is not well studied. The aim of the review was to determine the impact of cognition on physical performance in COPD. Methods: Scoping review methods were performed including searches of the databases: MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane (CENTRAL), APA PsycINFO, and CINAHL. Two reviewers independently assessed articles for inclusion, data abstraction, and quality assessment. Results: Of 11,252 identified articles, 44 met the inclusion criteria. The review included 5743 individuals with COPD (68% male) with the forced expiratory volume in one second range of 24-69% predicted. Cognitive scores correlated with strength, balance, and hand dexterity, while 6-min walk distance (n = 9) was usually similar among COPD patients with and without cognitive impairment. In 2 reports, regression analyses showed that delayed recall and the trail making test were associated with balance and handgrip strength, respectively. Dual task studies (n = 5) reported impaired balance or gait in COPD patients compared to healthy adults. Cognitive or physical Interventions (n = 20) showed variable improvements in cognition and exercise capacity. Conclusions: Cognition in COPD appears to be more related to balance, hand, and dual task function, than exercise capacity.
Collapse
Affiliation(s)
- Peter Rassam
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
| | | | - Umi Matsumura
- Department of Health Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Ani Orchanian-Cheff
- Library and Information Services, 7989University Health Network, Toronto, ON, Canada
| | - Saina Aliabadi
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, 7989University Health Network, Toronto, ON, Canada
| | - Manjiri Kulkarni
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
| | | | - Antenor Rodrigues
- Department of Critical Care, St Michael's Hospital, Toronto, ON, Canada
| | - Daniel Langer
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, 26657Katholieke Universiteit Leuven, Leuven, Belgium
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Dmitry Rozenberg
- Division of Respirology, Temerty Faculty of Medicine, 7938University of Toronto, University Health Network, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, 7989University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, 7938University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Yentes JM, Liu WY, Zhang K, Markvicka E, Rennard SI. Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician. Int J Chron Obstruct Pulmon Dis 2022; 17:2653-2675. [PMID: 36274993 PMCID: PMC9585958 DOI: 10.2147/copd.s339195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) demonstrate extra-pulmonary functional decline such as an increased prevalence of falls. Biomechanics offers insight into functional decline by examining mechanics of abnormal movement patterns. This review discusses biomechanics of functional outcomes, muscle mechanics, and breathing mechanics in patients with COPD as well as future directions and clinical perspectives. Patients with COPD demonstrate changes in their postural sway during quiet standing compared to controls, and these deficits are exacerbated when sensory information (eg, eyes closed) is manipulated. If standing balance is disrupted with a perturbation, patients with COPD are slower to return to baseline and their muscle activity is differential from controls. When walking, patients with COPD appear to adopt a gait pattern that may increase stability (eg, shorter and wider steps, decreased gait speed) in addition to altered gait variability. Biomechanical muscle mechanics (ie, tension, extensibility, elasticity, and irritability) alterations with COPD are not well documented, with relatively few articles investigating these properties. On the other hand, dyssynchronous motion of the abdomen and rib cage while breathing is well documented in patients with COPD. Newer biomechanical technologies have allowed for estimation of regional, compartmental, lung volumes during activity such as exercise, as well as respiratory muscle activation during breathing. Future directions of biomechanical analyses in COPD are trending toward wearable sensors, big data, and cloud computing. Each of these offers unique opportunities as well as challenges. Advanced analytics of sensor data can offer insight into the health of a system by quantifying complexity or fluctuations in patterns of movement, as healthy systems demonstrate flexibility and are thus adaptable to changing conditions. Biomechanics may offer clinical utility in prediction of 30-day readmissions, identifying disease severity, and patient monitoring. Biomechanics is complementary to other assessments, capturing what patients do, as well as their capability.
Collapse
Affiliation(s)
- Jennifer M Yentes
- Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX, USA
| | - Wai-Yan Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherlands
| | - Kuan Zhang
- Department of Electrical & Computer Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Eric Markvicka
- Department of Electrical & Computer Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
- Department of Mechanical & Materials Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Stephen I Rennard
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
4
|
Amiss E, Cottrell M. Evaluation of a Novel Step Training Mobile App Intervention in Cardiopulmonary Rehabilitation: A Single-Arm Prospective Cohort Study. Games Health J 2022; 11:330-336. [PMID: 36067152 DOI: 10.1089/g4h.2021.0142] [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: 11/13/2022] Open
Abstract
Objective: To establish the usability, acceptability, safety, and exercise adherence of a step training mobile app. Design: A single-arm prospective cohort study. Setting: Royal Brisbane and Women's Hospital, Australia. Subjects: Twenty-six cardiopulmonary rehabilitation participants. Intervention: Twelve weeks of step training using the mobile app Clock Yourself. Participants used Clock Yourself at home and during cardiopulmonary rehabilitation sessions, prescribed for a total of 15-20 minutes three times a week. Main Measures: The primary outcomes of interest were usability and acceptability and were measured using the System Usability Scale (SUS) and Attitudes to Falls-Related Interventions Scale (AFRIS) questionnaire, respectively. Safety and adherence were measured by self-report and participant diary, respectively. Secondary outcomes measuring changes in stepping, gait, balance, and physical performance included Manual test of Choice Stepping Reaction Time (CSRT-M), Short Physical Performance Battery (SPPB), Gait speed with and without a cognitive dual task (DT) and Timed Up and Go with and without a cognitive DT (TUG and TUGcog). Results: Twenty-one participants completed the study. Clock Yourself was considered highly useable (SUS [median] = 82.5/100; interquartile range [IQR, 67.5-95], equating to an "A" rating [A-F scale]) and acceptable (AFRIS [median] = 38/42 [IQR, 31-41]). Participants practiced Clock Yourself for a median of 18.29 minutes per week and no adverse events were reported. At 12 weeks, mean change in CSRT-M, SPPB, gait speed, DT gait speed, TUG, and TUGcog were all statistically significant (P < 0.01). Conclusion: Twelve weeks of mobile app-based step training was safe and considered usable and acceptable by participants. On average, participants did not meet the prescribed practice dosage. Statistically significant changes were observed in all physical measures; however, results are confounded by participation in cardiopulmonary rehabilitation and lack of control group.
Collapse
Affiliation(s)
- Emilie Amiss
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Michelle Cottrell
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia
| |
Collapse
|
5
|
Pistol Shooting Performance Correlates with Respiratory Muscle Strength and Pulmonary Function in Police Cadets. SUSTAINABILITY 2022. [DOI: 10.3390/su14127515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breathing patterns play a crucial role in shooting performance; however, little is known about the respiratory muscle strength and pulmonary capacities that control these patterns. The present study aimed to examine the relationship between shooting performance, respiratory muscle strength, and pulmonary function and to determine differences in respiratory capacities according to the shooting performance categories in police cadets. One hundred sixty-seven police cadets were recruited to assess respiratory muscle strength, pulmonary function, and shooting performance in a well-controlled environment. Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), slow vital capacity (SVC), maximal voluntary ventilation (MVV), and pistol shooting scores. The shooting score had a moderate positive correlation with MIP (ρ = 0.33) and MEP (ρ = 0.45). FVC (ρ = 0.25), FEV1 (ρ = 0.26), SVC (ρ = 0.26) (p < 0.001) and MVV (ρ = 0.21) (p < 0.05) were slightly correlated with shooting score. There were differences between shooting performance categories in MIP, MEP, FVC, FEV1, SVC, and MVV (p < 0.001, p < 0.05). The results imply that both strong respiratory muscles and optimal pulmonary function may be one of the necessary prerequisites for superior shooting performance in police.
Collapse
|
6
|
Kaygusuz MH, Oral Tapan O, Tapan U, Genc S. Balance impairment and cognitive dysfunction in patients with chronic obstructive pulmonary disease under 65 years. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:200-207. [PMID: 35081270 PMCID: PMC9060058 DOI: 10.1111/crj.13469] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
Objective Balance and cognitive problems may develop in COPD. Studies investigating cognitive functions are mostly in elderly patients, and the number of studies on balance impairment is less than studies about cognitive dysfunction in COPD. We aimed to evaluate both balance and cognitive functions in patients with COPD under 65 years. Methods A total of 60 COPD patients and 60 healthy control group were enrolled. The patients with COPD were divided into two groups due to dyspnea severity. Demographic data and dyspnea scores of all patients were recorded. BECK depression scale, standardized Mini Mental Test (MMT), and BERG balance scale were applied to the individuals. Factors affecting BERG balance scale were evaluated. Results BERG balance scale and MMT values were found to be significantly lower in patients with COPD compared with the control group (p = 0.009). It was observed that the mean values of BERG balance scale and MMT were significantly low in the severe dyspnea group. BERG scale had significant correlations with MMT (rho = 0.331, p = 0.001), BECK (rho = −0.222, p = 0.016), age (rho = −0.318, p = 0.018), MMRC (rho = −0.368, p < 0.001), CAT (rho = −0.338, p = 0.008), FEV1% (rho = 0.307, p = 0.017), SpO2 (rho = 0.448, p < 0.001), and number of hospitalization per year (rho = −0.316, p = 0.014). According to the results of multiple linear regression analysis, the effect of oxygen saturation on BERG was found to be statistically significant (B = 0.512, p = 0.008). Conclusions Balance tests in patients with COPD under the age of 65 are significantly low when compared with healthy controls at the same age. Balance and cognitive functions are significantly associated with each other. It may be beneficial to perform balance and cognitive function tests earlier even at the beginning of the treatment period of COPD, and strategies should be planned to prevent the progression of functional losses.
Collapse
Affiliation(s)
| | - Ozge Oral Tapan
- Department of Pulmonology, Mugla Sitki Kocman University, Mugla, Turkey
| | - Utku Tapan
- Department of Pulmonology, Mugla Sitki Kocman University, Mugla, Turkey
| | - Sebahat Genc
- Department of Pulmonology, Mugla Sitki Kocman University, Mugla, Turkey
| |
Collapse
|
7
|
Porto EF, Castro AAM, Fausto DM, Kümpel C, Brandão AD, De Lima PB, Fagundes JC, Zozimo B. Balance impairment and lower limbs strength in patients with COPD who fell in the previous year. Monaldi Arch Chest Dis 2022; 92. [PMID: 35225440 DOI: 10.4081/monaldi.2022.1204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Fall-related causes in patients with COPD might be associated to functional balance impairments and greater disease severity. We aimed to evaluate the reasons for falls in patients with COPD who had presented any fall during the previous year. This is a cross-sectional study. All COPD's GOLD classifications (mild, moderate, severe, and very severe) patients were recruited. In order to participate, patients ought to be clinically stable and without any exacerbation within 30 days prior to study entry. History of falls was self-reported by patients through an interview. Pre and post bronchodilator (salbutamol 400 μg) spirometry was performed. All patients accomplished postural balance tests such as the Berg Balance Scale, Falls Efficacy Scale-International, Time up and Go, Functional Reach test, Tinetti test and Chalder Scale; furthermore, lower limbs muscle strength (muscle dynamometry) and the COPD Assessment Test (CAT) were assessed. Ninety-six patients with COPD were evaluated and divided into two groups stratified according to any positive history of falls in the previous year. Patients with COPD who had any fall in the previous year presented older age (p=0.01), higher BMI (p=0.04) and worse pulmonary function than those who did not fall. The risk of falls was increased in patients with lower muscle strength in the lower limbs (OR 2.9, CI 95%;1.6 to 3.9), age greater than 65 years (OR 2.7, CI 95%;1.3 to 3.4), BMI greater than 28.8 kg/m2 (OR 3.2, CI 95%;1.1 to 5.6), very severe airway obstruction (OR 3.9, CI 95%;2.2 to 3.9) and fatigue (OR 3.2, CI 95%;1.5 to 5.3). Impaired body balance, reduced lower limb strength, disease severity, presence of fatigue and elevated BMI are important factors for falls in patients with COPD.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jordania C Fagundes
- Pulmonary Rehabilitation Center and Physiotherapy Curse at Adventist University of São Paulo.
| | - Brenda Zozimo
- Physiotherapy and Health Promotion program at Adventist University of São Paulo .
| |
Collapse
|
8
|
Tounsi B, Acheche A, Lelard T, Tabka Z, Trabelsi Y, Ahmaidi S. Effects of specific inspiratory muscle training combined with whole-body endurance training program on balance in COPD patients: Randomized controlled trial. PLoS One 2021; 16:e0257595. [PMID: 34555068 PMCID: PMC8460029 DOI: 10.1371/journal.pone.0257595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aims to assess the effect of inspiratory muscle training (IMT) combined with endurance training (ET) on balance in patients with chronic obstructive pulmonary disease (COPD). METHODS We studied 32 male patients (62 ± 6 years) with moderate to very severe COPD. They were randomly assigned to an experimental group (IMT+ET) n = 16 or a control group (ET) n = 16 with similar characteristics. The evaluations were carried out at inclusion and after eight weeks of the training period. Functional balance was assessed by the Berg Balance Scale (BBS), the Timed-up and Go (TUG), the Single Leg Stance test (SLS), and the Activities-specific Balance Confidence (ABC) scale. The strength of the inspiratory muscles (PImax) was assessed by maximal inspiratory mouth pressure. Functional exercise performance was assessed by the 6 minutes walking test (6MWT). IMT program consists in performing two daily sets of 30 inspirations with 50% of PImax increased by 10% every two weeks. ET program consists in performing 30 min treadmill exercise at 60% to 80% of the average speed achieved during the 6MWT three days per week. RESULTS After the training period, the experimental group demonstrated greater improvements in BBS (IMT+ET vs. ET; p = 0.019), and in ABC (IMT+ET vs. ET; p = 0.014). However, no significant differences between groups were observed for TUG, SLS, and 6MWT. There was a significant difference between groups in PImax (IMT+ET vs. ET; p = 0.030). Significant moderate correlations were obtained between ΔPImax and ΔBBS for both groups (IMT+ET: r = 0.624, p = 0.010; ET r = 0.550, p = 0.027) as well as for ΔABC but only in the experimental group (IMT+ET: r = 0.550, p = 0.027). CONCLUSION Compared to ET alone, the results suggest that IMT combined with ET enhances inspiratory muscle function and functional balance according to BBS and ABC in patients with COPD. We suggest that inspiratory muscle training might be introduced as additional training to pulmonary rehabilitation programs aimed at improving balance in COPD patients. TRIAL REGISTRATION The trial registry name: Clinical Trials; Registration number: NCT04084405; URL: https://clinicaltrials.gov/ct2/show/NCT04084405.
Collapse
Affiliation(s)
- Bilel Tounsi
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Amal Acheche
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Thierry Lelard
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
| | - Zouhair Tabka
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Yassine Trabelsi
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Said Ahmaidi
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
| |
Collapse
|
9
|
Valle MS, Casabona A, Di Fazio E, Crimi C, Russo C, Malaguarnera L, Crimi N, Cioni M. Impact of chronic obstructive pulmonary disease on passive viscoelastic components of the musculoarticular system. Sci Rep 2021; 11:18077. [PMID: 34508166 PMCID: PMC8433214 DOI: 10.1038/s41598-021-97621-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/27/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) produces skeletal muscle atrophy and weakness, leading to impairments of exercise performance. The mechanical work needed for movement execution is also provided by the passive tension developed by musculoarticular connective tissue. To verify whether COPD affects this component, the passive viscoelastic properties of the knee joint were evaluated in 11 patients with COPD and in 11 healthy individuals. The levels of stiffness and viscosity were assessed by means of the pendulum test, consisting in a series of passive leg oscillations. In addition, to explore the contribution of passive tension in the mechanical output of a simple motor task, voluntary leg flexion-extension movements were performed. Patients with COPD showed a statistically significant reduction in stiffness and viscosity compared to controls. Voluntary execution of flexion-extension movements revealed that the electromyographic activity of the Rectus Femoris and Biceps Femoris was lower in patients than in controls, and the low viscoelastic tension in the patients conditioned the performance of active movements. These results provide novel insights on the mechanism responsible for the movement impairments associated with COPD.
Collapse
Affiliation(s)
- Maria Stella Valle
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy.
| | - Antonino Casabona
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Eugenia Di Fazio
- Respiratory Medicine Unit, "Policlinico Vittorio Emanuele-San Marco" University Hospital, Catania, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico Vittorio Emanuele-San Marco" University Hospital, Catania, Italy
| | - Cristina Russo
- Section of Pathology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Lucia Malaguarnera
- Section of Pathology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Matteo Cioni
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
- Gait and Posture Analysis Laboratory, "Policlinico Vittorio Emanuele-San Marco" University Hospital, Catania, Italy
| |
Collapse
|
10
|
Eymir M, Yakut H, Özalevli S, Alpaydın AÖ. Static and dynamic balance impairment and relationship with disease-related factors in patients with chronic obstructive pulmonary disease : A cross-sectional study. Wien Klin Wochenschr 2021; 133:1186-1194. [PMID: 34351502 DOI: 10.1007/s00508-021-01918-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Disease and aging-related factors may predispose chronic obstructive pulmonary disease (COPD) patients to impaired balance, although the underlying determinants of impaired balance in COPD patients are still unknown. The purpose of this study was to identify the determinants of impaired balance in COPD patients. Also, we aimed to determine which balance measures (clinical or laboratory tests) are more indicative in determining balance impairment in these patients. METHODS This cross-sectional study recruited 24 patients with moderate to severe COPD and 24 age-matched healthy subjects. Participants were evaluated regarding demographic and clinical data, previous falls history, lower limb muscle strength, exercise capacity, physical activity and balance level. RESULTS COPD patients exhibited significantly a longer test duration on timed up and go test, a higher sway index on the postural stability and lower directional control score on the limit of stability of Biodex balance system (all, p < 0.001) compared to healthy controls, whereas there was no difference in Berg balance scale score between groups (p > 0.05). Balance impairment of the patient group was significantly associated with nonpulmonary conditions, such as physical activity level, exercise capacity, lower limb muscle strength, and with fall history. Also, COPD patients represented significantly lower physical activity level and exercise capacity, weaker lower limb muscle strength than healthy controls (all, p < 0.001). CONCLUSIONS Patients with moderate to severe COPD exhibit apparently important reductions in balance control that is directly associated with nonpulmonary consequences and fall history. These results may be extremely important to fall prevention and to guide the development of interventions for this population.
Collapse
Affiliation(s)
- Musa Eymir
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balcova-Izmir, Turkey.
| | - Hazal Yakut
- Eskişehir Osmangazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Eskişehir, Turkey
| | - Sevgi Özalevli
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balcova-Izmir, Turkey
| | - Aylin Ö Alpaydın
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
11
|
Gloeckl R, Schneeberger T, Leitl D, Reinold T, Nell C, Jarosch I, Kenn K, Koczulla AR. Whole-body vibration training versus conventional balance training in patients with severe COPD-a randomized, controlled trial. Respir Res 2021; 22:138. [PMID: 33947416 PMCID: PMC8097810 DOI: 10.1186/s12931-021-01688-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole-body vibration training (WBV) performed on a vibration platform can significantly improve physical performance in patients with chronic obstructive pulmonary disease. It has been suggested that an important mechanism of this improvement is based on an improvement in balance. Therefore, the aim of this study was to investigate the effects of WBV compared to conventional balance training. METHODS 48 patients with severe COPD (FEV1: 37 ± 7%predicted) and low exercise performance (6 min walk distance (6MWD): 55 ± 10%predicted) were included in this randomized controlled trial during a 3 week inpatient pulmonary rehabilitation. All patients completed a standardized endurance and strength training program. Additionally, patients performed 4 different balance exercises 3x/week for 2 sets of 1 min each, either on a vibration platform (Galileo) at varying frequencies (5-26 Hz) (WBV) or on a conventional balance board (BAL). The primary outcome parameter was the change in balance performance during a semi tandem stance with closed eyes assessed on a force measurement platform. Muscular power during a countermovement jump, the 6MWD, and 4 m gait speed test (4MGST) were secondary outcomes. Non-parametric tests were used for statistical analyses. RESULTS Static balance performance improved significantly more (p = 0.032) in favor of WBV (path length during semi-tandem stand: - 168 ± 231 mm vs. + 1 ± 234 mm). Muscular power also increased significantly more (p = 0.001) in the WBV group (+ 2.3 ± 2.5 W/kg vs. - 0.1 ± 2.0 W/kg). 6MWD improved to a similar extent in both groups (WBV: 48 ± 46 m, p < 0.001 vs. BAL: 38 ± 32 m; p < 0.001) whereas the 4MGST increased significantly only in the WBV-group (0.08 ± 0.14 m/s2, p = 0.018 vs. 0.01 ± 0.11 m/s2, p = 0.71). CONCLUSIONS WBV can improve balance performance and muscular power significantly more compared to conventional balance training. TRIAL REGISTRATION Clinical-Trials registration number: NCT03157986; date of registration: May 17, 2017. https://clinicaltrials.gov/ct2/results?cond=&term=NCT03157986&cntry=&state=&city=&dist = .
Collapse
Affiliation(s)
- Rainer Gloeckl
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research, Malterhoeh 1, 83471 Schoenau Am Koenigssee, Marburg, Germany. .,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land - Schoenau am Koenigssee, Königsee, Germany.
| | - Tessa Schneeberger
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research, Malterhoeh 1, 83471 Schoenau Am Koenigssee, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land - Schoenau am Koenigssee, Königsee, Germany
| | - Daniela Leitl
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research, Malterhoeh 1, 83471 Schoenau Am Koenigssee, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land - Schoenau am Koenigssee, Königsee, Germany
| | - Tobias Reinold
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Munich, Germany
| | - Christoph Nell
- Department of Internal Medicine, Division of Pulmonary Diseases, Philipps University of Marburg, Marburg, Germany
| | - Inga Jarosch
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research, Malterhoeh 1, 83471 Schoenau Am Koenigssee, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land - Schoenau am Koenigssee, Königsee, Germany
| | - Klaus Kenn
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research, Malterhoeh 1, 83471 Schoenau Am Koenigssee, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land - Schoenau am Koenigssee, Königsee, Germany
| | - Andreas R Koczulla
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, German Center for Lung Research, Malterhoeh 1, 83471 Schoenau Am Koenigssee, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land - Schoenau am Koenigssee, Königsee, Germany.,Teaching Hospital, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
12
|
Birinci T, Kısa EP, Akıncı B, Kuran Aslan G, Kıyan E. The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD. COPD 2021; 18:147-156. [PMID: 33821729 DOI: 10.1080/15412555.2021.1904867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was (1) to compare the activities of daily living (ADLs), perceived falling risk and balance in chronic obstructive pulmonary disease (COPD) patients with or without falling history and (2) to investigate the relationship between ADLs and balance. Fourteen patients with COPD with a history of falling whose mean falling frequency was 2.64 ± 0.74 times in the last 12-months (fallers) and 14 age and sex-matched patients with COPD with no history of falling (non-fallers) were included. The outcome measures were the London Chest Activity of Daily Living (LCADL) scale, Activities-Specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), 6-minute walking test, and quadriceps-femoris strength. Fallers reported increased dyspnoea perception in ADLs, decreased balance confidence, and disturbed balance compared with non-fallers (p < 0.05). A strong correlation was found between the LCADL scale item score (dressing the upper body) and the BBS total score (rho = -0.81, p = 0.001) in fallers. The LCADL scale item score (going out socially) was significantly correlated with the total score of the ABC scale (rho = -0.61, p = 0.001). Moderate correlations were found between the LCADL scale item scores (dressing the upper body, washing hair, and walking up stairs) and the BBS total score (p < 0.003). This study demonstrated that increased severity of dyspnoea perception during ADLs is associated with impaired balance and poor balance confidence, regardless of functional capacity and peripheral muscle strength in patients with COPD. The balance confidence was low in functional mobility-based activities in patients with COPD with a history of falling.
Collapse
Affiliation(s)
- Tansu Birinci
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Medeniyet University, Istanbul, Turkey.,Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eylul Pınar Kısa
- Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Biruni University, Istanbul, Turkey
| | - Buket Akıncı
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Biruni University, Istanbul, Turkey
| | - Goksen Kuran Aslan
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esen Kıyan
- Istanbul Medical Faculty, Department of Chest Disease, Istanbul University, Istanbul, Turkey
| |
Collapse
|
13
|
Acheche A, Mekki M, Paillard T, Tabka Z, Trabelsi Y. The Effect of Adding Neuromuscular Electrical Stimulation with Endurance and Resistance Training on Exercise Capacity and Balance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Can Respir J 2020; 2020:9826084. [PMID: 33062081 PMCID: PMC7542502 DOI: 10.1155/2020/9826084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022] Open
Abstract
This study investigated the effectiveness of adding neuromuscular electrical stimulation (NMES) to endurance training (ET) and resistance training (RT) on exercise tolerance and balance in COPD patients. 42 patients were assigned randomly to the ET + RT + NMES group (n = 22) or ET + RT group (n = 20). Two training programs were performed including 72 sessions. The center of pressure (CoP) displacement in the mediolateral direction (CoPML), in the anteroposterior direction (CoPAP), and the center of pressure velocity (CoPV) were recorded using a stabilometric platform with eyes open (EO) and eyes closed (EC). Time up and go and Berg Balance Scale tests, 6-minute walking test (6MWT), and the maximal voluntary contraction (MVC) were measured before and after the intervention. The walking distance, the dyspnea, and the heart rate were improved after the training period (p < 0.001) for both groups (p < 0.05). The ET + RT + NMES group showed better improvement than the ET + RT group in terms of 6MWD. CoPML, CoPAP, and CoPV were significantly (p < 0.001; p < 0.05; p < 0.001, respectively) more improved in EO and EC conditions in the ET + RT + NMES group than the ET + RT group. BBS, TUG, and MVC values improved in both groups after the training (p < 0.001). The performances in TUG and MVC tests were significantly greater in the ET + RT + NMES group than those in the ET + RT group (p < 0.01; p < 0.001, respectively). Combining NMES, RT, and ET improves balance in patients with COPD.
Collapse
Affiliation(s)
- Amal Acheche
- Laboratoire de Recherche Physiologie de l'Exercice et Physiopathologie: de l'intégré au moléculaire « Biologie, Médecine et Santé » (LR19ES09), Faculté de Médecine de Sousse, Sousse 4002, Tunisia
- Biology Department, Faculty of Sciences of Sfax, Sfax3038, Tunisia
| | - Marwa Mekki
- Laboratoire de Recherche Physiologie de l'Exercice et Physiopathologie: de l'intégré au moléculaire « Biologie, Médecine et Santé » (LR19ES09), Faculté de Médecine de Sousse, Sousse 4002, Tunisia
| | - Thierry Paillard
- Movement, Balance, Performance and Health Laboratory (EA 4445), University of Pau and des Pays de l'Adour, Pau 64012, France
| | - Zouhair Tabka
- Laboratoire de Recherche Physiologie de l'Exercice et Physiopathologie: de l'intégré au moléculaire « Biologie, Médecine et Santé » (LR19ES09), Faculté de Médecine de Sousse, Sousse 4002, Tunisia
| | - Yassine Trabelsi
- Laboratoire de Recherche Physiologie de l'Exercice et Physiopathologie: de l'intégré au moléculaire « Biologie, Médecine et Santé » (LR19ES09), Faculté de Médecine de Sousse, Sousse 4002, Tunisia
| |
Collapse
|
14
|
(Examination of the musculoskeletal system of an athlete with a focus on cardiorespiratory problems). COR ET VASA 2020. [DOI: 10.33678/cor.2020.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
15
|
Rehman A, Ganai J, Aggarwal R, Alghadir AH, Iqbal ZA. Effect of Passive Stretching of Respiratory Muscles on Chest Expansion and 6-Minute Walk Distance in COPD Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186480. [PMID: 32899902 PMCID: PMC7559714 DOI: 10.3390/ijerph17186480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Hyperinflation of the lungs leads to a remodeling of the inspiratory muscles that causes postural deformities and more labored breathing. Postural changes include elevated, protracted, or abducted scapulae with medially rotated humerus, and kyphosis that leads to further tightening of respiratory muscles. As the severity of the disease progresses, use of the upper limbs for functional tasks becomes difficult due to muscle stiffness. There are various studies that suggest different rehabilitation programs for COPD patients; however, to the best of our knowledge none recommends passive stretching techniques. The aim of this study was to assess the effect of respiratory muscle passive stretching on chest expansion and 6-min walk distance (6MWD) in patients with moderate to severe COPD. METHODS Thirty patients were divided into two groups, experimental (n = 15) and control (n = 15). The experimental group received a hot pack followed by stretching of the respiratory muscles and relaxed passive movements of the shoulder joints. The control group received a hot pack followed by relaxed passive movements of the shoulder joints. RESULTS In the control group, there was no difference in chest expansion at the levels of both the axilla and the xiphisternum or in 6MWD between baseline and post treatment (p > 0.05). In the experimental group, chest expansion at the level of the axilla (p < 0.05) and 6MWD (p < 0.001) were significantly higher post treatment, while there was no difference in chest expansion at the level of the xiphisternum (p > 0.05). A comparison between control and experimental groups showed that chest expansion at the level of the axilla (p < 0.05) and 6MWD (p < 0.01) were significantly higher in the experimental group, while there was no difference in chest expansion at the level of the xiphisternum (p > 0.05). CONCLUSIONS Although COPD is an irreversible disease, results of this study indicate that passive stretching of respiratory muscles can clinically improve the condition of such patients, especially in terms of chest expansion and 6MWD. Given the good effects of muscle stretching and the fact that such an exercise is harmless, clinicians and physiotherapists should consider including passive stretching of respiratory muscles in the rehabilitation plan of COPD patients.
Collapse
Affiliation(s)
- Asma Rehman
- Al Hosn One Day Surgery Center LLC, Al Sahel Tower Building, Post Box 37384, Abu Dhabi, UAE;
| | - Jyoti Ganai
- Department of Rehabilitation Sciences, Jamia Hamdard, New Delhi 110062, India;
| | - Rajeev Aggarwal
- Neuro-Physiotherapy Unit, NSC, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Ahmad H. Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
| | - Zaheen A. Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
- Correspondence: or
| |
Collapse
|
16
|
Lian T, Fu Y, Sun M, Yin M, Zhang Y, Huang L, Huang J, Xu Z, Mao C, Ni J, Liu G. Effect of temperature on accidental human mortality: A time-series analysis in Shenzhen, Guangdong Province in China. Sci Rep 2020; 10:8410. [PMID: 32439880 PMCID: PMC7242478 DOI: 10.1038/s41598-020-65344-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 05/01/2020] [Indexed: 12/16/2022] Open
Abstract
Health-risk assessments of temperature are central to determine total non-accidental human mortality; however, few studies have investigated the effect of temperature on accidental human mortality. We performed a time-series study combined with a distributed lag non-linear model (DLNM) to quantify the non-linear and delayed effects of daily mean temperature on accidental human mortality between 2013 and 2017 in Shenzhen, China. The threshold for effects of temperature on accidental human mortality occurred between 5.6 °C and 18.5 °C. Cold exposures, but not hot exposures, were significantly associated with accidental human mortality. All of the observed groups were susceptible to cold effects, with the strongest effects presented in females (relative risk [RR]: 3.14, 95% confidence interval (CI) [1.44-6.84]), followed by poorly educated people (RR: 2.63, 95% CI [1.59-4.36]), males (RR: 1.79, 95% CI [1.10-2.92]), and well-educated people (RR: 1.20, 95% CI [0.58-2.51]). Pooled estimates for cold effects at a lag of 0-21 days (d) were also stronger than hot effects at a lag of 0-2 d. Our results indicate that low temperatures increased the risk of accidental human mortality. Females and poorly educated people were more susceptible to the low temperatures. These findings imply that interventions which target vulnerable populations during cold days should be developed to reduce accidental human mortality risk.
Collapse
Affiliation(s)
- Tingyu Lian
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Key Laboratory of Precision Public Health, Guangdong Medical University, 1 Xincheng Avenue Songshanhu District, Dongguan, 523000, Guangdong, China
| | - Yingbin Fu
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Longzhu Avenue Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Mingwei Sun
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Key Laboratory of Precision Public Health, Guangdong Medical University, 1 Xincheng Avenue Songshanhu District, Dongguan, 523000, Guangdong, China
| | - Mingjuan Yin
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Key Laboratory of Precision Public Health, Guangdong Medical University, 1 Xincheng Avenue Songshanhu District, Dongguan, 523000, Guangdong, China
| | - Yan Zhang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Key Laboratory of Precision Public Health, Guangdong Medical University, 1 Xincheng Avenue Songshanhu District, Dongguan, 523000, Guangdong, China
| | - Lingfeng Huang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Key Laboratory of Precision Public Health, Guangdong Medical University, 1 Xincheng Avenue Songshanhu District, Dongguan, 523000, Guangdong, China
| | - Jingxiao Huang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Key Laboratory of Precision Public Health, Guangdong Medical University, 1 Xincheng Avenue Songshanhu District, Dongguan, 523000, Guangdong, China
| | - Ziqian Xu
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Longzhu Avenue Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jindong Ni
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Key Laboratory of Precision Public Health, Guangdong Medical University, 1 Xincheng Avenue Songshanhu District, Dongguan, 523000, Guangdong, China.
| | - Gang Liu
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Road, Longzhu Avenue Nanshan District, Shenzhen, 518000, Guangdong, China.
| |
Collapse
|
17
|
Bordoni B, Simonelli M. Chronic Obstructive Pulmonary Disease: Proprioception Exercises as an Addition to the Rehabilitation Process. Cureus 2020; 12:e8084. [PMID: 32542139 PMCID: PMC7292710 DOI: 10.7759/cureus.8084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022] Open
Abstract
Respiratory rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is recognized as a cornerstone for the therapeutic path. Physiotherapy involves physical activity with aerobic and anaerobic exercises, which can improve the patient's symptomatic picture, such as motor function, emotional status (depression and anxiety), and improve the pain perception. The training of proprioception is not included in the structure of the exercises proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The training of proprioception is a very useful strategy for stimulating the cerebellum, a neurological suffering area in patients with COPD. The cerebellum sorts information about pain and emotions, as well as motor stimuli. The article discusses the need to introduce proprioception in respiratory rehabilitation protocols, highlighting the neurological relationships with the management of comorbidities.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Marta Simonelli
- Integrative/Complimentary Medicine, French-Italian School of Osteopathy, Pisa, ITA
| |
Collapse
|
18
|
Park JK, Deutz NEP, Cruthirds CL, Kirschner SK, Park H, Madigan ML, Engelen MPKJ. Risk Factors for Postural and Functional Balance Impairment in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2020; 9:jcm9020609. [PMID: 32102421 PMCID: PMC7074538 DOI: 10.3390/jcm9020609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
Reduced balance function has been observed during balance challenging conditions in the chronic obstructive pulmonary disease (COPD) population and is associated with an increased risk of falls. This study aimed to examine postural balance during quiet standing with eyes open and functional balance in a heterogeneous group of COPD and non-COPD (control) subjects, and to identify risk factors underlying balance impairment using a large panel of methods. In COPD and control subjects, who were mostly overweight and sedentary, postural and functional balance were assessed using center-of-pressure displacement in anterior-posterior (AP) and medio-lateral (ML) directions, and the Berg Balance Scale (BBS), respectively. COPD showed 23% greater AP sway velocity (p = 0.049). The presence of oxygen therapy, fat mass, reduced neurocognitive function, and the presence of (pre)diabetes explained 71% of the variation in postural balance in COPD. Transcutaneous oxygen saturation, a history of exacerbation, and gait speed explained 83% of the variation in functional balance in COPD. Neurocognitive dysfunction was the main risk factor for postural balance impairment in the control group. This suggests that specific phenotypes of COPD patients can be identified based on their type of balance impairment.
Collapse
Affiliation(s)
- Jaekwan K. Park
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (J.K.P.); (N.E.P.D.); (C.L.C.); (S.K.K.)
| | - Nicolaas E. P. Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (J.K.P.); (N.E.P.D.); (C.L.C.); (S.K.K.)
| | - Clayton L. Cruthirds
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (J.K.P.); (N.E.P.D.); (C.L.C.); (S.K.K.)
| | - Sarah K. Kirschner
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (J.K.P.); (N.E.P.D.); (C.L.C.); (S.K.K.)
| | - Hangue Park
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA;
| | - Michael L. Madigan
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Mariëlle P. K. J. Engelen
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (J.K.P.); (N.E.P.D.); (C.L.C.); (S.K.K.)
- Correspondence: ; Tel.: +1-979-422-1789; Fax: +1-979-862-3244
| |
Collapse
|
19
|
Exercise Performance as a Predictor for Balance Impairment in COPD Patients. ACTA ACUST UNITED AC 2019; 55:medicina55050171. [PMID: 31137581 PMCID: PMC6572262 DOI: 10.3390/medicina55050171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 11/16/2022]
Abstract
Background and objective: Six-minute walk test (6-MWT) is a widely used test for assessing exercise performance in chronic obstructive pulmonary (COPD). However, the association between reduced walking distance and balance impairment in COPD has not been directly investigated. Therefore, the aim of this study was to identify exercise performance as a predictor for balance impairment in COPD. Materials and Methods: The cross-sectional study was conducted at a single visit involving stable COPD patients in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from November 2015 to October 2017. The 6-MWT was measured for in all subjects. The prognostic confounding factors were also collected for all subjects. Balance test was measured using the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. A cut-off score of BBS < 46 and/or the TUG ≥ 13.5 s was classified as balance impairment. Multivariable logistic regressions were performed to identify the six-minute walk distance (6-MWD) as a predictor for balance impairment in COPD. Results: Of the 176 COPD subjects assessed for eligibility, 118 COPD patients were enrolled including 86 males (72.9%) with a mean age of 73.5 ± 8.1 years. Thirty-three (28.0%) cases were classified with a balance impairment. The 6-MWD < 300 m was the predictor of balance impairment in COPD with an adjusted risk ratio of 10.10 (95%CI; 2.87, 35.61, p-value < 0.001). Conclusions: The 6-MWT is not only useful for evaluation of exercise performance, but also for prediction of balance impairment in patients with COPD. Our study suggests that the 6-MWD < 300 m is an important risk factor for balance impairment in COPD.
Collapse
|
20
|
Bonnevie T, Allingham M, Prieur G, Combret Y, Debeaumont D, Patout M, Cuvelier A, Viacroze C, Muir JF, Medrinal C, Gravier FE. The six-minute stepper test is related to muscle strength but cannot substitute for the one repetition maximum to prescribe strength training in patients with COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:767-774. [PMID: 30992662 PMCID: PMC6445245 DOI: 10.2147/copd.s193585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose There are many barriers to pulmonary rehabilitation, including a limited access to evaluation centers. To cope with these difficulties, field tests are often used to prescribe endurance training. As field tests are related to muscle strength, they could also be used to prescribe strength training and increase the access to pulmonary rehabilitation in rural area. However, their validity for this purpose has never been studied. Patients and methods The relationship between the 6-minute stepper test (6MST), 6-minute walk test, maximal workload achieved during cardiopulmonary exercise testing (Wpeak), and one repetition maximum (1RM) was assessed in 35 patients with COPD through a retrospective chart review to derive predictive equation of the 1RM from these tests. The effectiveness of these equations to prescribe strength training at 70% of the 1RM was assessed in an independent cross-validation group of 34 patients with COPD. Results There was a moderate relationship between the 6MST, Wpeak and the 1RM (r=0.44 and r=0.41, respectively, both P≤0.01). Whatever the test, the prescription of strength training using the estimated 1RM compared with the measured 1RM resulted in a mean absolute difference and a mean bias of about 30 kg. Conclusion The use of the 6MST and Wpeak for the prescription of strength training would result in a clinically not acceptable error. Therefore, they should not be used as a substitute for the 1RM to prescribe strength training.
Collapse
Affiliation(s)
- Tristan Bonnevie
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France, .,ADIR Association, Rouen University Hospital, Rouen, France,
| | | | - Guillaume Prieur
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France, .,Intensive Care Unit Department, Le Havre Hospital, Hôpital Jacques Monod, Montivilliers, France
| | - Yann Combret
- Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium.,Physiotherapy Department, Le Havre Hospital, Le Havre, France
| | - David Debeaumont
- Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Maxime Patout
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France, .,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France, .,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Catherine Viacroze
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Jean-François Muir
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France, .,ADIR Association, Rouen University Hospital, Rouen, France, .,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Clement Medrinal
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France, .,Intensive Care Unit Department, Le Havre Hospital, Hôpital Jacques Monod, Montivilliers, France
| | - Francis-Edouard Gravier
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France, .,ADIR Association, Rouen University Hospital, Rouen, France,
| |
Collapse
|
21
|
Terui Y, Iwakura M, Suto E, Kawagoshi A, Sugawara K, Takahashi H, Hasegawa K, Uemura S, Satake M, Shioya T. New evaluation of trunk movement and balance during walking in COPD patients by a triaxial accelerometer. Int J Chron Obstruct Pulmon Dis 2018; 13:3957-3962. [PMID: 30584295 PMCID: PMC6290864 DOI: 10.2147/copd.s184212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Individuals with COPD may experience ambulatory difficulty due to both effort intolerance arising from respiratory dysfunction and impaired balance control during walking. However, the trunk movement during walking has not been evaluated or adjusted for patients with COPD. The Lissajous index (LI) visually and numerically evaluates the left–right symmetry of the trunk movement during walking and is useful in clinical practice. In COPD patients, the LI is used as an indicator of the left–right symmetry of the trunk during walking. Here, we used the LI to evaluate the symmetry of COPD patients based on bilateral differences in mediolateral and vertical accelerations, and we investigated the correlation between the patients’ symmetry evaluation results and their physical function. Patients and methods Sixteen stable COPD patients (all males; age 71.3±9.2 years) and 26 healthy control subjects (15 males; age 68.2±6.9 years) participated in this study. They performed the 10-minute walk test at a comfortable gait speed wearing a triaxial accelerometer, and we measured their trunk acceleration for the evaluation of symmetry. Motor functions were also evaluated in the patients with COPD. Results The average mediolateral bilateral difference and LI values of the COPD patients were significantly larger than those of the healthy subjects. The COPD patients’ LI values were significantly correlated with their static balance. Conclusion The LI measured using a triaxial accelerometer during walking is useful in balance assessments of patients with COPD.
Collapse
Affiliation(s)
- Yoshino Terui
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan,
| | - Masahiro Iwakura
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan, .,Department of Rehabilitation Medicine, Akita City Hospital, Akita, Japan
| | - Eriko Suto
- Department of Rehabilitation, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Japan
| | | | - Keiyu Sugawara
- Department of Rehabilitation Medicine, Akita City Hospital, Akita, Japan
| | - Hitomi Takahashi
- Department of Rehabilitation Medicine, Akita City Hospital, Akita, Japan
| | - Kouichi Hasegawa
- Department of Rehabilitation, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Japan
| | - Sachiko Uemura
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan,
| | - Masahiro Satake
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan,
| | - Takanobu Shioya
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan, .,Geriatric Health Services Facility Nikonikoen, Akita, Japan
| |
Collapse
|
22
|
Muralt L, Furian M, Lichtblau M, Aeschbacher SS, Clark RA, Estebesova B, Sheraliev U, Marazhapov N, Osmonov B, Bisang M, Ulrich S, Latshang TD, Ulrich S, Sooronbaev TM, Bloch KE. Postural Control in Lowlanders With COPD Traveling to 3100 m: Data From a Randomized Trial Evaluating the Effect of Preventive Dexamethasone Treatment. Front Physiol 2018; 9:752. [PMID: 29988503 PMCID: PMC6024910 DOI: 10.3389/fphys.2018.00752] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022] Open
Abstract
Objective: To evaluate the effects of acute exposure to high altitude and preventive dexamethasone treatment on postural control in patients with chronic obstructive pulmonary disease (COPD). Methods: In this randomized, double-blind parallel-group trial, 104 lowlanders with COPD GOLD 1-2 age 20–75 years, living near Bishkek (760 m), were randomized to receive either dexamethasone (2 × 4 mg/day p.o.) or placebo on the day before ascent and during a 2-day sojourn at Tuja-Ashu high altitude clinic (3100 m), Kyrgyzstan. Postural control was assessed with a Wii Balance BoardTM at 760 m and 1 day after arrival at 3100 m. Patients were instructed to stand immobile on both legs with eyes open during five tests of 30 s each, while the center of pressure path length (PL) was measured. Results: With ascent from 760 to 3100 m the PL increased in the placebo group from median (quartiles) 29.2 (25.8; 38.2) to 31.5 (27.3; 39.3) cm (P < 0.05); in the dexamethasone group the corresponding increase from 28.8 (22.8; 34.5) to 29.9 (25.2; 37.0) cm was not significant (P = 0.10). The mean difference (95% CI) between dexamethasone and placebo groups in altitude-induced changes (treatment effect) was -0.3 (-3.2 to 2.5) cm, (P = 0.41). Multivariable regression analysis confirmed a significant increase in PL with higher altitude (coefficient 1.6, 95% CI 0.2 to 3.1, P = 0.031) but no effect of dexamethasone was shown (coefficient -0.2, 95% CI -0.4 to 3.6, P = 0.925), even when controlled for several potential confounders. PL changes were related more to antero-posterior than lateral sway. Twenty-two of 104 patients had an altitude-related increase in the antero-posterior sway velocity of >25%, what has been associated with an increased risk of falls in previous studies. Conclusion: Lowlanders with COPD travelling from 760 to 3100 m revealed postural instability 24 h after arriving at high altitude, and this was not prevented by dexamethasone. Trial Registration:clinicaltrials.gov Identifier: NCT02450968.
Collapse
Affiliation(s)
- Lara Muralt
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan
| | - Mona Lichtblau
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan
| | - Sayaka S Aeschbacher
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan
| | - Ross A Clark
- School of Health and Sports Science, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Bermet Estebesova
- Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Ulan Sheraliev
- Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Nuriddin Marazhapov
- Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Batyr Osmonov
- Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Maya Bisang
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan
| | - Stefanie Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan
| | - Tsogyal D Latshang
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan
| | - Talant M Sooronbaev
- Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.,Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja-Ashu, Kyrgyzstan.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| |
Collapse
|
23
|
Iwakura M, Okura K, Shibata K, Kawagoshi A, Sugawara K, Takahashi H, Shioya T. Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients. Int J Chron Obstruct Pulmon Dis 2016; 11:1505-14. [PMID: 27445470 PMCID: PMC4936819 DOI: 10.2147/copd.s107936] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Little is known regarding the relationship between balance impairments and physical activity in COPD. There has been no study investigating the relationship between balance and objectively measured physical activity. Here we investigated the association between balance and physical activity measured by an activity monitor in elderly COPD patients. Materials and methods Twenty-two outpatients with COPD (mean age, 72±7 years; forced expiratory volume in 1 second, 53%±21% predicted) and 13 age-matched healthy control subjects (mean age, 72±6 years) participated in the study. We assessed all 35 subjects’ balance (one-leg standing test [OLST] times, Short Physical Performance Battery total scores, standing balance test scores, 4 m gait speed, and five-times sit-to-stand test [5STST]) and physical activity (daily steps and time spent in moderate-to-vigorous physical activity per day [MV-PA]). Possible confounders were assessed in the COPD group. The between-group differences in balance test scores and physical activity were analyzed. A correlation analysis and multivariate regression analysis were conducted in the COPD group. Results The COPD patients exhibited significant reductions in OLST times (P=0.033), Short Physical Performance Battery scores (P=0.013), 4 m gait speed (P<0.001), five-times sit-to-stand times (P=0.002), daily steps (P=0.003), and MV-PA (P=0.022) compared to the controls; the exception was the standing balance test scores. The correlation and multivariate regression analyses revealed significant independent associations between OLST times and daily steps (P<0.001) and between OLST times and MV-PA (P=0.014) in the COPD group after adjusting for possible confounding factors. Conclusion Impairments in balance and reductions in physical activity were observed in the COPD group. Deficits in balance are independently associated with physical inactivity.
Collapse
Affiliation(s)
- Masahiro Iwakura
- Department of Rehabilitation, Akita City Hospital; Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Kazuki Okura
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Kazuyuki Shibata
- Department of Rehabilitation, Akita City Hospital; Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Atsuyoshi Kawagoshi
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Keiyu Sugawara
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Hitomi Takahashi
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | | |
Collapse
|
24
|
Lee PH, Kok VC, Chou PL, Ku MC, Chen YC, Horng JT. Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study. PeerJ 2016; 4:e2634. [PMID: 27812429 PMCID: PMC5088616 DOI: 10.7717/peerj.2634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/30/2016] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Osteoporosis is becoming an impending epidemic in the Asia-Pacific region. The association between risk of osteoporotic fracture (OTPF) and chronic obstructive pulmonary disease (COPD) in East Asian patients is yet to be fully examined. We conducted a nationwide population-based retrospective cohort study of 98,700 patients aged ≥50 years with or without COPD using a national administrative claims dataset. MATERIALS AND METHODS The patients were divided into COPD and comparison groups comprising 19,740 and 78,960 patients, respectively. The groups were 1 to 4 matched for age, gender, index date, diabetes mellitus, pre-existing osteoporosis and chronic kidney disease. Information such as the geographic area where southern part represented more sunshine exposure, smoking-related diagnoses, alcohol use disorder, whether there was regular use of inhaled corticosteroids and oral corticosteroids, vitamin D prescriptions, Charlson-Deyo comorbidity index score, and other relevant medical comorbidities were extracted for analysis. They were followed up until OTPF or the end of the year 2013. The outcome measure was an osteoporotic vertebral fracture and other long-bone fractures. A multivariate Cox model was constructed to derive adjusted hazard ratios (aHR) for OTPF with corresponding 95% confidence intervals (CI) after controlling for age, sex, insurance premium category, vitamin D prescription, osteoporosis, and coronary heart disease (CHD). Kaplan-Meier curves of the probability of OTPF-free survival for each cohort were compared using the log-rank test. Patients with OTPF during the first follow-up year were excluded from the overall risk calculation. Contributing factors to the increased risk of OTPF in COPD patients were examined in a sensitivity analysis. RESULTS After a total follow-up of 68,743 patient-years for the COPD group and 278,051 patient-years for the matched comparison group, the HR for OTPF was 1.24 (95% CI [1.02-1.51]; P = 0.0322) in COPD patients. The aHR was increased by 30% for vertebral OTPF (aHR = 1.297, 95% CI [1.020-1.649]; P = 0.0339). Differential lag time sensitivity analysis revealed a progressively elevated risk up to 8-fold increase in women (aHR = 8.0 (95% CI [1.81-35.4]; P < 0.01)) during the fifth follow-up year. COPD patients with pre-existing osteoporosis or given vitamin D prescription harbor a sustained increased risk up to the 5th (aHR, 4.1; 95% CI [1.61-10.35]) and third (aHR, 2.97; 95% CI [1.48-5.97]) follow-up year, respectively. CONCLUSIONS Our nationwide population-based cohort study demonstrates that East Asian COPD patients aged 50 and beyond do harbor a modestly increased risk for osteoporotic vertebral fractures particularly for those who are female, have pre-existing osteoporosis or require vitamin D prescription.
Collapse
Affiliation(s)
- Ping-Hsueh Lee
- Department of Geriatric Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - Victor C. Kok
- KTGH Cancer Center, Kuang Tien General Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Po-Liang Chou
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
| | - Ming-Chang Ku
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
- Department of Diagnostic Radiology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yu-Ching Chen
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Jorng-Tzong Horng
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
| |
Collapse
|