Improvements in Perimeter Thoracic Mobility on Patients with COPD after Pulmonary Rehabilitation: A Case Series

Respiratory, cardio-metabolic and neurodevelopmental long-term outcomes of moderate to late preterm birth: not just a near term-population. A follow-up study

Introduction

Moderate-to-late preterm infants constitute the majority within the preterm infant population. Most research on preterm infants has focused on very preterm children, often treating moderate-to-late preterm infants as similar to full-term infants. Our objective was to compare clinical, respiratory, cardio-metabolic and neurodevelopmental outcomes in adolescents aged 12-15 years born moderate and late preterm with a control group of the same age born full-term.

Methods

Observational cross-sectional study, comparing moderate-to-late preterm (32-36+6 weeks' gestational age) with full-term adolescents (37-41+6 weeks' gestational age; 75 each group). Perinatal and neonatal history were collected as well as data on respiratory evolution (ISAAC questionnaire for asthma symptoms for adolescents 13-14 years), anthropometric values, learning difficulties, behavioral test (screening questionnaire for high-performance autism spectrum disorder and evaluation test for attention deficit hyperactivity disorder), skin prick test, pulmonary function test, echocardiogram and blood pressure. A blood test with metabolic profile was conducted.

Results

Moderate-to-late preterm adolescents had more current asthma [p = 0.008, OR3 (95% CI 1.26-7.14)] and longer duration of combined treatments to control asthma (inhaled corticosteroids and anti-leukotrienes; p = 0.048). Forced vital capacity <80% was detected more often in moderate-to-late preterm patients (p = 0.013). When assessing right ventricle, moderate-to-late preterm adolescents showed better tricuspid annular plane systolic excursion z-score (p = 0.003), shortening fraction (p < 0.001) and E/A ratio z-score (p = 0.002). Regarding left ventricular assessment, moderate-to-late preterm group had smaller ventricle diastolic diameter (p = 0.04) and lower posterior wall z-score values (p = 0.037). They also showed a better S'wave z-score (p = 0.027), E wave (p = 0.005), E/A ratio (p = 0.003) and a higher septal myocardial performance index z-score (p = 0.025). Moderate-to-late preterm adolescents presented lower weight z-score (p = 0.039), body mass index z-score (p = 0.013), Waterlow weight index (p = 0.006) and higher undernutrition index [p = 0.04; OR 1.4 (95% CI 1-1.9)]. Although there were no differences in neurodevelopmental survey or behavioral tests.

Conclusion

Our findings underscore the importance of extended follow-up for this predominant group of premature infants to identify potential respiratory, cardiac and anthropometric issues that may emerge in the future.

The pulmonary rehabilitation effect on long covid-19 syndrome: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aims to evaluate the efficacy of pulmonary rehabilitation (PR) in improving dyspnea, fatigue, physical activity, quality of life, anxiety and depression in patients with Long COVID-19 (LC). The impact of PR on LC and a comparison of face-to-face and telerehabilitation approaches was explored.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. A literature search included PubMed, Web of Science, and Cochrane Library until January 2023. No language filters were applied. Randomized controlled trials, non-randomized controlled trials, and observational studies were included. The risk of bias was assessed using appropriate tools. Descriptive analysis and meta-analysis were performed. Forest plots presented results. Statistical analyses were conducted using the Metafor Package in R v.3.4.2.

RESULTS/FINDINGS

This systematic review and meta-analysis included 16 studies on PR in LC patients. A total of 1027 adults were included. The studies varied in design, with seven observational studies, three quasi-experimental studies, and six randomized controlled trials. Dyspnea, physical function, quality of life, psychological state, and fatigue were assessed as outcomes. The review found that pulmonary rehabilitation had a significant positive effect on dyspnea, physical function, quality of life (both global and physical domain), anxiety, and depression. However, the effect on fatigue was not significant. Heterogeneity was observed in some analyses, and publication bias was found in certain outcomes. Age and study design were identified as potential moderators. Both face-to-face and telerehabilitation interventions improved the studied outcomes, with only differences in the physical domain of quality of life favoring the face-to-face group.

IMPLICATIONS ON PHYSIOTHERAPY PRACTICE

PR improved dyspnea, physical function, quality of life, and psychological state in LC patients, but not fatigue. Face-to-face and telerehabilitation have similar effects, except for physical quality of life.

Comparative effectiveness of 10-week equipment-based pilates and diaphragmatic breathing exercise on heart rate variability and pulmonary function in young adult healthy women with normal BMI - a quasi-experimental study

BACKGROUND

The positive effects of Pilates and slow-controlled breathing exercises on health are examined in different studies. The purpose of the study was to investigate the effects of 10-week equipment-based Pilates, slow-controlled breathing exercises, and a combination of both on heart rate variability (HRV), pulmonary function, and body composition (BC) in young adult healthy women with normal BMI.

METHODS

Forty female participants were assigned to either equipment-based Pilates group (PG), slow-controlled breathing exercise group (BG), equipment-based Pilates + breathing exercise group (PBG), and control groups (CG). Equipment-based Pilates exercise consists of training for two days a week and 50 min per day, and breathing exercises were done twice a week for 15 min a day for 8 weeks. In addition, PBG performed a 15-minute breathing exercise after each Pilates session. Pilates sessions were created with Reformer, Cadillac, Ladder Barrel, Chair Barrel, and Spine Corrector. On the other hand, breathing exercises were based on a controlled 5 s inhale and 5 s exhale cycles.

RESULTS

Before and after the implementation, pulmonary function, HRV, and BC parameters were measured. The body weight and BMI improved in PG and PBG, and the percent body fat decreased only in PBG (p < 0.05). Both PG and PBG noted significant changes in HRV indices SDSD, SDNN, TP, HF, and LF. However, the RMSSD was recorded higher in only PBG. Similar changes were found in pulmonary parameters. The FVC, FEV1, VC, IC, TV, MVV, and VE im-proved in PBG. PG showed increases in VC and TV. The only changes found in BG were PEF and ERV.

CONCLUSIONS

The finding highlights the ample effect of combined breathing and Pilates exercise on HRV, pulmonary function and body composition which has important implications for health promotion.

Bioinformatics analysis of PLA2G7 as an immune-related biomarker in COPD by promoting expansion and suppressive functions of MDSCs

BACKGROUND

Immune mechanism is involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, the exact immune pathogenesis still remains unclear. This study aimed to identify the immune-related biomarkers in COPD through bioinformatics analysis and its potential molecular mechanism.

METHODS

GSE76925 was downloaded from Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were screened, and enrichment analysis was performed. Single sample gene enrichment analysis (ssGSEA) was conducted to score the infiltration levels of immune cells. Weighted gene co-expression network analysis (WGCNA) was applied to identify trait-related modules and to further determine the key module-related DEGs. Moreover, the correlations between the key genes and clinical parameters and infiltration levels of immune cells were analyzed. Furthermore, expression of the selected one key gene, PLA2G7, the frequency of MDSCs, and the expression of MDSCs-related immunosuppressive mediators were determined among healthy, smokers and COPD patients. Finally, effects of PLA2G7 abnormal expression on the frequency of MDSCs and the expression of MDSCs-related immunosuppressive mediators were examined.

RESULTS

A total of 352 DEGs were observed. These DEGs were mainly related to RNA metabolism and positive regulation of organelle organization. In addition, the black module was the most correlated with COPD. Six key genes (ADAMDEC1, CCL19, CHIT1, MMP9, PLA2G7, and TM4SF19) were identified between the black module and DEGs. Serum Lp-PLA2 and mRNA levels of PLA2G7, MDSCs, and MDSCs-related immunosuppressive mediators were found to be upregulated in COPD patients compared to the controls. The expression of PLA2G7 represented positive impact on the frequency of MDSCs and the expression of MDSCs-related immunosuppressive mediators.

CONCLUSION

PLA2G7 may serve as a potential immune-related biomarker contributing to the progression of COPD by promoting expansion and suppressive functions of MDSCs.

Effect of progressive muscle relaxation as an add-on to pulmonary telerehabilitation in discharged patients with COVID-19: A randomised controlled trial

BACKGROUND

and purpose: Most patients with coronavirus disease 2019 (COVID-19) experience persistent physical and psychological symptoms. This study aimed to investigate the effects of pulmonary telerehabilitation (PTR) combined with progressive muscle relaxation (PMR) on the physical and psychological outcomes of discharged patients with COVID-19.

MATERIALS AND METHODS

This randomised, assessor-blinded, parallel-group study was conducted in hospitals affiliated with Qom University of Medical Sciences between May and October 2021. Discharged COVID-19 patients aged 18-65 years were randomly assigned to two groups of 26 patients each. The experimental group underwent PTR and PMR for six weeks, while the comparison group received PTR alone. Primary (functional capacity) and secondary (dyspnoea, anxiety, depression, fatigue, sleep quality, and quality of life) outcomes were evaluated at baseline and after six weeks.

RESULTS

The experimental group showed significantly higher sleep quality (P = 0.001, 95% confidence interval [CI]: 1.20-4.09) and significantly lower fatigue (P = 0.041, 95% CI: 4.79-5.25) and anxiety (P = 0.001, 95% CI: 1.21-4.47) than the comparison group. No between-group differences were observed in terms of other outcomes (P > 0.05).

CONCLUSION

PTR coupled with PMR was more effective for promoting sleep quality and alleviating anxiety and fatigue than PTR alone.

Muscle Power in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

This study aimed to review the impact of training on muscle power in patients with chronic obstructive pulmonary disease (COPD). Randomized controlled trials evaluating the effects of exercise-based interventions on limbs muscle power and rate of force development in COPD patients were investigated. Five international databases were searched until October 2022. Meta-analyses were performed calculating the mean difference or standardized mean difference. Risk of bias in studies was assessed using Cochrane Risk of Bias tool 2.0. A total of nine studies were included in the analysis. There were concerns about risk of bias in seven out of nine studies. Comparison of exercising and non-exercising groups showed a significant effect of exercise in improving muscle power (P=0.0004) and rate of force development (P<0.001), in five and three trials, respectively. Four studies comparing different trainings showed no significant results on muscle power (P=0.45). Eight to 16 weeks of exercise-based intervention versus no intervention might be beneficial to enhance upper and lower limbs muscle power and rate of force development in people with COPD. In contrast, muscle power did not improve when different training modalities were compared. Future studies performing power training in COPD patients are encouraged.

Pulmonary Rehabilitation in SARS-CoV-2: A Systematic Review and Meta-Analysis of Post-Acute Patients

BACKGROUND

Pulmonary Rehabilitation (PR) was initially developed for the management of Chronic Obstructive Pulmonary Disease (COPD) and is now recognized as a core management of COVID-19 patients. This systematic review and meta-analysis examined the efficacy of PR in patients with post-acute COVID-19 infection.

METHODS

A literature search was conducted in PubMed, the Web of Science (WoS), and the Cochrane Library from their inceptions until October 2022, and randomized controlled trials and observational studies were considered. The outcomes measured included dyspnea, physical function, and quality of life.

RESULTS

Eleven studies including 677 participants with post-acute COVID-19 were included in this analysis. From a qualitative point of view and analyzing the studies separately, PR improves dyspnea, physical function, and quality of life in patients with post-acute COVID-19. However, in pooling the data of all the studies, no significant changes pre-postintervention, compared to the control, were found among the experimental studies included in the analysis in any outcome measures, due to the high heterogeneity between the studies, as well as no significant improvements being found in the observational studies. A subgroup analysis revealed significant differences in all the included outcomes. Future studies should include the same scale to assess the actual efficacy of PR.

CONCLUSION

From a qualitative analysis point of view, PR is effective in improving physical function, reducing dyspnea, and improving quality of life in patients with post-acute COVID-19. However, an exploratory meta-analysis was performed to evaluate, by subgroups, the efficacy of PR, and positive results were found in favor of PR.

Multicomponent Exercise Program to Improve the Immediate Sequelae of COVID-19: A Prospective Study with a Brief Report of 2-Year Follow-Up

COVID-19 placed teams of professionals in a hostile and unfamiliar environment where the lack of knowledge of its pathology led to the adaptation of programs used so far for other conditions to try to address the immediate sequelae of COVID-19 infection. That is why the aim of this study was to assess the effects of a multicomponent exercise program (MEP) in improving cardio-respiratory performance, health status, disability due to dyspnea, aerobic capacity and endurance, and the immediate sequelae of COVID-19. Thirty-nine patients referred from different hospital services were included in this study. An intervention of seven weeks with sessions twice a week was carried out, where patients underwent intervallic training sessions followed by strengthening exercises and individualized respiratory physiotherapy exercises. The results of this study show a significant improvement in cardio-respiratory performance, health status, disability due to dyspnea, and aerobic capacity and endurance after intervention; and an increase in health status and reduction in disability due to dyspnea at the 2-year follow-up. In addition, none of the patients had any adverse effects either pre-post treatment or at the 2-year follow-up. Individualized and monitored MEP in survivors of COVID-19 showed positive effects in a pre-post evaluation and the 2-year follow up, improving the immediate sequelae of post-COVID-19 patients. This highlights the importance of the professional background of the rehabilitation teams in adapting to an unknown clinical environment.

A Combination of Long-Duration Electrical Stimulation with External Shoulder Support during Routine Daily Activities in Patients with Post-Hemiplegic Shoulder Subluxation: A Randomized Controlled Study

The study objective was to determine the effect of long-duration neuromuscular electric stimulation (NMES) on shoulder subluxation and upper-extremity function during the acute post-stroke stage. Twenty-eight subjects (mean age ± standard deviation -70.0 ± 14.0 years) were randomly assigned to an experimental or to a control group receiving NMES to the supraspinatus and posterior deltoid muscles or sham treatment for 6 weeks. All the subjects continued standard rehabilitation and external shoulder support (EST). Assessments were conducted pre- and post-intervention and at a 2 week follow-up session by an assessor blind to group allocation. Outcome measures included the degree of shoulder subluxation, Fugl-Meyer assessment-upper extremity (FMA-UE) test, FMA-hand and finger subscales, Functional Independence Measure (FIM), and shoulder pain (using the Numeric Pain Rate Scale). Shoulder subluxation was significantly lower, while the FMA-UE and FMA-hand and finger subscales were significantly improved in the experimental group post-intervention and at follow-up compared to the control group. FIM at follow-up improved more in the experimental group. No change was observed in pain level in both groups. Supplementing NMES to standard rehabilitation and EST is beneficial in reducing shoulder subluxation and improving upper-extremity function. Further research is necessary to determine effect of longer treatment duration and longer follow-up periods.