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    Methodology and baseline characteristics of a randomized controlled trial testing a health care professional and peer-support program for patients with chronic obstructive pulmonary disease: The BREATHE2 study. Aboumatar Hanan,Naqibuddin Mohammad,Neiman Joseph,Saunders Jamia,Kim Samuel,Chaudhry Hina,Garcia-Morales Emmanuel,Robinson Nancy,McBurney Marjorie,Jager Leah,Ajayi Tokunbo,Bone Lee,Chung Suna,Farrell Bernard,Joo Jin Hui,Linnell John,Pirfo Marlene,Rand Cynthia,Riley Peggy,Salvaterra Carmen,Shea Kai,Singh Jorawar,Wise Robert Contemporary clinical trials BACKGROUND:Self-management support (SMS) for patients with COPD can improve health-related quality of life (HRQOL). However, it remains unclear what SMS strategies are most effective. Using peer support to advance self-management is promising, as peer supporters possess credibility and can serve as role models. METHODS:We conducted a single-blinded RCT comparing the effectiveness of two strategies to support patients with COPD. The strategies were 'Health Care Professional (HCP)' and 'HCP Plus Peer' support. Peer support was provided by patients with COPD who have stopped smoking, completed an acute pulmonary rehabilitation program, and met the requirements for becoming a peer supporter. We enrolled patients receiving treatment at inpatient and outpatient settings. Patients were encouraged to invite one family-caregiver to enroll with them. The primary outcome measure was the change in HRQOL at 6 months post enrollment. Secondary outcomes included COPD-related and all-cause hospitalizations and ED visits. Caregiver outcomes included preparedness for caregiving, caregiver stress, and coping. RESULTS:A total of 292 patients as well as 50 family-caregivers were enrolled. The average patient age was 67.3 yrs. (SD 9.4), 61% were female and 26% were African-Americans. The majority of caregivers were females (68%) and were a spouse/partner (58%). DISCUSSION:This study tested a dual strategy for providing support to patients with COPD that incorporates peer and health care professional support. The study had minimal exclusion criteria. If shown effective, the study offers a program of peer support that can be readily implemented in health care settings. 10.1016/j.cct.2020.106023
    Isolated Resistance Training Programs to Improve Peripheral Muscle Function in Outpatients with Chronic Obstructive Pulmonary Diseases: A Systematic Review. Pancera Simone,Lopomo Nicola F,Bianchi Luca N C,Pedersini Paolo,Villafañe Jorge H Healthcare (Basel, Switzerland) This systematic review aims to establish which isolated resistance training (RT) programs have been used in outpatients with chronic obstructive pulmonary disease (COPD) and their impact on all aspects of peripheral skeletal muscle function. Electronic databases were systematically searched up to June 2021. The eligibility criteria were: (1) randomized controlled trials investigating the effects of supervised and isolated RT programs in outpatients with COPD and (2) RT programs lasting 8-12 weeks, (3) including at least one outcome measure related to trainable muscle characteristics. Initially, 6576 studies were identified, whereas 15 trials met the inclusion criteria. All the included trials reported that isolated RT improved both upper and lower limbs' maximal strength. Muscle endurance and power also increased after RT but received less attention in the analysis. Furthermore, few studies assessed the effect of RT on muscle mass and cross-sectional area, reporting only limited improvement. Isolated RT programs carried out 2-3 days a week for 8-12 weeks improved skeletal muscle function in individuals with COPD. The RT program should be specifically focused to the trainable muscle characteristic to be improved. For this reason, we further encourage the introduction of a detailed assessment of muscle function and structure during the pulmonary rehabilitation practice. 10.3390/healthcare9101397
    Pulmonary Pathology Among Patients with Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-analysis. Saini Minaxi,Kulandaivelan Sivachidambaram,Bansal Virender Kumar,Saini Vikram,Sharma Suresh,Kaur Jaspreet,Sondh Aparajita Current diabetes reviews BACKGROUND:Restrictive lung pathology was reported in the previous meta-analysis among patients with Type 2 Diabetes mellitus (T2DM) which is date back to 2010. OBJECTIVE:To see the effect of T2DM on pulmonary functions through updated systematic review and meta-analysis. DATA SOURCE:PubMed. STUDY ELIGIBILITY CRITERIA:English language case-control or cross-sectional studies, published between 1 January 2010 to 31 August 2018. PARTICIPANTS AND INTERVENTION:T2DM and non-diabetic subjects were compared for at least one of the pulmonary function variables i.e. Forced expiratory volume in 1st second (FEV1), % FEV1, Forced vital capacity (FVC), % FVC and % FEV1/FVC. STUDY APPRAISAL AND SYNTHESIS METHODS:Methodological quality of the study was assessed using Newcastle-Ottawa Quality Assessment Scale. Meta-analysis was done using Review Manager 5.3 (RevMan 5.3) and meta-regression was conducted using R statistical software. RESULTS:We selected 22 articles that met our inclusion and exclusion criteria. Results reveal that among patients with T2DM all variables were reduced except %FEV1/FVC which shows statistically nonsignificant results with P=0.46. This confirms that T2DM patients have a restrictive type of lung pathology. LIMITATION:Only articles from the PubMed database were included. Conclusion and Implications of Key Findings: This review affirms the existing evidence of restrictive pathology among patients with T2DM. The future study could be conducted to see the effect of various rehabilitation protocols on pulmonary function among patients with T2DM. 10.2174/1573399815666190716130324
    The relationship between exercise capacity and neutrophil//lymphocyte ratio in patients taken to cardiopulmonary rehabilitation program. Okan S Bratislavske lekarske listy OBJECTIVES:The aim of the present study was to evaluate the relationship between exercise capacity and n/lymphocyte ratio (NLR) in patients enrolled in a cardiopulmonary rehabilitation program. BACKGROUND:NLR has recently been used as a potential marker to determine inflammation in cardiac and non-cardiac diseases. METHODS:In this retrospective study, an exercise test and six-minute walking test (6MWT) were carried out in 23 patients with coronary artery disease and 28 patients with pulmonary disease before cardiopulmonary rehabilitation program, and routine hemogram test results were evaluated. RESULTS:The result of 6MWT test distance was 333.43 ± 86.58 m in the cardiac rehabilitation group and 348.46 ± 81.37 m in the pulmonary rehabilitation group. There was a negative correlation between 6MWT and NLR in the cardiac rehabilitation group (p < 0.05). As NLR increased, the MET value and duration of exercise decreased in the pulmonary rehabilitation group (p < 0.05). CONCLUSION:NLR could be used as a predictor to evaluate the exercise capacity in patients to be enrolled in cardiopulmonary rehabilitation program (Tab. 3, Ref. 30) Keywords: exercise capacity, neutrophil/lymphocyte ratio, rehabilitation. 10.4149/BLL_2020_031
    Nutritional supplementation during pulmonary rehabilitation in COPD: A systematic review. Aldhahir Abdulelah M,Rajeh Ahmed M Al,Aldabayan Yousef S,Drammeh Salifu,Subbu Vanitha,Alqahtani Jaber S,Hurst John R,Mandal Swapna Chronic respiratory disease Uptake of nutritional supplementation during pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD) has been limited by an absence of rigorous evidence-based studies supporting use. The objective was to report and summarise the current evidence supporting the use of nutritional supplementation to improve outcomes during PR in stable COPD patients. A systematic search was conducted up to 7 August 2019 (registration number CRD42018089142). The preferred reporting items for systematic reviews and meta-analyses guidelines were used. Six databases were included: Medical Literature Analysis and Retrieval System Online or MEDLARS Online, Allied and Complementary Medicine Database, the Cochrane Database of Systematic Reviews, Excerpta Medica dataBASE, Cumulative Index of Nursing and Allied Health Literature and Web of Science. This systematic search generated 580 initial matches, of which 22 studies (917 COPD participants) met the pre-specified criteria and were included. Sixteen of 19 studies that used nutritional supplements in addition to PR did not show additional benefit compared to PR alone when measuring exercise capacity. Nutritional supplements significantly increased body weight in 7 of 11 studies. Body mass index increased significantly in two of six studies. Handgrip strength did not improve, while quadriceps muscle strength significantly improved in 3 of 11 studies. Four of eight studies showed a significant improvement in inspiratory muscle function. Only 2 of 14 studies demonstrated a significant improvement in quality of life with supplementation in addition to PR. There remains insufficient evidence on the effect of nutritional supplementation on improving outcomes during PR in patients with COPD due to heterogeneity in supplements, outcome measures and PR programmes. Therefore, controversy remains and further research is needed. 10.1177/1479973120904953
    Novel Input for Designing Patient-Tailored Pulmonary Rehabilitation: Telemonitoring Physical Activity as a Vital Sign-SMARTREAB Study. Santos Catarina Duarte,das Neves Rui César,Ribeiro Ruy M,Caneiras Cátia,Rodrigues Fátima,Spruit Martijn A,Bárbara Cristina Journal of clinical medicine Physical inactivity may be a consequence of chronic diseases but also a potential modifiable risk factor. Therefore, it should be clinically assessed as a vital sign of patients' general physical condition prior to any exercise-based intervention. This cross-sectional study describes physical activity in the daily life of 100 chronic respiratory patients before pulmonary rehabilitation, comparing subjective and objective measures. The assessment combined the International Physical Activity Questionnaire (IPAQ) and 4-day accelerometer and oximeter telemonitoring with SMARTREAB technology, assessing heart rate, transcutaneous oxygen saturation and activity-related energy expenditure by metabolic equivalent of task (MET). According to IPAQ, 49% of patients had a moderate level of physical activity in daily life (PADL), a weekly mean level of 2844 ± 2925 MET.min/week, and a mean sedentary time of 5.8 ± 2.7 h/day. Alongside this, SMARTREAB telemonitoring assessed maximum activity ranging from 1.51 to 4.64 METs, with 99.6% daytime spent on PADL below 3 METs and 93% of patients with daily desaturation episodes. Regardless of the self-reported IPAQ, patients spend at least 70% of daytime on PADL below 2 METs. SMARTREAB was demonstrated to be an innovative methodology to measure PADL as a vital sign, combining oximetry with accelerometry, crossmatched with qualitative patient data, providing important input for designing patient-tailored pulmonary rehabilitation. 10.3390/jcm9082450
    The effects of core stabilization training on dynamic balance and pulmonary parameters in patients with asthma. Develi Elif,Subasi Feryal,Aslan Goksen K,Bingol Zuleyha Journal of back and musculoskeletal rehabilitation BACKGROUND:In the literature, novel physiotherapy and rehabilitation approaches are getting significant attention as a way to cope with secondary complications in the management of asthma. OBJECTIVE:To investigate the effectiveness of core stabilization exercises combined with the Asthma Education Program (AEP) and breathing exercises in patients with asthma. METHODS:The study sample consists of 40 asthmatic patients (age 52.25 ± 11.51 years) who were randomly divided into a Training Group (TG) (n= 20) and a Control Group (CG) (n= 20). All subjects were included in the AEP, and both groups were trained in breathing retraining exercises (2 times/wk, 6-week duration in the clinic). The core stabilization exercise program was also applied in the TG. Respiratory muscle strength (maximum inspiratory and expiratory pressures), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ)), health-related quality of life (Asthma Quality of Life Questionnaire (AQOL)), functional exercise capacity (six-minute walking test (6MWT)), and dynamic balance (Prokin PK200) were assessed before and after the interventions. RESULTS:The TG showed more significant improvements in MIP (ΔTG:4.55 cmH2O, ΔCG:0.95 cmH2O), IPAQ (ΔTG:334.15 MET-min/wk., ΔCG:99 MET-min/wk.), 6MWT (ΔTG:24.50 m, ΔCG:11.50 m), and dynamic balance sub-parameters compared to the mean difference between the initial assessment and after a 6-week intervention program, which included twelve exercise sessions (p< 0.01). CONCLUSIONS:The findings present greater improvements in inspiratory muscle strength, physical activity level, functional exercise capacity, and dynamic balance when core stabilization exercises are included in the pulmonary rehabilitation program for the management of asthma. 10.3233/BMR-191803
    Lung volume reduction eligibility in patients with COPD completing pulmonary rehabilitation: results from the UK National Asthma and COPD Audit Programme. Buttery Sara C,Lewis Adam,Kemp Samuel V,Banya Winston,Quint Jennifer K,Steiner Michael C,Hopkinson Nicholas S BMJ open OBJECTIVES:To establish what proportion of patients completing a UK pulmonary rehabilitation (PR) programme meet the 2018 National Institute for Health and Care Excellence (NICE) chronic obstructive pulmonary disease (COPD) guideline (NG115) criteria to have a respiratory review to establish whether referral to a lung volume reduction multidisciplinary team would be appropriate. This respiratory review would include evaluation of the presence of hyperinflation and the presence of emphysema on CT scan. The NICE criteria include measures of breathlessness and exercise capacity but these parameters are not completely defined. DESIGN:Observational study. SETTING:PR programmes across the UK in 2015 (210 centres) and 2017 (184 centres) entering data into the Royal College of Physicians' National Asthma and COPD Audit Programme. PARTICIPANTS:8295 (55.7%) of 14 889 patients in programmes using incremental shuttle walk test (ISWT) or 6-minute walk test (6MWT) as an outcome measure completed PR, and 4856 (32.6%) had complete data recorded (6MWT/ISWT, baseline spirometry, Medical Research Council (MRC) dyspnoea score). RESULTS:Depending on the walking test safety threshold adopted for the ISWT (≥140 m or ≥ 80 m) and the MRC dyspnoea score threshold used (MRC score ≥3 or ≥4 at the end of PR), between 4.9% and 18.1% of PR completers met the NICE criteria for a lung volume reduction-focused respiratory review. CONCLUSIONS:Lung volume reduction therapies are beneficial in appropriately selected patients with COPD, but few procedures are performed, and treatment pathways are unclear. These data help to inform the feasibility of the approach recommended by NICE and highlight the need for future systematic pathways to reduce inequalities in patients being considered for effective treatments. 10.1136/bmjopen-2020-040942
    Electroacupuncture reduces hypothalamic and medullary expression of orexins and their receptors in a rat model of chronic obstructive pulmonary disease. Zhang Xin-Fang,Qin Qin,Geng Wen-Ye,Jiang Chuan-Wei,Liu Yong,Liu Xiao-Li,Li Jing,Liu Zi-Bing Acupuncture in medicine : journal of the British Medical Acupuncture Society OBJECTIVES:Decreased lung function in chronic obstructive pulmonary disease (COPD) is correlated with abnormal excitability of the respiratory centre where orexin neuropeptides from the hypothalamus are responsible for regulating respiration. We hypothesised that improvements in pulmonary function with electroacupuncture (EA) may be related to orexins in a rat model of COPD. METHODS:The COPD model was established by cigarette smoke exposure and lipopolysaccharide injection. Modelled rats received EA at BL13 and ST36 for two weeks, after which lung function was tested. Orexin levels in the hypothalamus and medulla were detected by ELISA, while mRNA/protein expression and localisation of orexins and their receptors were investigated using real time PCR, Western blotting and immunohistochemistry, respectively. RESULTS:The decrease in lung function observed in COPD rats was improved after EA treatment. Orexin levels in the hypothalamus and medulla were significantly higher in COPD rats than in normal rats, but were significantly reduced in the EA-treated group. There was a negative correlation between orexin content and lung function. In the hypothalamus, mRNA and protein expression and immunoreactivity of orexins were significantly higher in the COPD group than in the normal group, but a significant decrease was observed after EA. In the medulla, the expression and immunoreactivity of orexin receptors were significantly higher in the COPD group than in the normal group, but a significant decrease was observed after EA. CONCLUSIONS:The positive effect of EA on pulmonary function in COPD rats may be related to downregulation of orexins and their receptors in the medulla. 10.1136/acupmed-2017-011391
    Assessment of a Domiciliary Integrated Pulmonary Rehabilitation Program for Patients with a History of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective 12-Month Observational Study. Li Yi,Feng Jing,Li Yuechuan,Jia Wei,Qian Hongyu Medical science monitor : international medical journal of experimental and clinical research BACKGROUND Integrated pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) may prevent acute exacerbations of COPD (AECOPD). The aim of this study was to evaluate the effectiveness, before and 12 months after, the use of an integrated PR program in patients discharged from hospital for AECOPD. MATERIAL AND METHODS A retrospective observational clinical study included patients diagnosed with COPD who participated in a domiciliary integrated PR program that included a weekly phone interview supervised by a respiratory team. A six-minute walk test (6MWT), COPD assessment test (CAT), and the modified Medical Research Council scale (mMRC) were evaluated every three months. RESULTS Of the 303 eligible patients, 267 patients (88.1%), with a mean age of 64.9±8.7 years, a mean FEV1 percentage predicted of 48.8±12.9%, successfully completed the 12-month study program and achieved a significant improvement in their clinical performance with a significantly reduced frequency of episodes of EACOPD (3.1±1.7 vs. 2.0±1.4) (p<0.001), a significant reduction in emergency department visits (2.5±1.5 vs. 1.2±1.1) (p<0.001), and significantly reduced episodes of hospitalization (2.0±1.2 vs. 1.4±1.2) (p<0.001). Significant patient benefits were found during the 12-month study, on CAT, mMRC, and patient well-being when compared with the end of the study after 12 months (p<0.001). CONCLUSIONS A multidisciplinary integrated PR program maintained a significant clinical improvement, in patients with COPD by reducing episodes of AECOPD, CAT, mMRC, emergency hospital admissions, and improved patient well-being, for the duration of the program. 10.12659/MSM.908463
    Muscle energy technique for chronic obstructive pulmonary disease: a systematic review. Baxter Danielle A,Shergis Johannah L,Fazalbhoy Azharuddin,Coyle Meaghan E Chiropractic & manual therapies Background:Chronic Obstructive Pulmonary Disease (COPD) is an increasingly prevalent respiratory disease that impacts on daily living. In addition to difficulty breathing, many people experience extrapulmonary comorbidities such as musculoskeletal disorders. Pulmonary rehabilitation can improve fitness and strength but may be difficult for patients with musculoskeletal disorders. Recent research indicates promising benefits of adding manual therapy to standard care to improve clinical outcomes. Objectives:To evaluate the efficacy and safety of Muscle Energy Technique (MET) for people with COPD. Methods:Ten databases were searched from inceptions to May 2018. Eligible studies were randomised controlled trials assessing MET compared to any control for COPD. Outcomes included lung function, exercise capacity, health-related quality of life, and adverse events. Results:Three randomised controlled trials assessing 90 participants were included. The quality of the research was limited by reporting of outcome measures and results, varying treatment protocols, and small sample sizes. Results from one study showed that pulmonary function was not statistically different between groups at end of treatment (FEV% MD 4.87%; 95% CI - 0.79 to 10.53). Exercise capacity and perceived dyspnoea ratings were improved in single studies. Adverse events were unrelated to the MET intervention. Conclusions:The use of MET for COPD is an emerging field of research, with few studies evaluating its efficacy and safety. Currently, there is insufficient evidence to support the use of MET in the management of COPD. Rigorously designed studies with larger sample sizes are needed to better understand the role of MET for COPD. 10.1186/s12998-019-0256-9
    Effects of home-based lower limb resistance training on muscle strength and functional status in stable Chronic obstructive pulmonary disease patients. Chen Yi,Niu Mei'e,Zhang Xiuqin,Qian Hongying,Xie Anwei,Wang Xiya Journal of clinical nursing AIMS AND OBJECTIVES:This study aimed to determine the effect of home-based lower limb resistance training (LLRT) in patients with stable COPD. BACKGROUND:Pulmonary rehabilitation (PR) in COPD patients has been substantially investigated, but the rehabilitation components differ among studies. Few works have focused on home-based LLRT. Furthermore, few studies have assessed muscle strength and functional status by isokinetic/isometric extensor muscle peak torque (PT) and five-repetition sit-to-stand test (FTSST), respectively. DESIGN:A randomised controlled design was adopted. METHODS:(i) The home-based LLRT consisted of six sets of lower limb training cycles by self-gravity resistance and Thera-band resistance at 8-12RM, 20-30 min/session and 3 sessions/week for 12 weeks. (ii) The intervention group (n = 25) received routine PR guidance and home-based LLRT, whereas the control group (n = 22) received routine PR guidance only. The muscle strengths, FTSST durations, 6-min walking distances (6MWDs) and COPD assessment test results at enrolment and week 12 were compared. RESULTS:Relative to the baseline findings, all the indexes of muscle strength (isometric extensor muscle PT, isometric extensor muscle PT to body weight ratio [PT/BW], isokinetic extensor muscle PT and isokinetic extensor muscle PT/BW) did not significantly change in the intervention group. Meanwhile, no significant intragroup difference was noted among the indexes of muscle strength (except for isometric extensor muscle PT) in the control group. The FTSST decrease was significant between and within groups. By contrast, the 6MWD significantly increased within both groups, but not between the groups. The COPD assessment tool score decreased significantly within the intervention group. CONCLUSIONS:Compared with routine PR guidance, home-based LLRT can improve not only the muscle strength and exercise endurance but also the lower limb functional status. RELEVANCE TO CLINICAL PRACTICE:Our developed home-based LLRT intervention is simple, safe and feasible in stable COPD patients and could hence be promoted in clinical practice. 10.1111/jocn.14131
    Low rates of participation and completion of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease in primary health care. Méndez Andrea,Labra Patricio,Pizarro Rafael,Baeza Nelly Revista medica de Chile BACKGROUND:Only 6% of patients with chronic obstructive pulmonary disease (COPD) participate in pulmonary rehabilitation programs (PR) and only 50% of those who participate, complete these programs. AIM:To determine rates of PR program participation and completion among patients with COPD in Chile. MATERIAL AND METHODS:Analysis of a database available at the Ministry of Health, which included data of 277491 patients with COPD (55% females) and their participation in PR programs, between 2014 and 2016. RESULTS:Forty percent of patients were over 75 years of age. Participation rates in PR programs ranged from 2.4 to 2.9%. Rates of completion ranged from 26 to 36%. CONCLUSIONS:There is a low rate of participation in PR programs among patients with COPD. Approximately one third of participants complete these programs. 10.4067/S0034-98872018001101304
    Two Interventions for PatientsWith Major Depression and Severe Chronic Obstructive Pulmonary Disease: Impact on Quality of Life. Jackson Danielle S,Banerjee Samprit,Sirey Jo Anne,Pollari Cristina,Solomonov Nili,Novitch Richard,Chalfin Alexandra,Wu Yiyuan,Alexopoulos George S The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry OBJECTIVE:Clinically significant depression occurs in approximately 40% of chronic obstructive pulmonary disease (COPD) patients, and both illnesses severely impair quality of life. This study tests the hypothesis that problem-solving integrated with a treatment adherence intervention, the Problem Solving-Adherence (PSA), is superior to a personalized treatment adherence intervention, the Personalized Intervention for Depressed Patients with COPD (PID-C), alone in improving quality of life in depressed COPD patients. METHODS:After screening 633 admissions for acute rehabilitation, we studied quality of life in 87 participants with major depression (by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and severe COPD randomly assigned to 14 sessions of PID-C or PSA over 26 weeks. Quality of life was assessed using the Word Health Organization Quality of Life-BREF at baseline and weeks 10, 14, and 26. RESULTS:The hypothesis was not supported. Exploratory latent class growth modeling identified two quality of life trajectories. In 80.5% of participants, quality of life remained unchanged and improved in the remaining 19.5% during the first 14 weeks. Patients with a stable quality trajectory had higher qualityof life at baseline and a stronger sense of personal agency. CONCLUSION:Maintaining quality of life is a favorable outcome in depressed patients with COPD whose course is one of deterioration. These findings highlight the usefulness of PID-C, an easy to learn, personalized adherence enhancement intervention that, after further testing, may be integrated into the rehabilitation and care of depressed COPD patients. 10.1016/j.jagp.2018.12.004
    Effectiveness of early rehabilitation on patients with chronic obstructive lung disease and acute respiratory failure in intensive care units: A case-control study. Chou Willy,Lai Chih-Cheng,Cheng Kuo-Chen,Yuan Kuo-Shu,Chen Chin-Ming,Cheng Ai-Chin Chronic respiratory disease The effect of early rehabilitation on the outcome of patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF) in intensive care units (ICUs) remains unclear. We examined the effect of early rehabilitation on the outcomes of COPD patients requiring mechanical ventilation (MV) in the ICU. This retrospective, observational, case-control study was conducted in a medical center with a 19-bed ICU. The records of all 105 ICU patients with COPD and ARF who required MV from January to December 2011 were examined. The outcomes (MV duration, rates of successful weaning and survival, lengths of ICU and hospital stays, and medical costs) were recorded and analyzed. During the study period, 35 patients with COPD underwent early rehabilitation in the ICU and 70 demographically and clinically matched patients with similar COPD stage, cause of intubation, type of respiratory failure, and levels of disease severity who had not undergone early rehabilitation in the ICU were selected as comparative controls. Multiple regression analysis showed that early rehabilitation was significantly negatively associated with MV duration. Early rehabilitation for COPD patients in the ICU with ARF shortened the duration of their MV. 10.1177/1479973118820310
    Aortic Pulse Wave Velocity as a Measure of Cardiovascular Risk in Chronic Obstructive Pulmonary Disease: Two-Year Follow-Up Data from the ARCADE Study. Gale Nichola S,Albarrati Ali M,Munnery Margaret M,Mcdonnell Barry J,Benson Victoria S,Singer Ruth M Tal,Cockcroft John R,Shale Dennis J Medicina (Kaunas, Lithuania) Cardiovascular (CV) disease is a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Patients with COPD have increased arterial stiffness, which may predict future CV risk. However, the development of arterial stiffness in COPD has not yet been studied prospectively. The Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE) is a longitudinal study of CV risk and other comorbidities in COPD. The aims of this analysis were to explore factors associated with aortic pulse wave velocity (aPWV) at baseline and to describe the progression of aPWV in patients with COPD and comparators over two years At baseline, 520 patients with COPD (confirmed by spirometry) and 150 comparators free from respiratory disease were assessed for body composition, blood pressure, aPWV, noninvasive measures of cardiac output, inflammatory biomarkers, and exercise capacity. This was repeated after two years, and mortality cases and causes were also recorded. At baseline, aPWV was greater in COPD patients 9.8 (95% confidence interval (CI) 9.7-10.0) versus comparators 8.7 (8.5-9.1) m/s ( < 0.01) after adjustments for age, mean arterial pressure (MAP), and heart rate. Mean blood pressure was 98 ± 11 in COPD patients and 95 ± 10 mmHg in comparators at baseline ( = 0.004). After two years, 301 patients and 105 comparators were fully reassessed. The mean (95% CI) aPWV increased similarly in patients 0.44 (0.25-0.63) and comparators 0.46 (0.23-0.69) m/s, without a change in blood pressure. At the two-year follow-up, there were 29 (6%) deaths in COPD patients, with the majority due to respiratory causes, with an overall dropout of 43% of patients with COPD and 30% of comparators. This was the first large longitudinal study of CV risk in COPD patients, and we confirmed greater aPWV in COPD patients than comparators after adjustments for confounding factors. After two years, patients and comparators had a similar increase of almost 0.5 m/s aPWV. 10.3390/medicina55040089
    Does health coaching improve health-related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta-analysis. Long Hannah,Howells Kelly,Peters Sarah,Blakemore Amy British journal of health psychology PURPOSE:To systematically review the evidence for health coaching as an intervention to improve health-related quality of life (HRQoL) and reduce hospital admissions in people with chronic obstructive pulmonary disease (COPD). METHODS:We systematically searched MEDLINE, EMBASE, PsycINFO, and CINAHL from database inception to August 2018 to identify all randomized controlled trials (RCTs) of health coaching for people with COPD. Eligible health coaching interventions had to include three components: goal setting, motivational interviewing, and COPD-related health education. Data were extracted on study characteristics and the effects of the intervention on HRQoL, hospital admissions, physical activity, self-care behaviour, and mood. Study quality was appraised by two authors using the Cochrane tool for assessing the risk of bias in RCTs. Effect sizes (standardized mean differences [SMD] or odds ratios [OR]) with 95% confidence intervals (CIs) were calculated and pooled using random effects meta-analyses. RESULTS:Of 1578 articles, 10 RCTs were included. Meta-analysis showed that health coaching has a significant positive effect on HRQoL (SMD = -0.69, 95% CI: -1.28, -0.09, p = .02, from k = 4) and leads to a significant reduction in COPD-related hospital admissions (OR = 0.46, 95% CI: 0.31, 0.69, p = .0001, from k = 5), but not in all-cause hospital admissions (OR = 0.70, 95% CI: 0.41-1.12, p = .20, from k = 3). Three of four studies reported significant improvements to self-care behaviours such as medication adherence and exercise compliance. CONCLUSIONS:This is the first systematic review to show that health coaching may be a candidate intervention to improve HRQoL and reduce costly hospital admissions in people with COPD. Statement of contribution What is already known on this subject? COPD is a leading cause of death worldwide and considerably reduces HRQoL. In turn, HRQoL is associated with a range of adverse health outcomes in COPD. Health coaching is a self-management intervention for people with long-term conditions such as COPD. Studies have examined whether health coaching improves HRQOL and other health outcomes in people with COPD, but no systematic review has been conducted. What does this study add? The first systematic review and meta-analysis of RCTs of health coaching for people with COPD. Health coaching may be a candidate intervention for improving HRQoL and reducing COPD-related hospital admissions in people with COPD. The need to establish the most effective health coaching components, delivery modality, and economic impact. 10.1111/bjhp.12366
    The efficacy of a flipping education program on improving self-management in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Chang Yi-Ya,Dai Yu-Tzu International journal of chronic obstructive pulmonary disease Self-management is widely used among patients with a chronic disease to control their condition. However, the self-management programs are less distinctive for patients with chronic obstructive pulmonary disease (COPD) than those with other chronic diseases. This study examines the efficacy of a flipping education program on improving self-management in patients with COPD. A single-blinded, randomized controlled trial was conducted at a medical center in northern Taiwan from January 2015 to May 2016. Sixty participants were randomized to an experimental group and a control group. The self-management program with flipped teaching, customized action plans, and scheduled telephone interviews was implemented in the experimental group for three months. Conventional patient education was implemented in the control group. Disease knowledge, self-efficacy, the patient's activation level, and the impact of COPD were assessed at baseline, 1 month, and 3 months after the intervention. SPSS 22.0 was used for data analysis. The results showed that the patients who received the flipping education program of self-management had statistically significant improvements in their disease knowledge (<0.05), self-efficacy (<0.01), and activation levels (<0.01) from baseline to the 1 month and 3 months follow-up compared to the control group. The findings supported that flipped teaching could be applied to patient education in adults and that a nurse case manager can feasibly use this flipping education program of self-management to motivate and support patients with COPD to acquire self-management skills, carry out their action plans, and help them achieve beneficial behaviors in their daily lives. 10.2147/COPD.S196592
    Effect of Physical Activity Coaching on Acute Care and Survival Among Patients With Chronic Obstructive Pulmonary Disease: A Pragmatic Randomized Clinical Trial. Nguyen Huong Q,Moy Marilyn L,Liu In-Lu Amy,Fan Vincent S,Gould Michael K,Desai Smita A,Towner William J,Yuen George,Lee Janet S,Park Stacy J,Xiang Anny H JAMA network open Importance:While observational studies show that physical inactivity is associated with worse outcomes in chronic obstructive pulmonary disease (COPD), there are no population-based trials to date testing the effectiveness of physical activity (PA) interventions to reduce acute care use or improve survival. Objective:To evaluate the long-term effectiveness of a community-based PA coaching intervention in patients with COPD. Design, Setting, and Participants:Pragmatic randomized clinical trial with preconsent randomization to the 12-month Walk On! (WO) intervention or standard care (SC). Enrollment occurred from July 1, 2015, to July 31, 2017; follow-up ended in July 2018. The setting was Kaiser Permanente Southern California sites. Participants were patients 40 years or older who had any COPD-related acute care use in the previous 12 months; only patients assigned to WO were approached for consent to participate in intervention activities. Interventions:The WO intervention included collaborative monitoring of PA step counts, semiautomated step goal recommendations, individualized reinforcement, and peer/family support. Standard COPD care could include referrals to pulmonary rehabilitation. Main Outcomes and Measures:The primary outcome was a composite binary measure of all-cause hospitalizations, observation stays, emergency department visits, and death using adjusted logistic regression in the 12 months after randomization. Secondary outcomes included self-reported PA, COPD-related acute care use, symptoms, quality of life, and cardiometabolic markers. Results:All 2707 eligible patients (baseline mean [SD] age, 72 [10] years; 53.7% female; 74.3% of white race/ethnicity; and baseline mean [SD] percent forced expiratory volume in the first second of expiration predicted, 61.0 [22.5]) were randomly assigned to WO (n = 1358) or SC (n = 1349). The intent-to-treat analysis showed no differences between WO and SC on the primary all-cause composite outcome (odds ratio [OR], 1.09; 95% CI, 0.92-1.28; P = .33) or in the individual outcomes. Prespecified, as-treated analyses compared outcomes between all SC and 321 WO patients who participated in any intervention activities (23.6% [321 of 1358] uptake). The as-treated, propensity score-weighted model showed nonsignificant positive estimates in favor of WO participants compared with SC on all-cause hospitalizations (OR, 0.84; 95% CI, 0.65-1.10; P = .21) and death (OR, 0.62; 95% CI, 0.35-1.11; P = .11). More WO participants reported engaging in PA compared with SC (47.4% [152 of 321] vs 30.7% [414 of 1349]; P < .001) and had improvements in the Patient-Reported Outcomes Measurement Information System 10 physical health domain at 6 months. There were no group differences in other secondary outcomes. Conclusions and Relevance:Participation in a PA coaching program by patients with a history of COPD exacerbations was insufficient to effect improvements in acute care use or survival in the primary analysis. Trial Registration:ClinicalTrials.gov identifier: NCT02478359. 10.1001/jamanetworkopen.2019.9657
    Mood Monitoring Over One Year for People With Chronic Obstructive Pulmonary Disease Using a Mobile Health System: Retrospective Analysis of a Randomized Controlled Trial. Whelan Maxine E,Velardo Carmelo,Rutter Heather,Tarassenko Lionel,Farmer Andrew J JMIR mHealth and uHealth BACKGROUND:Comorbid anxiety and depression can add to the complexity of managing treatment for people living with chronic obstructive pulmonary disease (COPD). Monitoring mood has the potential to identify individuals who might benefit from additional support and treatment. OBJECTIVE:We used data from the sElf-management anD support proGrammE (EDGE) trial to examine: (1) the extent to which the mood-monitoring components of a mobile health system for patients with COPD were used by participants; (2) the levels of anxiety and depression symptoms among study participants; (3) the extent to which videos providing advice about coping with low mood were viewed; and (4) the characteristics of participants with differing levels of mood and utilization of mood monitoring. METHODS:A total of 107 men and women with a clinical diagnosis of COPD, aged ≥40 years old, were recruited to the intervention arm of the EDGE trial. Participants were invited to complete the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 test every four weeks using a tablet computer. Mood disturbance based on these measures was defined as a score ≥5 on either scale. Participants reporting a mood disturbance were automatically directed (signposted) to a stress or mood management video. Study outcomes included measures of health status, respiratory quality of life, and symptoms of anxiety and depression. RESULTS:Overall, 94 (87.9%) participants completed the 12-month study. A total of 80 participants entered at least one response each month for at least ten months. On average, 16 participants (range 8-38 participants) entered ≥2 responses each month. Of all the participants, 47 (50%) gave responses indicating a mood disturbance. Participants with a mood disturbance score for both scales (n=47) compared with those without (n=20) had lower health status (P=.008), lower quality of life (P=.009), and greater anxiety (P<.001) and increased depression symptoms (P<.001). Videos were viewed by 64 (68%) people over 12 months. Of the 220 viewing visualizations, 70 (34.7%) began after being signposted. Participants signposted to the stress management video (100%; IQR 23.3-100%) watched a greater proportion of it compared to those not signposted (38.4%; IQR 16.0-68.1%; P=.03), whereas duration of viewing was not significantly different for the mood management video. CONCLUSIONS:Monitoring of anxiety and depression symptoms for people with COPD is feasible. More than half of trial participants reported scores indicating a mood disturbance during the study. Signposting participants to an advisory video when reporting increased symptoms of a mood disturbance resulted in a longer view-time for the stress management video. The opportunity to elicit measures of mood regularly as part of a health monitoring system could contribute to better care for people with COPD. 10.2196/14946
    [The application of holistic nursing in the rehabilitation of occupational pneumoconiosis complicated with chronic obstructive pulmonary disease]. Ju F,Jiang H,Wang X,Ren W Y Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases To investigate the effect of holistic nursing on the rehabilitation of patients with occupational pneumoconiosis complicated with acute exacerbation of chronic obstructive pulmonary disease (COPD) . In October 2018, from September 2016 to September 2018, 120 pneumoconiosis patients with copd admitted to the occupational disease department of Laigang Hospital attached to Affilated to Shandong First Medical University were selected, according to random number table method is divided into experimental group (60 cases) and control group (60 cases) in the control group given conventional nursing, the experimental group to implement the holistic nursing, before and after the intervention were compared of two groups of patients with disease recognition grade self-management behavior of related parameters of blood gas analysis and lung function changes. Comparison of disease recognition score between the two groups, the experimental group was higher than the control group (<0.05) . Comparison of scores of self-management behaviors such as diseases medical management, daily life management. Emotion management and so on between the two groups showed that the experimental group was higher than the control group (<0.05) . Comparison of blood gas analysis indicators between the two groups showed that PaO(2) in the experimental group was higher than that in the control group (<0.05) . Comparison of pulmonary function indicators between the two groups showed that FEV(1) and FEV(1)/FVC in the experimental group were higher than that in the control group (<0.05) . Holistic nursing can effectively improve the cognition of pneumoconiosis patients with copd in the acute exacerbation stage, regulate their self-management behavior, improve arterial oxygen content, improve pulmonary ventilation function. and promote the recovery of the disease. 10.3760/cma.j.issn.1001-9391.2019.12.003
    Meta-analysis of the Effect of a Pulmonary Rehabilitation Program on Respiratory Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease. Lee Eun Nam,Kim Moon Ja Asian nursing research PURPOSE:Pulmonary rehabilitation (PR) programs are important in the treatment of patients with chronic obstructive pulmonary disease (COPD) but vary widely in type, duration, and efficacy. This meta-analysis investigated the effect of PR programs on respiratory muscle strength in patients with COPD. METHODS:PubMed, Embase, and CINAHL were searched. The primary outcome variables were maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP). The secondary outcome variables were the modified Borg score after the 6-min walking test, percent predicted forced expiratory volume in 1 second (FEV%pred), and percent FEV/forced volume capacity (FVC). Comprehensive Meta-Analysis, version 3.0, was used to analyze the data. The effect size was calculated using the standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS:Twenty randomized controlled trials (with 992 participants) were included in the analysis. The PR programs had a significant effect on the MEP (SMD, 0.87; 95% CI, 0.42-1.32; p < .001), MIP (SMD, 0.53; 95% CI, 0.13-0.93; p = .009), and modified Borg score (SMD, -0.37; 95% CI, -0.52 to -0.22; p < .001) in patients with COPD. There was no effect on FEV%pred (SMD, 0.09; 95% CI, -0.12 to 0.30; p = .406) or FEV/FVC% (SMD, 0.04; 95% CI, -0.17 to 0.26; p = .702). CONCLUSION:PR programs improve respiratory muscle strength in patients with COPD. Strategies for selecting a suitable PR program need to be developed, and future studies should evaluate the long-term effects of such programs on pulmonary function. 10.1016/j.anr.2018.11.005
    The Role of Cardiopulmonary Exercise Testing (CPET) in Pulmonary Rehabilitation (PR) of Chronic Obstructive Pulmonary Disease (COPD) Patients. Stringer William,Marciniuk Darcy COPD Chronic obstructive pulmonary disease (COPD) is a common multisystem inflammatory disease with ramifications involving essentially all organ systems. Pulmonary rehabilitation is a comprehensive program designed to prevent and mitigate these disparate systemic effects and improve patient quality of life, functional status, and social functioning. Although initial patient assessment is a prominent component of any pulmonary rehabilitation (PR) program, cardiopulmonary exercise testing (CPET) is not regularly performed as a screening physiologic test prior to PR in COPD patients. Further, CPET is not often used to assess or document the improvement in exercise capacity related to completion of PR. In this review we will describe the classic physiologic abnormalities related to COPD on CPET parameters, the role of CPET in Risk Stratification/Safety prior to PR, the physiologic changes that occur in CPET parameters with PR, and the literature regarding the use of CPET to assess PR results. Finally, we will compare CPET to 6MW in COPD PR, the common minimal clinically important difference (MCID) is associated with CPET, and the potential future roles of CPET in PR and Research. 10.1080/15412555.2018.1550476
    Concordant Evidence-Based Interventions in Cardiac and Pulmonary Rehabilitation Guidelines. Smith Sheree M S,Chaudhary Katrina,Blackstock Felicity Journal of cardiopulmonary rehabilitation and prevention Chronic conditions such as chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) contribute to a significant burden to patients and many experience a reduction in physical functioning, psychological health, and quality of life. The sentinel symptom for COPD and CVD is breathlessness. Rehabilitation programs have been proven to reduce disease symptoms and increase levels of physical and psychological wellness. Pulmonary and cardiac rehabilitation programs have been recommended in international and national guidelines for managing COPD and CVD. Given that these programs seek to reduce breathlessness and improve the physical and psychological functioning of people with COPD and CVD, this review examines the concordant evidence-based interventions in rehabilitation guidelines. The findings of this review indicate that there was concordance in the program design, location of programs, types of health professionals involved in program delivery, assessments of patient at commencement and completion of program, and the delivery of educational topics with minor deviations that were related to disease-specific topics. Apart from disease-specific recommendations, the main divergence from rehabilitation guidelines was found to be dietary screening, inspiratory muscle training, and psychological assessments in evidence-based recommendations for cardiac and pulmonary programs. 10.1097/HCR.0000000000000359
    The role of physical activity in the context of pulmonary rehabilitation. Blondeel Astrid,Demeyer Heleen,Janssens Wim,Troosters Thierry COPD Pulmonary rehabilitation is an important treatment for patients with chronic obstructive pulmonary disease (COPD). Although this intervention leads to large and clinically meaningful improvements in exercise capacity and quality of life, the effect of pulmonary rehabilitation on physical activity is controversial. Physical activity is lower in patients with COPD as compared to healthy age-matched controls and it is related to important health outcomes (e.g. increased risk of mortality and hospitalization). It is an important goal for rehabilitation programs to enhance physical activity to more normal levels in order to achieve the ultimate goal of rehabilitation 'to improve adherence to health enhancing behaviors'. This review discusses the role of physical activity in the context of pulmonary rehabilitation and possible ways to embed interventions geared to behavior change (i.e. to enhance physical activity) and exercise training (i.e. to enhance physical fitness) into comprehensive rehabilitation programs for patients with COPD. 10.1080/15412555.2018.1563060
    The Role of Manual Therapy in Patients with COPD. Clarke Stephanie,Munro Prue E,Lee Annemarie L Healthcare (Basel, Switzerland) Chronic obstructive pulmonary disease (COPD) is a respiratory condition associated with altered chest wall mechanics and musculoskeletal changes. In this narrative review, we describe the underlying musculoskeletal abnormalities in COPD, the reasons for applying manual therapy techniques, their method of application and clinical effects. A variety of manual therapy techniques have been applied in individuals with COPD, including soft tissue therapy, spinal and joint manipulation and mobilisation, and diaphragmatic release techniques. These have been prescribed in isolation and in conjunction with other treatments, including exercise therapy. When applied in isolation, transient benefits in respiratory rate, heart rate and symptoms have been reported. Combined with exercise therapy, including within pulmonary rehabilitation, benefits and their corresponding clinical relevance have been mixed, the extent to which may be dependent on the type of technique applied. The current practical considerations of applying these techniques, including intense therapist⁻patient contact and the unclear effects in the long term, may limit the broad use of manual therapy in the COPD population. Further high quality research, with adequate sample sizes, that identifies the characteristic features of those with COPD who will most benefit, the optimal choice of treatment approach and the longevity of effects of manual therapy is required. 10.3390/healthcare7010021
    Comparison of 3-minute Step Test (3MStepT) and 6-minute Walk Test (6MWT) in Patients with COPD. Beaumont Marc,Losq Antoine,Péran Loic,Berriet Anne-Cécile,Couturaud Francis,Le Ber Catherine,Reychler Grégory COPD Chronic obstructive pulmonary disease (COPD) is frequently associated with a reduced functional exercise capacity. This parameter is usually evaluated using 6-minute walking test (6MWT). New tools appear regularly. The aim of this study was to validate the 3-minute step test (3MStepT) and to compare 3MStepT and 6MWT in stable patients with COPD as a tool to quantify the functional exercise capacity. Patients with COPD admitted for a pulmonary rehabilitation program in a dedicated center were recruited and randomly performed both tests: 6MWT and 3MStepT. A training test was performed systematically before each test. Walking distance and number of repetitions (3MStepT) were measured. Cardiorespiratory parameters, dyspnea and lower limb fatigue (Borg) were recorded pre and post the tests. Fifty patients with COPD (FEV1: 45.2 ± 18.3) were included. 6MWT (423.6 ± 96.3 m) was strongly correlated with 3MStepT (62.1 ± 18.0;  = 0.780;  < 0.001). Heart rate and SpO2 were significantly different at the end of the 6MWT and 3MStepT (respectively, 106.2 ± 16.3 vs. 112.9 ± 13.4bpm,  = 0.002; 87.6 ± 5.4 vs. 89.6 ± 5.3bpm,  = 0.001). Lower limb fatigue was significantly higher after the 3MStepT (2.5 ± 2.6 vs. 3.4 ± 2.4,  = 0.01). The 3MStepT is an alternative to the 6MWT to estimate functional exercise capacity in stable patients with COPD but cardiorespiratory adaptation and lower limb fatigue are not similar between these tests. 10.1080/15412555.2019.1656713
    Effects of a community-based pulmonary rehabilitation programme during acute exacerbations of chronic obstructive pulmonary disease - A quasi-experimental pilot study. Authors' reply. Machado Ana,Oliveira Ana,Valente Carla,Burtin Chris,Marques Alda Pulmonology 10.1016/j.pulmoe.2019.09.001
    Effects of thoracic kinesio taping on pulmonary functions, respiratory muscle strength and functional capacity in patients with chronic obstructive pulmonary disease: A randomized controlled trial. Tomruk Murat,Keleş Elvan,Özalevli Sevgi,Alpaydin Aylin Özgen Explore (New York, N.Y.) CONTEXT:Respiratory and peripheral muscle dysfunctions seen in Chronic Obstructive Pulmonary Disease (COPD) cause ventilatory limitation, dyspnea and inactivity, which then result in a reduction in functional capacity. Kinesio Taping (KT) is a rehabilitative technique performed by the cutaneous application of a special elastic tape, thus increasing muscle activation and blood circulation. OBJECTIVES:To investigate the effects of KT application that was applied on respiratory muscles to improve pulmonary function, respiratory muscle strength and functional capacity in patients with COPD. PATIENTS AND METHODS:In total, 27 COPD patients (16 in KT group, 11 in control group) were included. Thoracic KT was applied to facilitate the respiratory muscles along the subcostal area for KT group. Deep breathing exercises were applied to both groups. Interventions were done 2 days a week, through 6 weeks. Pulmonary function and maximal respiratory mouth pressures were measured with a spirometer. Severity of dyspnea and fatigue were assessed with Modified Medical Research Council dyspnea scale and Modified Borg Scale, respectively. Functional capacity was evaluated using six-minute walk test. RESULTS:Percentage predicted of forced expiratory volume in one second (FEV%), peak expiratory flow (PEF) value, percentage predicted of peak expiratory flow (PEF%) and walking distance were significantly increased in KT group (p = 0.038, p = 0.011, p = 0.013, p = 0.004, respectively). The severity of dyspnea and fatigue were reduced in KT group (p < 0.05). There was no significant change for other variables in-group and between-group analyses (p > 0.05). CONCLUSIONS:Thoracic KT may be beneficial for improving pulmonary function and functional capacity in patients with COPD. 10.1016/j.explore.2019.08.018
    Determination of whether supplemental oxygen therapy is beneficial during exercise training in patients with COPD: A systematic review and meta-analysis. Liu Ying,Gong Fanghua Experimental and therapeutic medicine Exercise training is an integral component of the pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to systematically search the published literature and analyze the evidence on the efficacy of supplemental oxygen in improving outcomes during exercise training in patients with COPD. The PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Google scholar databases were searched electronically for articles in the English language published up to May, 2019. In total, 7 trials were included in this systematic review and meta-analysis. There was considerable heterogeneity amongst the included studies. Meta-analysis indicated no significant difference in power (random: MD = -2.38; 95% CI, -5.79 to 1.03; P=0.86) and maximum energy expenditure (VO max) (random: MD = -0.01; 95% CI, -0.06 to 0.07; P=0.45) between the oxygen and control groups on maximal exercise testing. Qualitative analysis of the included studies revealed no benefits of supplemental oxygen in improving exercise capacity and dyspnea scores. Data on the quality of life assessed by the Chronic Respiratory Disease Questionnaire was pooled for 95 participants in the study group and 91 participants in the control group. The results indicated no beneficial effects of supplemental oxygen in improving quality of life outcomes (random: MD = -0.09; 95% CI, -0.16 to -0.01; P=0.59). On the whole, the findings of this study indicate that supplemental oxygen during the exercise training of patients with COPD does not improve exercise capacity, dyspnea scores and quality of life. However, the quality of the evidence is weak. Multi-center randomized controlled trials with homogenous methodology and intervention are required to provide stronger evidence on this subject. 10.3892/etm.2019.8026
    Effects of a high-intensity pulmonary rehabilitation program on the minute ventilation/carbon dioxide output slope during exercise in a cohort of patients with COPD undergoing lung resection for non-small cell lung cancer. Perrotta Fabio,Cennamo Antonio,Cerqua Francesco Saverio,Stefanelli Francesco,Bianco Andrea,Musella Salvatore,Rispoli Marco,Salvi Rosario,Meoli Ilemando Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia OBJECTIVE:Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. METHODS:We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. RESULTS:There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). CONCLUSIONS:Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results. 10.1590/1806-3713/e20180132
    Physiological and Symptomatic Responses to Arm versus Leg Activities in People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Frykholm Erik,Lima Vanessa Pereira,Selander Hanna-Vega,Nyberg Andre,Janaudis-Ferreira Tania COPD While the mechanisms underlying exercise limitations and symptoms during leg activities have been investigated in detail, knowledge of potential differences between leg and arm activities are not well understood and results from individual studies are contradictory. Thus, the aim of the present study was to synthesize physiological and symptomatic responses during activities involving the arms relative to activities involving the legs in people with Chronic Obstructive Pulmonary Disease (COPD). Any study with a cross-sectional comparison of acute physiological (cardiorespiratory, metabolic) and symptomatic responses to activities performed with the arms versus the legs were included. Studies were sub-grouped based on the type of activity performed (cycle ergometer, resistance exercises, or functional test/activities). Eighteen studies with 423 individuals with COPD were included. Leg cycle ergometer resulted in greater tidal volume (137 mL), minute ventilation (4.8 L/min), and oxygen consumption (164 mL/min) than arm cycle ergometer, while symptomatic responses were similar. Resistance exercises resulted in similar physiological and symptomatic responses irrespective of whether the legs or the arms were involved while studies on functional activities report different results depending on the type and intensity of the activity performed. With the exception of cycle ergometer activities, physiological and symptomatic responses do not seem to depend on whether the arms or the legs are used, but rather seem to be task and intensity dependent. These novel findings suggest, for example, that strategies used to increase exercise tolerance should not be dependent on whether the arms or the legs are used, but rather the intensity of specific activity performed. 10.1080/15412555.2019.1674269
    Benefits of different intensities of pulmonary rehabilitation for patients with moderate-to-severe COPD according to the GOLD stage: a prospective, multicenter, single-blinded, randomized, controlled trial. He Guo Xia,Li Ning,Ren Lei,Shen Hong Hua,Liao Ning,Wen Jian Jun,Xu Yi Min,Wang Jing,Li Qing Yun International journal of chronic obstructive pulmonary disease Purpose:Pulmonary rehabilitation (PR) is essential to manage patients with COPD. The aim of this study was to investigate the appropriate intensity of PR exercise training for patients with moderate-to-severe COPD. Patients and methods:A prospective multicenter randomized controlled trial was conducted from January 2014 to October 2018. The subjects were randomly assigned to three groups with different intensities of PR, according to their maximum oxygen uptake percentage determined by cardiopulmonary exercise testing. After 20 weeks of exercise training, the effects of low-, moderate-, and high-intensity exercise interventions on patients were compared to determine the most appropriate PR prescription. Results:For patients with moderate COPD, all the measured parameters were significantly improved in the moderate- and high-intensity PR groups (<0.01), while there was no significant difference in the frequency of acute exacerbations and the mMRC questionnaire after 20 weeks of PR exercise in the low-intensity PR group. For patients with severe COPD, all variables were also improved in the high-intensity PR group (<0.05), while the mean differences of pre- and post-PR were lower than those in patients with moderate COPD. Moreover, the Hamilton Anxiety Scale and body mass index showed no significant difference in low-intensity PR group (>0.05). Conclusion:High-intensity PR exercise is helpful for patients with moderate to severe COPD. Moderate COPD patients need to receive intensive PR training; the improvement degrees from PR intervention were higher than those of the severe COPD patients. For patients with severe COPD, high-intensity PR exercise may be more beneficial if patients can tolerate it. 10.2147/COPD.S214836
    Update on management of stable chronic obstructive pulmonary disease. Agrawal Ritwick,Moghtader Shahram,Ayyala Uma,Bandi Venkata,Sharafkhaneh Amir Journal of thoracic disease Chronic obstructive pulmonary disease (COPD) is a major chronic debilitating condition with significant impact on quality of life, symptoms, comorbidity, health care utilization and longevity. The main pathophysiological hallmark of COPD is expiratory flow limitation which impairs the ability of respiratory system to adequately and properly ventilate. To be able to prognosticate and manage patients with COPD, various societies have developed classifications of disease severity. Current classification schemes combine three elements that include lung function, patient reported symptoms (shortness of breath) and frequency of exacerbations. Global Initiative for Obstructive Lung Disease (GOLD), an international guideline for diagnosis and management of COPD, started using this approach since the 2011 revision. Management according to this scheme has been developed and is in use. Comprehensive COPD management is multifaceted. It includes pharmacologic management, patient education, smoking cessation, influenza and pneumococcal vaccinations, depression and anxiety management, pulmonary rehabilitation, and if indicated, home oxygen therapy. The following chapter will review management recommendations currently in use for stable COPD. We intend to make the chapter to the point and practical and avoid an exhaustive review of the literature. 10.21037/jtd.2019.06.12
    Implementation of a real-world based ICF set for the rehabilitation of respiratory diseases: a pilot study. Vitacca Michele,Giardini Anna,Corica Giacomo,Ceriana Piero,Carone Mauro,Balbi Bruno,Fracchia Claudio,Maniscalco Mauro,Fanfulla Francesco,Sarno Nicola,Raccanelli Rita,Traversoni Silvia,Spanevello Antonio Minerva medica BACKGROUND:International Classification Functioning (ICF) Core Sets represent a holistic approach to functioning within rehabilitation field. Information-reporting efficacy of a rehabilitation-based Respiratory ICF set applied on a large scale throughout the ICS Maugeri network was tested. METHODS:A prospective multi-center study (May-November 2018) was conducted for all respiratory inpatients consecutively admitted for rehabilitation. Doctors, physiotherapists, psychologists, nurses used an electronic Respiratory ICF set (33 items among the ICF body functions, activity and participations components) at admission and at discharge to assess the disability changes. The ICF report qualifiers, from 0 (no impairment) to 4 (maximum impairment), guided clinical, diagnostic and rehabilitation prescriptions. RESULTS:1886 patients (69.6±10.8 years; M=1045) were admitted (589 chronic obstructive pulmonary disease, 494 chronic respiratory failure [CRF], 21 prolonged mechanical ventilation [PMV], 496 with other respiratory diseases), of whom 15 died, and 117 were transferred to acute care. The mean length of stay was 23.1±11.8 days (range 1-122). The mean time to fill in the ICF set was 23.16±0.70 min. The rate of filled charts improved from 16% in May to 100% in November. The baseline distribution of the more severe qualifiers (>2) progressively increased from the whole sample to the PMV subgroup. After rehabilitation, in the whole sample and in the CRF and PMV subgroups, the severity qualifiers significantly decreased (P<0.0001), showing a positive effect of the intervention on patients' disability. CONCLUSIONS:Routine use of a Respiratory ICF set for chronic respiratory diseases helps to prepare a personalized rehabilitation program discriminating disability level in different respiratory diseases and assessing disability outcomes pre-post rehabilitation. 10.23736/S0026-4806.19.06261-X
    Effect of Virtual Reality-Based Rehabilitation on Physical Fitness in Patients with Chronic Obstructive Pulmonary Disease. Rutkowski Sebastian,Rutkowska Anna,Jastrzębski Dariusz,Racheniuk Henryk,Pawełczyk Witold,Szczegielniak Jan Journal of human kinetics The aim of the study was to evaluate the effects of rehabilitation in patients with chronic obstructive pulmonary disease (COPD) using the Kinect system during stationary rehabilitation. The study included 68 patients with COPD (35 men, 33 women, mean age 61.3 ± 3.7). The subjects were randomly assigned to one of the two experimental groups described below. Group I included 34 patients - non-participants in Kinect training. Group II included 34 patients - participants in Kinect training. In all patients before and after rehabilitation physical fitness was assessed using the Senior Fitness Test (SFT). The Xbox 360 and Kinect motion sensor were used to carry out virtual reality training. In group I, statistically significant improvements in SFT performance were observed. Patients in group II also showed statistically significant improvement in physical fitness in all attempts of the SFT. Virtual rehabilitation training in patients with COPD seems to be a practical and beneficial intervention capable of enhancing mobility and physical fitness. 10.2478/hukin-2019-0022
    Evaluation of meaning of life and self-care agency in nursing care given to chronic obstructive pulmonary patients according to health promotion model. Karasu Fatma,Aylaz Rukuye Applied nursing research : ANR The study was conducted to evaluate the meaning of life and self-care agency in nursing care given to chronic obstructive pulmonary patients according to the health promotion model. The sample of the study was determined by power analysis and 40 COPD patients were assigned to each group by simple random sampling method. Descriptive Information Form, Life Attitude Profile and Self-care Agency Scale were used to obtain the data. Nursing care was applied by the researcher 3 times in every 2 weeks according to the health promotion model in the houses of the patients in the experimental groups. Number, percentage, mean, standard deviation, dependent samples t-test, independent samples t-test, chi-square and ANOVA were used to analyze the data. It was determined that while posttest mean score of the patients in the Experimental group 1 for Self-care agency scale was 112.70 ± 29.0; their posttest mean score for Life Attitude Profile was 156.37 ± 13.5. Posttest mean score of the patients in the Control group 1 for Self-care agency scale was 81.35 ± 17.7; whereas, their posttest mean score for Life Attitude Profile was 120.50 ± 31.9. The difference between the posttest mean scores of the groups was statistically significant (p < 0.05). The care applied to the patients with COPD according to health promotion model was found to increase self-care agency and meaning of life of the patients. 10.1016/j.apnr.2019.151208
    Exercise Training Modalities for People with Chronic Obstructive Pulmonary Disease. Nolan Claire M,Rochester Carolyn L COPD Exercise training confers health benefits for people with chronic obstructive pulmonary disease (COPD). This article reviews the evidence for several exercise training modalities shown to be beneficial among individuals with COPD. These modalities include aerobic, resistance, nonlinear periodized, upper limb and balance training, as well as yoga, Tai Chi, inspiratory muscle training, whole body vibration training and neuromuscular electrical stimulation. The literature pertaining to each modality was critically reviewed, and information on the rationale, mechanism(s) of action (where known), benefits, and exercise prescription is described to facilitate easy implementation into clinical practice. 10.1080/15412555.2019.1637834
    Effects of Different Modes of Upper Limb Training in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Kruapanich Chathipat,Tantisuwat Anong,Thaveeratitham Premtip,Lertmaharit Somrat,Ubolnuar Nutsupa,Mathiyakom Witaya Annals of rehabilitation medicine OBJECTIVE:To determine effects of different modes of upper limb training on dyspnea and quality of life of individuals with chronic obstructive pulmonary disease (COPD) having different disease severity. METHODS:Randomized clinical trials were retrieved from five electronic databases. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's tool and the GRADE approach, respectively. Effects of upper limb training compared to control were identified using standardized mean difference and 95% confidence interval. RESULTS:Fifteen studies with 514 subjects were included. When compared to control, upper limb endurance and strength training with moderate quality of evidence resulted in significant improvement in dyspnea. However, quality of life was not significantly different between upper limb training of all modes of and the control. The upper limb training was more effective in reducing dyspnea in patients with severe COPD than in those with mild to moderate levels of COPD. Although quality of life was slightly improved by upper limb training for those with moderate or severe level of COPD, such improvement did not reach a significant level when compared to the control. CONCLUSION:Upper limb endurance and strength training could significantly improve dyspnea in individuals with chronic obstructive pulmonary disease. Thus, incorporating the upper limb training into pulmonary rehabilitation is recommended to reduce dyspnea, especially for those with severe patients. Further studies with larger sample size and standardized training protocol are needed to confirm these finding (Registration No. CRD42018102805). 10.5535/arm.2019.43.5.592
    COPD patients need more information about self-management: a cross-sectional study in Swedish primary care. Sandelowsky Hanna,Krakau Ingvar,Modin Sonja,Ställberg Björn,Nager Anna Scandinavian journal of primary health care In Sweden, patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), often receive education at specialized nurse-led clinics at primary health care centers (PHCCs). Identifying patients' needs for information about COPD is the key to individualized care. This study aimed to assess self-reported needs for information about COPD in primary care patients with either moderate (GOLD 2) or severe (GOLD 3) COPD and identify patient characteristics and exacerbation patterns associated with the findings. A cross-sectional study. Twenty-four PHCCs in Stockholm, Sweden. Randomly selected primary care patients with COPD in GOLD stages 2 and 3 ( = 542). The Lung Information Needs Questionnaire (LINQ) was used to assess perceived information needs. Spirometry results and descriptive, self-reported data on patient factors such as exacerbation history, treatment, smoking, weight/height, comorbidities, health care contacts, education and symptoms were collected. Overall, the greatest reported needs were for information about self-management and diet. GOLD 2 patients (68%) expressed greater needs for information than GOLD 3 patients (32%). We found significant associations between high information needs and patient-related factors such as 'No assigned GP' (OR = 4.32 [95% CI 2.65-7.05]) and 'No contact with COPD nurse in the past 12 months' (OR = 1.83 [95% CI 1.19-2.81]). COPD patients felt they knew too little about self-management of their disease. Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. These associations were strongest in patients with moderate COPD. As patients with COPD often have multimorbidity, identifying patients' needs for information about COPD is essential to providing individualized patient education and care. In this study of 542 patients from 24 Swedish primary care centers, we found that:Patients with COPD, particularly those with moderate airflow limitation (i.e. GOLD 2) felt they needed more information about COPD than currently provided by health care professionals in primary care.Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. GPs' part in COPD patient education should not be overlooked, as individualized COPD care relies on GPs' expertise in managing patients with multimorbidity. 10.1080/02813432.2019.1684015
    Measuring and monitoring skeletal muscle function in COPD: current perspectives. Marklund Sarah,Bui Kim-Ly,Nyberg Andre International journal of chronic obstructive pulmonary disease Skeletal muscle dysfunction is an important systemic consequence of chronic obstructive pulmonary disease (COPD) that worsens the natural cause of the disease. Up to a third of all people with COPD express some form of impairment which encompasses reductions in strength and endurance, as well as an increased fatigability. Considering this complexity, no single test could be used to measure and monitor all aspects of the impaired skeletal muscle function within the COPD population, resulting in a wide range of available tests and measurement techniques. The aim of the current review is to highlight current and new perspectives relevant to skeletal muscle function measurements within the COPD population in order to provide guidance for researchers as well as for clinicians. First of all, standardized and clinically feasible measurement protocols, as well as normative values and predictive equations across the spectrum of impaired function in COPD, are needed before assessment of skeletal muscle function can become a reality in clinical praxis. This should minimally target the quadriceps muscle; however, depending on the objective of measurements, eg, to determine upper limb muscle function or walking capacity, other muscles could also be tested. Furthermore, even though muscle strength measurements are important, current evidence suggests that other aspects, such as the endurance and power capacity of the muscle, should also be considered. Moreover, although static (isometric) measurements have been favored, dynamic measurements of skeletal muscle function should not be neglected as they, in a larger extent than static measurements, are related to tasks of daily living. Lastly, the often modest relationships between functional tests and skeletal muscle function measurements indicate that they evaluate different constructs and thus cannot replace one another. Therefore, for accurate measurements of skeletal muscle function in people with COPD, specific and formal measurements should still be prioritized. 10.2147/COPD.S178948
    Association between chronic obstructive pulmonary disease and activity of daily living among oldest-old in China: based on Chinese Longitudinal Health Longevity Survey. Liu Miao,Yue Yanhong,He Yao International journal of chronic obstructive pulmonary disease Aims:This study was designed to investigate the association between COPD and activity of daily living among oldest-old in People's Republic of China. Patients and methods:The data of Chinese Longitudinal and Health Longevity Study in 2014 was used, and those who were aged more than 80 years old were included. Both basic activity of daily living (BADL) and instrumental activity of daily living (IADL) were measured. Results:A total of 4621 oldest-old (≥80 years old) were included. 32.1% (1482) of the oldest-old had BADL disability and 79.0% (3129) had IADL disability. The BADL disability and IADL disability rates were higher for participants with COPD than those without, and this difference was more robust among male (31.8% vs 25.6%, =0.018). The IADL disability rate showed similar trends. Multivariate logistic regression analysis showed that the odds ratios of COPD on BADL disability and IADL disability were 1.261 (95% CI: 1.044-1.525) and 2.014 (95% CI: 1.561-2.598), respectively. The odds ratios of COPD on moderate to severe BADL disability and IADL disability were 1.007 (95% CI: 0.790-1.284) and 1.713 (95% CI: 1.397-2.100), respectively. Conclusion:There were independent associations between COPD and disability among oldest-old in People's Republic of China, and the associations were greater among male population. Besides, COPD had a profound influence on the mild disability of BADL, while had a greater impact on the moderate and severe disability of IADL. 10.2147/COPD.S215803
    The responsiveness of the Manchester Chronic Obstructive Pulmonary Disease Fatigue Scale to pulmonary rehabilitation. Therapeutic advances in chronic disease BACKGROUND:We examined the responsiveness of the Manchester Chronic Obstructive Pulmonary Disease (COPD) Fatigue Scale (MCFS) in patients with COPD following 8 weeks of pulmonary rehabilitation (PR). METHODS:Patients ( = 273) with clinically stable COPD completed 8 weeks of outpatient multidisciplinary PR, comprising 2 h (1 h exercise and 1 h education) weekly. Anxiety, exercise capacity, quality of life, dyspnea, fatigue were measured pre- and post-PR, utilizing the Anxiety Inventory for Respiratory Disease (AIR), Incremental Shuttle Walk Test (ISWT), St. George's Respiratory Questionnaire (SGRQ), and modified Medical Research Council (mMRC) scale and MCFS, respectively. RESULTS:The mean (SD) age of participants was 72 (8) years, and 50% were women. Total MCFS score fell after PR mean (95% confidence interval) -4.89 (-7.90 to -3.79) as did domain scores: physical -1.89 (-2.33 to -1.46), cognition -1.37 (-1.65 to -1.09), and psychosocial -1.62 (-2.00 to -1.62). Total MCFS effect size (ES) was 0.55; and for domains, physical was 0.52, cognition was 0.59, and psychosocial was 0.51. The ES for AIR was 0.30, mMRC was 0.38, SGRQ was 0.66, and ISWT was 1.19. MCFS changes correlated with changes in both SGRQ ( < 0.002) and AIR ( < 0.004), but not ISWT ( = 0.30) or mMRC ( = 0.18). The AIR, SGRQ, mMRC, and ISWT all improved after PR (all,  < 0.001). CONCLUSION:The MCFS scale is a valid and responsive scale to measure fatigue in patients with COPD after pulmonary rehabilitation. 10.1177/2040622319882206
    Self-management interventions in COPD patients with multimorbidity. Vanfleteren Lowie E G W,Fabbri Leonardo M The European respiratory journal 10.1183/13993003.01850-2019
    Innovative strategies to improve the reach and engagement in pulmonary rehabilitation. McNamara Renae J,Dale Marita,McKeough Zoe J Journal of thoracic disease Evidence of personal and health-system benefits of pulmonary rehabilitation are undeniable. However, the capacity of traditional centre-based models to both reach and appeal to the intended population of people living with chronic obstructive pulmonary disease (COPD) remains difficult. It is well established that issues with access, suitability, referral, uptake, and attrition exist. Consequently, considerable energy has been invested into exploring innovative alternative modes of rehabilitation in an effort to increase the awareness and appeal, and expand the availability of pulmonary rehabilitation. The process of 'thinking differently' and 'pushing the boundaries' of clinical practice is underway, particularly in the United Kingdom and Australia, where new models of pulmonary rehabilitation are being evaluated. The number one priority is reaching the population of people with COPD and ensuring they are referred to rehabilitation services. Active case-finding in primary care, inviting health professionals and health consumers to pulmonary rehabilitation programs to increase understanding and awareness, and utilizing peer support via patient success stories, are just a few suggestions for increasing awareness of pulmonary rehabilitation. Once referred, engaging the population to complete a program is the next challenge. Marketing, patient co-design, alternative rehabilitation settings and modes of exercise training, use of technology, and focusing on modes which provide patient enjoyment and choice are all potential strategies to target in an effort to broaden the appeal and reduce the high attrition rate of traditional centre-based pulmonary rehabilitation programs. Reaching and engaging the target population in pulmonary rehabilitation is an important first step in people with COPD achieving successful outcomes from rehabilitation. 10.21037/jtd.2019.10.29
    [Pulmonary Rehabilitation]. Frey Martin Therapeutische Umschau. Revue therapeutique Pulmonary Rehabilitation Pulmonary rehabilitation is a comprehensive therapeutic approach for patients with advanced chronic lung diseases which leads to a decline of dyspnea, an increase of exercise capacity and an increase of quality of life. Further effects are a reduction of frequency of hospitalisations and an increase of physical activity, if a self management education program is integrated. Pulmonary rehabilitation incorporates an individualised training program with focus on endurance, strength and mobility, further a disease specific education with the goal to improve self efficacy and self management of the patients, specially with the goal to improve their daily physical activity. Due to the good evidence of pulmonary rehabilitation, the accredited programs are accepted and paid by the swiss insurances. 10.1024/0040-5930/a001099
    Randomized feasibility study of twice a day functional electrostimulation in patients with severe chronic obstructive pulmonary disease hospitalized for acute exacerbation. Lopez-Lopez Laura,Torres-Sanchez Irene,Rodriguez-Torres Janet,Cabrera-Martos Irene,Cahalin Lawrence P,Valenza Marie C Physiotherapy theory and practice Pulmonary rehabilitation is an effective intervention for individuals who have Chronic Obstructive Pulmonary Disease (COPD). The adequate intensity, components, and number of sessions are difficult to determine, specifically in patients who have severe ventilatory limitations in order to produce true physiological training effects without adverse events. Our aim is to assess the feasibility and possible effects of a daily versus a twice-daily functional electrostimulation program in hospitalized individuals who have a severe COPD. In this randomized controlled trial, 48 severe patients with COPD were randomized into three groups: Control Group (CG; n = 16), daily functional electrostimulation group (DFEG; n = 15) or twice-daily functional electrostimulation group (TFEG; n = 17). The main outcome measures were quadriceps strength, symptoms at rest and after exercise, and adverse events measured before and after the intervention. After eight sessions, DFEG and TFEG showed significant differences when compared to the CG in all measured variables at discharge ( ≤ .001), no adverse events were observed in any of the treatment groups. Significant improvements were found in strength ( ≤ .05) between DFEG and TFEG groups. However, lower limb function did not present significant differences in spite of the fact that the mean change favored the TFEG (23.53 ± 3.53 vs. 19.56 ± 11.89). Further examination of twice per day functional electrostimulation in hospitalized patients with COPD with acute exacerbation appears warranted. 10.1080/09593985.2019.1694611
    Coexistence of malnutrition, frailty, physical frailty and disability in patients with COPD starting a pulmonary rehabilitation program. Ter Beek L,van der Vaart H,Wempe J B,Krijnen W P,Roodenburg J L N,van der Schans C P,Jager-Wittenaar H Clinical nutrition (Edinburgh, Scotland) BACKGROUND & AIMS:Malnutrition, frailty, physical frailty, and disability are common conditions in patients with chronic obstructive pulmonary disease (COPD). Insight in the coexistence and relations between these conditions may provide information on the nature of the relationship between malnutrition and frailty. Such information may help to identify required interventions to improve the patient's health status. We therefore aimed to explore whether malnutrition, frailty, physical frailty, and disability coexist in patients with COPD at the start of pulmonary rehabilitation. METHODS:For this cross-sectional study, from March 2015 to May 2017, patients with COPD were assessed at the start of a pulmonary rehabilitation program. Nutritional status was assessed with the Scored Patient-Generated Subjective Global Assessment (PG-SGA) based Pt-Global app. Frailty was assessed by the Evaluative Frailty Index for Physical activity (EFIP), physical frailty by Fried's criteria, and disability by the Dutch version of World Health Organization Disability Assessment Schedule 2.0 (WHODAS). These variables were dichotomized to determine coexistence of malnutrition, frailty, physical frailty, and disability. Associations between PG-SGA score and respectively EFIP score, Fried's criteria, and WHODAS score were analyzed by Pearson's correlation coefficient. Two tailed P-values were used, and significance was set at P < 0.05. RESULTS:Of the 57 participants included (age 61.2 ± 8.7 years), malnutrition and frailty coexisted in 40%. Malnutrition and physical frailty coexisted in 18%, and malnutrition and disability in 21%. EFIP score and PG-SGA score were significantly correlated (r = 0.43, P = 0.001), as well as Fried's criteria and PG-SGA score (r = 0.37, P = 0.005). CONCLUSIONS:In this population, malnutrition substantially (40%) coexists with frailty. Although the prevalence of each of the four conditions is quite high, the coexistence of all four conditions is limited (11%). The results of our study indicate that nutritional interventions should be delivered by health care professionals across multiple disciplines. 10.1016/j.clnu.2019.11.016
    Influence Of Socioeconomic Deprivation On Short- And Long-Term Outcomes Of Home-Based Pulmonary Rehabilitation In Patients With Chronic Obstructive Pulmonary Disease. Grosbois Jean-Marie,Heluain-Robiquet Justine,Machuron François,Terce Gaelle,Chenivesse Cécile,Wallaert Benoit,Le Rouzic Olivier International journal of chronic obstructive pulmonary disease Background:Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes. Methods:In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6 min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline. Results:Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups. Conclusion:Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status. 10.2147/COPD.S224348
    Longevity of pulmonary rehabilitation benefit for chronic obstructive pulmonary disease-health care utilisation in the subsequent 2 years. Walsh James R,Pegg Jane,Yerkovich Stephanie T,Morris Norman,McKeough Zoe J,Comans Tracy,Paratz Jenny D,Chambers Daniel C BMJ open respiratory research Background:The primary aim was to determine the healthcare utilisation benefits including respiratory-related hospital admissions, hospital admission days and emergency department presentations in the 0-12 and 12-24 months postpulmonary rehabilitation compared with the 12 months preprogramme. Methods:An observational, data-linkage design of 11 standardised pulmonary rehabilitation programmes were used. All programmes were 8 weeks in duration with two supervised exercise sessions per week and were required to use the national pulmonary rehabilitation recommendations with regard to programme organisation, exercise training guidelines and multidisciplinary education. For each participant with chronic obstructive pulmonary disease (COPD), healthcare utilisation data were collected for the 12 months preprogramme and 24 months postprogramme. Results:426 participants (231 males, FEV49.3 (19.6) % predicted) were studied. The number of respiratory admissions/participant/year decreased from 0.7 (1.1) in the 12 months preprogramme to 0.5 (1.9) in the 12 months postprogramme, p=0.083; but increased in the 12-24 months postprogramme to 1.0 (2.3), p<0.001. The hospital days/participant/year improved from 4.0 (7.8) days in the 12 months preprogramme to 2.5 (8.5) days in the 12 months postprogramme, p<0.001; but increased in the 12-24 months postprogramme to 6.1 (16.6) days, p=0.004. The emergency department presentations/participant/year improved from 1.15 (1.75) in the 12 months preprogramme to 0.9 (1.8) in the 12 months postprogramme, p=0.003; but increased in the 12-24 months postprogramme to 2.0 (3.3), p<0.001. Conclusion:Pulmonary rehabilitation significantly improves hospital days and emergency department presentations in the first 12 months postprogramme. Healthcare utilisation benefits in the second 12 months are less clear. 10.1136/bmjresp-2019-000500
    Effects of combining functional exercises with exercise training on daily physical activities and functionality in patients with COPD: a protocol for a randomized clinical trial. de Lima Fabiano Francisco,Camillo Carlos Augusto,Grigoletto Isis,Uzeloto Juliana Souza,Vanderlei Franciele Marques,Ramos Dionei,Ramos Ercy Mara Cipulo Trials INTRODUCTION:Functional training has been shown to be a viable alternative for the elderly and patients with chronic obstructive pulmonary disease (COPD). However, whether the combination of this type of training with aerobic and resistance training, commonly performed in pulmonary rehabilitation (PR) programs, induces more pronounced effects on daily physical activities and functionality remains unclear. The aims of the study will be to evaluate the short-term and sustained effects of the combination of a functional circuit program with a training program consisting of aerobic and resistance exercise. METHODS:In this randomized controlled trial, patients with COPD will be randomly assigned (1:1:1) to an 8-week training program to follow one of the three a priori defined groups: (I) resistance and aerobic and functional exercises, (II) a conventional program including only resistance and aerobic exercises, or (III) a usual care program. Patients will be evaluated before and upon completion of 8 weeks of training regarding physical activity in daily life (PADL) using an activity monitor (accelerometer), activities of daily living (London Chest Activity of Daily Living), functional exercise capacity (6-minute walk test), and muscle strength (dynamometry). Additionally, the sustained effects of the interventions will be evaluated 22 weeks after commencing the study. DISCUSSION:The inclusion of a protocol of functional physical training in the training conventionally performed by patients with COPD as an alternative to increase PADL and functionality may provide subsidies for the treatment of these patients, representing an advance and impacting on the physical training of patients with COPD. TRIAL REGISTRATION:Brazilian Clinical Trials Registry (ReBEC) ID: RBR-3zmh3r. Registered: March 7, 2018. 10.1186/s13063-019-3780-y
    Impaired training-induced angiogenesis process with loss of pericyte-endothelium interactions is associated with an abnormal capillary remodelling in the skeletal muscle of COPD patients. Blervaque Léo,Passerieux Emilie,Pomiès Pascal,Catteau Matthias,Héraud Nelly,Blaquière Marine,Bughin François,Ayoub Bronia,Molinari Nicolas,Cristol Jean-Paul,Perez-Martin Antonia,Mercier Jacques,Hayot Maurice,Gouzi Fares Respiratory research Chronic obstructive pulmonary disease (COPD) is associated with exercise intolerance and limits the functional gains in response to exercise training in patients compared to sedentary healthy subjects (SHS). The blunted skeletal muscle angiogenesis previously observed in COPD patients has been linked to these limited functional improvements, but its underlying mechanisms, as well as the potential role of oxidative stress, remain poorly understood. Therefore, we compared ultrastructural indexes of angiogenic process and capillary remodelling by transmission electron microscopy in 9 COPD patients and 7 SHS after 6 weeks of individualized moderate-intensity endurance training. We also assessed oxidative stress by plasma-free and esterified isoprostane (F-IsoP) levels in both groups. We observed a capillary basement membrane thickening in COPD patients only (p = 0.008) and abnormal variations of endothelial nucleus density in response to exercise training in these patients when compared to SHS (p = 0.042). COPD patients had significantly fewer occurrences of pericyte/endothelium interdigitations, a morphologic marker of capillary maturation, than SHS (p = 0.014), and significantly higher levels of F-IsoP (p = 0.048). Last, the changes in pericyte/endothelium interdigitations and F-IsoP levels in response to exercise training were negatively correlated (r = - 0.62, p = 0.025). This study is the first to show abnormal capillary remodelling and to reveal impairments during the whole process of angiogenesis (capillary creation and maturation) in COPD patients. TRIAL REGISTRATION: NCT01183039 & NCT01183052, both registered 7 August 2010 (retrospectively registered). 10.1186/s12931-019-1240-6
    "Breathing New Life Into Chronic Obstructive Pulmonary Disease (COPD)" - Results From An Online Survey Of UK Patients. Titmarsh Steve,Poliziani Michele,Russell Richard E International journal of chronic obstructive pulmonary disease Background:There is a lack of data on the impact of COPD on individuals, their illness, behavior and attitude to the disease. Method:500 UK patients with a primary care diagnosis of COPD responded to an online survey. Results:61.2% of respondents were female and 85.8% were between 50 and 80 years old. Two-thirds (67.8%) of respondents did not smoke at the time of the survey. Almost half of those surveyed (46.2%, n=231) used three inhalers, and 31% (n=155) agreed or strongly agreed with the statement "I feel that my treatment is not adequately controlling my condition", while 39.4% (n=197) disagreed or strongly disagreed. 48.8% (n=244) agreed their COPD was well managed. Over half the sample (56.8%, n=284) said they never forgot to use their inhaler as prescribed. Checks on inhaler use by doctors or nurses were reported as every six months/twice a year by 24.4% (n=122) and once a year by 38.8% (n=194). However, 17.2% (n=86) said their technique had never been checked, and at their last annual review, a third (33.2%, n=166) did not receive inhaler technique advice. Exacerbations were reported to affect an average of 7.4 days a year. They led to time in hospital, time off work and significantly affected quality of life. Patients reported that their COPD affected all aspects of their daily lives to a greater or lesser extent, with some living in fear of what the impact of the next flare-up could bring. Conclusion:COPD impairs people's ability to carry out daily tasks, leads to hospital admission, time off work and even unemployment. Respondents reported stress, worry and depression or low mood because of their COPD. This study highlights areas of concern for patients not being addressed by health care practitioners, including: pulmonary rehabilitation referral, better information giving and medicines optimization. 10.2147/COPD.S222139
    Physical Activity in Patients with Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy: A Cross-Sectional Study. Paneroni Mara,Ambrosino Nicolino,Simonelli Carla,Bertacchini Laura,Venturelli Massimo,Vitacca Michele International journal of chronic obstructive pulmonary disease Background and aim:There are few studies evaluating physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). Aim:To assess PA in hypoxemic COPD patients on LTOT. Methods:In this cross-sectional study, we compared lung function, arterial blood gases, respiratory and peripheral muscle strength, 6-min walking distance (6MWD), daily energy expenditure and steps, and health-related quality of life (HRQL) in COPD patients on LTOT (LTOT group) versus two groups of control patients not needing LTOT: with (HYPOX) and without (COPD) exercise-induced desaturations. Results:Groups did not differ as regards demographics, anthropometrics, peripheral or respiratory muscle strength. Compared to the other groups, LTOT patients had more severe airway obstruction and lung hyperinflation, greater number and severity of comorbidities, shorter 6MWD, as well as lower mean SpO during 6MWD and worse quality of life. LTOT patients had a lower daily energy expenditure, shorter time spent > 3.0 METs and longer sedentary time compared to the COPD group, and less daily steps compared to the other groups. No significant difference in any parameter of PA was found between COPD and HYPOX. In LTOT patients, daily steps showed a strong correlation with 6MWD, and a moderate correlation with airway obstruction, level of oxygenation, comorbidities and quality of life but not with peripheral and respiratory muscle strength. In COPD and HYPOX patients, daily steps were strongly correlated with 6MWD and level of oxygenation as assessed by PaO/FiO. There was no significant correlation between mean SpO and 6MWD in any group. Conclusion:COPD patients on LTOT perform less physical activity than patients not needing LTOT, both with and without exercise-induced desaturations. Patients with exercise-induced desaturations do not perform less physical activity than those without. 10.2147/COPD.S228465
    Pulmonary rehabilitation: various diseases, many approaches, and multiple questions. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 10.1590/1806-3713/e20190351
    Prevalence of comorbidities and impact on pulmonary rehabilitation outcomes. ERJ open research BACKGROUND:The presence of comorbid conditions could impact performance in pulmonary rehabilitation (PR) programmes. We aimed to compare the comorbidity prevalence among those with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) and evaluate the impact on PR response. METHODS:We performed a retrospective cohort study, recording comorbidities for all patients with COPD or ILD referred to PR. Participants were classified as responders to PR if they met the minimal important difference for exercise capacity and health-related quality of life (HRQoL). The prevalence of comorbidities and impact on PR outcomes were compared by lung disease and by sex using a univariate analysis and multivariate logistic regression. RESULTS:The mean number of comorbidities was similar among those with COPD (3.3±2.1, n=242) and ILD (3.2±1.9, n=66) (p>0.05). Females had a higher number of comorbidities than males in both COPD (p=0.001) and ILD (p=0.017) populations. Circulatory (64%) and endocrine/metabolic (45%) conditions were most common in COPD. In ILD, digestive (55%) and circulatory (53%) comorbidities were most prevalent. In people with ILD, those over 65 years, with musculoskeletal/connective tissue disease or circulatory disease were less likely to obtain meaningful improvements in exercise capacity. There was no impact of comorbidities on exercise capacity in COPD or on HRQoL in ILD. CONCLUSIONS:The majority of patients with COPD or ILD enrolled in PR programmes have multiple comorbidities that may affect improvements in exercise capacity. PR programmes may be less effective for older adults with ILD and comorbid circulatory or musculoskeletal disease. 10.1183/23120541.00264-2019
    Participants' experiences of the benefits, barriers and facilitators of attending a community-based exercise programme for people with chronic obstructive pulmonary disease. Meshe Oluwasomi F,Bungay Hilary,Claydon Leica S Health & social care in the community Community-based exercise programmes (CEPs) are aimed at sustaining benefits of pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease (COPD). The aim of this study was to understand participants' experiences of the benefits, barriers and facilitators of adherence to a CEP. A descriptive qualitative design was applied, employing in-depth semi-structured interviews with a convenience sample of 12 participants with COPD attending a CEP in the East of England. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Four main themes were identified: perceived benefits, enablers and barriers, perception of safety and recommendations for programme improvement. Participants experienced physical, social and psychological benefits. Regular attendance is important to avoid deterioration in perceived benefits. CEPs may therefore provide a cost-effective approach to improving and sustaining initial benefits of PR. Enablers included ease of access, perceived benefits and convenient programme components, being a retiree, social support and seasons. Identified barriers to attendance were poor physical health, family commitments and transport difficulties. The findings clearly suggest that a CEP supervised by an exercise instructor motivates participants to attend and exercise regularly. Increasing adherence to an exercise programme will prevent deterioration in perceived health, in addition to the physical, psychological and social benefits to the individual. 10.1111/hsc.12929
    Efficacy of pulmonary rehabilitation in improving the quality of life for patients with chronic obstructive pulmonary disease: Evidence based on nineteen randomized controlled trials. Dong Jige,Li Zhanjun,Luo Lihua,Xie Hongzhi International journal of surgery (London, England) BACKGROUND:Increasing studies have shown that application of pulmonary rehabilitation may improve the quality of life of chronic obstructive pulmonary disease (COPD) patients. However, the results of some studies still remained controversial and sample size of them limited to small number of participants. A systematic review and meta-analysis was designed to evaluate the efficacy of pulmonary rehabilitation for improving the quality of life in patients with COPD. METHODS:We searched the Cochrane Library, PubMed, EMBASE and Web of Science up to March 29, 2019 to identify relevant randomized controlled trials (RCTs) analyzing and evaluating the efficacy of pulmonary rehabilitation (PR) in patients with COPD. Participants were randomly assigned to receive PR (intervention group) or usual care (controller group). We used St. George's Respiratory Questionnaire (SGRQ) scores as evaluating indicators of quality of life. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated to compare the outcomes of the groups. We also performed subgroup analysis for the pooled results of pulmonary rehabilitation effects in COPD patients. Besides, sensitivity analysis was performed to examine the stability of the combined results. Two reviewers assessed trial quality and extracted data independently. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2 and Stata 12.0. RESULTS:Nineteen randomized controlled trials (N = 1146 participants) were identified for the present analysis. Comparing pulmonary rehabilitation groups with usual care groups (control groups), statistically significant improvements were noted in total score of SGRQ, with MD of -6.53. In addition, life quality improvement of SGRQ scores was better than 5 units in symptoms score, impacts score and activity score, with MDs of -5.01, -7.23 and -6.08, respectively. CONCLUSIONS:Rehabilitation may constitute one of important components of the management of COPD and may be beneficial in improving the quality of life. Future research should focus on identifying which components of pulmonary rehabilitation are essential, its ideal length and location, the degree of supervision and intensity of training required and how long treatment effects persist. 10.1016/j.ijsu.2019.11.033
    Mind-Body Exercise for Anxiety and Depression in COPD Patients: A Systematic Review and Meta-Analysis. Li Zaimin,Liu Shijie,Wang Lin,Smith Lee International journal of environmental research and public health OBJECTIVES:Mind-body exercise has been generally recognized as a beneficial strategy to improve mental health in those with Chronic Obstructive Pulmonary Disease (COPD). However, to date, no attempt has been made to collate this literature. The aim of the present study was to systematically analyze the effects of mind-body exercise for COPD patients with anxiety and depression and provide scientific evidence-based exercise prescription. METHODS:both Chinese and English databases (PubMed, the Cochrane Library, EMBASE, Web of Science, Google Scholar, Chinese National Knowledge Infrastructure, Wanfang, Baidu Scholar) were used as sources of data to search randomized controlled trials (RCT) relating to mind-body exercise in COPD patients with anxiety and depression that were published between January 1982 to June 2019. 13 eligible RCT studies were finally used for meta-analysis. RESULTS:Mind-body exercise (tai chi, health qigong, yoga) had significant benefits on COPD patients with anxiety (SMD= -0.76, 95% CI -0.91 to -0.60, =0.04, I=47.4%) and depression (SMD= -0.86, 95% CI -1.14 to -0.58, =0.000, I=71.4%). Sub-group analysis indicated that, for anxiety, 30-60 min exercise session for 24 weeks of health qigong or yoga had a significant effect on patients with COPD who are more than 70 years and have more than a 10-year disease course. For depression, 2-3 times a week, 30-60 min each time of health qigong had a significant effect on patients with COPD patients who are more than 70 years old and have less than a 10-year disease course. CONCLUSIONS:Mind-body exercise could reduce levels of anxiety and depression in those with COPD. More robust RCT are required on this topic. 10.3390/ijerph17010022
    Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap? Rodrigues Antenor,de Oliveira Joice Mara,Furlanetto Karina Couto,Machado Felipe Vilaça Cavallari,Belo Letícia Fernandes,Schneider Lorena Paltanin,Morita Andrea Akemi,Andrelo Ana Carolina,Fonseca Jéssica,Brito Igor Lopes,Paes Thaís,Felcar Josiane Marques,Probst Vanessa Suziane,Hernandes Nidia Aparecida,Pitta Fabio Lung PURPOSE:This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program. METHODS:Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016). RESULTS:The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21-32) kg/m, FEV 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC. CONCLUSION:High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not. 10.1007/s00408-019-00311-7
    The effects of pulmonary rehabilitation on endothelial function and arterial stiffness in patients with chronic obstructive pulmonary disease. Pereira de Araujo Cintia Laura,Pereira Reinaldo Gustavo,Foscarini Betina Gabriele,Ferreira Schneider Bárbara,Moraes Menezes Vlademir Junior,Dal Lago Pedro Physiotherapy research international : the journal for researchers and clinicians in physical therapy OBJECTIVES:Cardiovascular disease is a major cause of mortality in chronic obstructive pulmonary disease (COPD) and endothelial dysfunction may enhance the mortality risk. Exercise training has shown to be beneficial for improvement of endothelial function in patients with cardiovascular disease, but this remains unclear in COPD. Thus, this study aimed to assess the effect of exercise-based pulmonary rehabilitation (PR) on endothelium function, arterial stiffness and plasma nitrite levels in patients with COPD. METHODS:Patients with COPD engaged a 48-session PR program. Reactive hyperaemia index (RHI), augmentation index (AIx), and heart rate (HR) assed by peripheral arterial tonometry (PAT), plasma nitrite levels, systemic blood pressure, functional capacity (six-minute walk test) and the BODE index were assessed at baseline and after 24 and 48 sessions of PR. Plasma nitrite levels were also assessed before and after the first session of PR. RESULTS:Twenty-one subjects were included and completed 24 PR sessions, and 16 subjects completed 48 sessions. It was observed that a poorer AIx adjusted for HR in frequent COPD exacerbators (4.67 ± 16.5 vs. 20.9 ± 12.9; p = .02). PR improved functional capacity (380 ± 107 m vs. 442 ± 115 m; p < .001) and the BODE index (6 [2.8] vs. 4 [3]; p = .001), but did not change HR, systemic arterial pressure, RHI, AIx, and plasma nitrite levels during the follow-up. Plasma nitrite levels reduced after the first session of PR (0.074 [0.079] μM vs. 0.061 [0.04] μM; p = .027). The acute change in plasma nitrite levels correlated with RHI in patients with preserved endothelial function (r = 0.71; p = .01). CONCLUSIONS:Although exercise-based PR improved functional capacity and the BODE index, it did not change endothelial function and arterial stiffness in patients with COPD. 10.1002/pri.1820
    Comparing the impact of different exercise interventions on fatigue in individuals with COPD: A systematic review and meta-analysis. Li Lok Sze Katrina,Butler Stacey,Goldstein Roger,Brooks Dina Chronic respiratory disease To systematically review randomized controlled trials that compared the effectiveness of different types of exercise on the symptom of fatigue in individuals with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, EMcare, PsychINFO, and Cochrane library were searched from inception to October 2018. Studies were included if individuals with COPD were randomized into two or more physical exercise interventions that reported fatigue. Of the 395 full-texts reviewed, 17 studies were included. Fifteen studies reported the impact of exercise on health-related quality of life with fatigue as a subdomain. Reduction in fatigue was observed following endurance, resistance, or a combination of both exercises. There was no significant difference between continuous and interval training ( = 3 studies, pooled standardized mean difference (SMD) = -0.17, 95% CI = -0.47, 0.12, = 0.25) or between endurance and resistance training ( = 3 studies, SMD = -0.35, 95% CI = -0.72, 0.01, = 0.07) on fatigue in people with COPD. Fatigue reduction is not usually a primary outcome of exercise interventions, but it is frequently a secondary domain. The type of exercise did not influence the impact of exercise on fatigue, which was reduced in endurance, resistance, or a combination of both exercises, enabling clinicians to personalize training to match targeted outcomes. 10.1177/1479973119894855
    Machine Learning Characterization of COPD Subtypes: Insights From the COPDGene Study. Castaldi Peter J,Boueiz Adel,Yun Jeong,Estepar Raul San Jose,Ross James C,Washko George,Cho Michael H,Hersh Craig P,Kinney Gregory L,Young Kendra A,Regan Elizabeth A,Lynch David A,Criner Gerald J,Dy Jennifer G,Rennard Stephen I,Casaburi Richard,Make Barry J,Crapo James,Silverman Edwin K,Hokanson John E, Chest COPD is a heterogeneous syndrome. Many COPD subtypes have been proposed, but there is not yet consensus on how many COPD subtypes there are and how they should be defined. The COPD Genetic Epidemiology Study (COPDGene), which has generated 10-year longitudinal chest imaging, spirometry, and molecular data, is a rich resource for relating COPD phenotypes to underlying genetic and molecular mechanisms. In this article, we place COPDGene clustering studies in context with other highly cited COPD clustering studies, and summarize the main COPD subtype findings from COPDGene. First, most manifestations of COPD occur along a continuum, which explains why continuous aspects of COPD or disease axes may be more accurate and reproducible than subtypes identified through clustering methods. Second, continuous COPD-related measures can be used to create subgroups through the use of predictive models to define cut-points, and we review COPDGene research on blood eosinophil count thresholds as a specific example. Third, COPD phenotypes identified or prioritized through machine learning methods have led to novel biological discoveries, including novel emphysema genetic risk variants and systemic inflammatory subtypes of COPD. Fourth, trajectory-based COPD subtyping captures differences in the longitudinal evolution of COPD, addressing a major limitation of clustering analyses that are confounded by disease severity. Ongoing longitudinal characterization of subjects in COPDGene will provide useful insights about the relationship between lung imaging parameters, molecular markers, and COPD progression that will enable the identification of subtypes based on underlying disease processes and distinct patterns of disease progression, with the potential to improve the clinical relevance and reproducibility of COPD subtypes. 10.1016/j.chest.2019.11.039
    A Retrospective Study Reviewing Interprofessional Advance Care Planning Group Discussions in Pulmonary Rehabilitation: A Proof-of-Concept and Feasibility Study. Journal of palliative care BACKGROUND:Advance care planning (ACP) is a process of reflection and discussion wherein a patient, in consultation with a health-care provider, family, and/or loved ones, clarifies values and treatment preferences and establishes goals, including a plan for end-of-life (EOL) care. Advance care planning encompasses appreciating and understanding illness and treatment options, elucidating patient values and beliefs, and identifying a substitute decision maker (SDM) or designating a power of attorney (POA) for personal care. These discussions have proven to be effective in improving patient-family satisfaction, reducing anxiety regarding EOL care in patients and family members, and improving patient-centered care by empowering patients to direct their care at EOL. However, ACP conversations are often difficult to have due to the sensitive nature of such discussions. OBJECTIVE:The aim of this study was to determine whether group facilitation for teaching and discussing ACP enhances participants' understanding of ACP and allows them to feel comfortable and supported when discussing these sensitive issues. METHODS:Patients who were registered in North York General Hospital's (NYGH) pulmonary rehabilitation program from June 2016 until August 2017 were given the opportunity to attend two 1-hour sessions related to ACP. The first session was dedicated to educating patients on ACP, explaining the hierarchy of the SDM and the role of the POA for personal care. The second session, provided a short time later, was devoted to discussions of values, wishes, fears, and trade-offs for future medical and EOL care. These discussions led by the supportive care nurse practitioner and a physician who are members of the NYGH Freeman Palliative Care Team were held in a group-facilitated format. Anonymous feedback forms, including both qualitative and quantitative feedback, were completed by the participants and analyzed. PARTICIPANTS:Analysis of a sample of 30 participants who attended 1 or 2 of the ACP sessions revealed that 21 identified as female and 9 identified as male. The average age of the participants was 76 years. FINDINGS:Participants felt the content was relevant to their needs and were comfortable asking questions with all feedback averages ranging from good to very good. Participants appreciated the opportunity to share their thoughts in an open and interactive format. CONCLUSION:Discussing issues relevant to ACP, including providing information about ACP, sharing fears, wishes, and tradeoffs, were well-received in a group-support environment. Future studies should assess the impact of ACP group discussion on the individual, such as identifying a POA, having discussions regarding wishes and values with the SDM/POA, and examining the clinical impact of such sessions. 10.1177/0825859719896421
    The role of adipokines in the pathogenesis and course of selected respiratory diseases. Chwalba Artur,Machura Edyta,Ziora Katarzyna,Ziora Dariusz Endokrynologia Polska Adipose tissue is also a secretory organ producing active substances called adipokines. Some of them (apelin, resistin, adiponectin, leptin, chemerin, or visfatin) may play a role in the pathogenesis and course of respiratory diseases, e.g. COPD, asthma, pulmonary hypertension, or lung cancer. There are limited and conflicting data on the role of adipokines in asthma. It has been confirmed, however, that visfatin and leptin can be markers of inflammation in COPD. Elevated concentrations of leptin and resistin play a pro-inflammatory role in the development of cancer cachexia. The role of adipokines has also been demonstrated in pulmonary hypertension, and the apelinadiponectin axis disruption may exacerbate pulmonary hypertension. 10.5603/EP.a2019.0051
    Baseline Exercise Tolerance and Perceived Dyspnea to Identify the Ideal Candidate to Pulmonary Rehabilitation: A Risk Chart in COPD Patients. Costi Stefania,Crisafulli Ernesto,Trianni Ludovico,Beghè Bianca,Faverzani Silvia,Scopelliti Giuseppe,Chetta Alfredo,Clini Enrico International journal of chronic obstructive pulmonary disease Background:The appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR). Methods:We retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 mins (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes. Results:Compared to the category of individuals with 6MWD >350 meters, those patients with 201-350 meters and ≤200 meters showed a higher probability (p<0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p<0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased. Conclusion:This study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR. 10.2147/COPD.S223038
    Lack of responsiveness of the PRAISE tool to pulmonary rehabilitation: instrument or protocol limitation? Karloh Manuela,Sousa Matias Thiago,Fleig Mayer Anamaria Physiotherapy 10.1016/j.physio.2019.09.001
    Response to letter to the Editor re 'Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool predicts reduction in sedentary time following pulmonary rehabilitation in people with Chronic Obstructive Pulmonary Disease (COPD)'. Holland Anne E,Liacos Athina,McDonald Christine F,Mahal Ajay,Hill Catherine J,Lee Annemarie L,Burge Angela T,Moore Rosemary,Nicolson Caroline,O'Halloran Paul,Cox Narelle S,Lahham Aroub,Gillies Rebecca Physiotherapy 10.1016/j.physio.2019.09.002
    Effectiveness of expiratory muscle strength training on expiratory strength, pulmonary function and cough in the adult population: a systematic review. Templeman Lucy,Roberts Fiona Physiotherapy BACKGROUND:Respiratory muscle strength declines in certain disease states, leading to impaired cough, reduced airway clearance and an increased risk of aspiration pneumonia. Respiratory muscle training may therefore reduce this risk. OBJECTIVES:To assess current evidence of expiratory muscle strength training (EMST) on maximum expiratory pressure, cough flow and spirometry. DATA SOURCES:Databases including CINAHL, Medline, Science Direct and PEDRo were searched. ELIGIBILITY CRITERIA:Randomised controlled trials investigating expiratory muscle strength training on maximum expiratory pressure, pulmonary function or cough in any adult population, published before December 2017. STUDY APPRAISAL:Data were extracted to a trial description form and study quality evaluated by two reviewers. Meta-analysis was performed with calculation of mean differences and 95% confidence intervals. RESULTS:Nine studies met inclusion criteria and ranged in size from 12 to 42 participants. Trials investigated EMST in healthy adults (2), multiple sclerosis (3), COPD (2), acute stroke (1) and spinal cord injury (1). Overall, EMST improved maximum expiratory pressure (15.95cmHO; 95% CI: 7.77 to 24.12; P<0.01) with no significant impact on cough flow (4.63L/minute; 95%CI -27.48 to 36.74; P=0.78), forced vital capacity (-0.16L; 95%CI -0.35 to 0.02; P=0.09) or forced expiratory volume in 1second (-0.09L; 95%CI -0.10 to -0.08; P<0.001) vs control or sham training. CONCLUSIONS:Meta-analysis indicated a small significant increase in maximum expiratory pressure following EMST. Improvements in maximum expiratory pressure did not lead to improvements in cough or pulmonary function. LIMITATIONS:Variations in protocol design and population limited the overall effect size. Systematic Review Registration PROSPERO CRD42018104190. 10.1016/j.physio.2019.06.002
    Therapeutic Exercise. Barker Kim,Eickmeyer Sarah The Medical clinics of North America Physicians often overlook exercise as a treatment or prophylactic measure for many common diseases and ailments. It can be used to treat comorbidities including obesity, cardiovascular disease, chronic obstructive pulmonary disease, diabetes mellitus, osteoporosis, osteoarthritis, cancer, and low back pain. Education on the general physical activity guidelines as well as easy exercise prescription methods can improve the ability of physicians to prescribe exercise as a therapeutic option. In addition, identifying barriers to compliance with exercise and ways to overcome these barriers is also necessary in order to use therapeutic exercise effectively. 10.1016/j.mcna.2019.10.003
    Impact of mild-to-moderate exacerbations on outcomes of neuromuscular electrical stimulation (NMES) in patients with COPD. Meys Roy,Sillen Maurice J,Franssen Frits M E,Stoffels Anouk A F,Wouters Emiel F M,van Hees Hieronymus W H,van den Borst Bram,Klijn Peter H,Spruit Martijn A, Respiratory medicine Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common among patients attending pulmonary rehabilitation (PR) and may compromise its outcomes. Neuromuscular electrical stimulation (NMES) seems one of the few exercise modalities that can actually be continued during AECOPD, due to its low burden on the impaired respiratory and cardiovascular system. However, the quality of evidence is low. The purpose of this study was to assess the impact of mild-to-moderate AECOPD on adherence/outcomes of a high-frequency (HF) or low-frequency (LF) NMES training program, as part of inpatient PR, in severely dyspneic, weakened individuals with COPD. 62 patients who received NMES as the sole supervised muscle training modality during an 8-week PR program (HF-NMES: n = 33; LF-NMES: n = 29) were analyzed retrospectively. 48.4% experienced ≥1 AECOPD during PR and were classified as exacerbators. Exacerbators completed 75 NMES sessions (interquartile range: 73-78) and were able to increase training intensity with 24 mA (15-39), while non-exacerbators completed 76 sessions (73-79) and increased training intensity with 35 mA (22-50), with no between-group differences (p = 0.474 and p = 0.065, respectively). The median change in 6-min walking distance, cycle endurance time, and isokinetic quadriceps strength and endurance did not differ between the exacerbation and non-exacerbation group. To conclude, the occurrence of mild-to-moderate AECOPD during a PR program primarily focused on NMES, does not affect adherence, intensity, and clinical outcomes in patients with severe COPD. Continuing NMES seems a feasible way to potentially counteract exacerbation-related lower-limb muscle dysfunction and improve outcomes of PR, with HF-NMES being the preferential muscle training modality. 10.1016/j.rmed.2019.105851
    [Easy come, easy go? Current strategies for maintaining the effects of pulmonary rehabilitation in COPD patients]. Spielmanns Marc,Ruprecht Martino,Schmid-Mohler Gabriela,Koczulla Andreas R,Boeselt Tobias Therapeutische Umschau. Revue therapeutique Easy come, easy go? Current strategies for maintaining the effects of pulmonary rehabilitation in COPD patients Pulmonary rehabilitation (PR) is a comprehensive treatment method in the non-drug management of chronic respiratory diseases. Most evident data exists for COPD patients. However, the effect of PR is no longer detectable after 6 to 12 months, unless the patient participates in a kind of maintenance program following PR. But the contents of such a maintenance program are still unclear in terms of duration, location, methods and intensity. They are still subject of current research. Therefore concrete recommendations are still missing and further studies are necessary. This review aims to give an overview of the existing results in this field. 10.1024/0040-5930/a001118
    Exercise training in chronic obstructive pulmonary disease. Rochester Carolyn L Journal of rehabilitation research and development Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high- and low-intensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower- and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed. 10.1682/jrrd.2003.10.0059
    Exercise and muscle dysfunction in COPD: implications for pulmonary rehabilitation. Man William D-C,Kemp Paul,Moxham John,Polkey Michael I Clinical science (London, England : 1979) Skeletal muscle dysfunction in COPD (chronic obstructive pulmonary disease) patients, particularly of the quadriceps, is of clinical interest because it not only influences the symptoms that limit exercise, but may also contribute directly to poor exercise performance and health status, increased healthcare utilization, and mortality. Furthermore, unlike the largely irreversible impairment of the COPD lung, skeletal muscles represent a potential site to improve patients' level of function and quality of life. However, despite expanding knowledge of potential contributing factors and greater understanding of molecular mechanisms of muscle wasting, only one intervention has been shown to be effective in reversing COPD muscle dysfunction, namely exercise training. Pulmonary rehabilitation, an intervention based on individually tailored exercise training, has emerged as arguably the most effective non-pharmacological intervention in improving exercise capacity and health status in COPD patients. The present review describes the effects of chronic exercise training on skeletal muscles and, in particular, focuses on the known effects of pulmonary rehabilitation on the quadriceps muscle in COPD. We also describe the current methods to augment the effects of pulmonary rehabilitation and speculate how greater knowledge of the molecular pathways of skeletal muscle wasting may aid the development of novel pharmaceutical agents. 10.1042/CS20080660
    Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients. Wang Kai,Zeng Guang-Qiao,Li Rui,Luo Yu-Wen,Wang Mei,Hu Yu-He,Xu Wen-Hui,Zhou Lu-Qian,Chen Rong-Chang,Chen Xin International journal of chronic obstructive pulmonary disease BACKGROUND:Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment. MATERIALS AND METHODS:Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program. RESULTS:Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPI [maximal inspiratory pressure] 5.20±0.89 cmHO vs 1.32±0.91 cmHO; <0.05). However, there were no significant differences in the other indices between the two groups (>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (>0.05). CONCLUSION:Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT. 10.2147/COPD.S140093
    [Care-Related intervention in Rehabilitative Pneumology: Pulmonary Rehabilitation in Chronic Obstructive Broncopneumopathies (COPD) can benefit from a multidisciplinary approach?] Vitacca Michele,Visca Dina,Spanevello Antonio Giornale italiano di medicina del lavoro ed ergonomia OBJECTIVES:Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation. Cardiovascular diseases, osteoporosis, depression/anxiety, musculoskeletal impairment and obstructive sleep apnea are frequent and important comorbidities in COPD, often under-diagnosed, and associated with poor health status and prognosis. METHODS:Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care in patients with chronic respiratory disease. By definition it is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change and designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors. Exercise limitation in patients with COPD is multifactorial and includes ventilatory limitation, gas transfer abnormalities, pulmonary vascular and cardiac dysfunction, limb muscle dysfunction, and comorbid impairments. RESULTS:Overall, pulmonary rehabilitation aims to improve cardiorespiratory and skeletal muscle function improving respiratory symptoms and quality of life in daily life activities adding a synergic support to the pharmacologic inhaled therapy. COPD has a variable natural history, but most of the time chronic respiratory failure complicates disease progression. Supplemental oxygen and noninvasive mechanical ventilation have been proven to improve survival and reduce hospital admissions in COPD patients. Furthermore additional studies have shown that exercise performance benefit from supplemental oxygen and NIV used both during rehabilitation exercise programs and over the night. CONCLUSIONS:In conclusion, an overarching approach to diagnosis, assessment of severity of COPD and its frequent comorbidities should guide to a multidisciplinary and synergic approach in terms of pharmacological and nonpharmacological management of a systemic inflammatory syndrome.
    Can muscle protein metabolism be specifically targeted by exercise training in COPD? Simoes Davina C M,Vogiatzis Ioannis Journal of thoracic disease Patients with stable chronic obstructive pulmonary disease (COPD) frequently exhibit unintentional accentuated peripheral muscle loss and dysfunction. Skeletal muscle mass in these patients is a strong independent predictor of morbidity and mortality. Factors including protein anabolism/catabolism imbalance, hypoxia, physical inactivity, inflammation, and oxidative stress are involved in the initiation and progression of muscle wasting in these patients. Exercise training remains the most powerful intervention for reversing, in part, muscle wasting in COPD. Independently of the status of systemic or local muscle inflammation, rehabilitative exercise training induces up-regulation of key factors governing skeletal muscle hypertrophy and regeneration. However, COPD patients presenting similar degrees of lung dysfunction do not respond alike to a given rehabilitative exercise stimulus. In addition, a proportion of patients experience limited clinical outcomes, even when exercise training has been adequately performed. Consistently, several reports provide evidence that the muscles of COPD patients present training-induced myogenic activity limitation as exercise training induces a limited number of differentially expressed genes, which are mostly associated with protein degradation. This review summarises the nature of muscle adaptations induced by exercise training, promoted both by changes in the expression of contractile proteins and their function typically controlled by intracellular signalling and transcriptional responses. Rehabilitative exercise training in COPD patients stimulates skeletal muscle mechanosensitive signalling pathways for protein accretion and its regulation during muscle contraction. Exercise training also induces synthesis of myogenic proteins by which COPD skeletal muscle promotes hypertrophy leading to fusion of myogenic cells to the myofiber. Understanding of the biological mechanisms that regulate exercise training-induced muscle growth and regeneration is necessary for implementing therapeutic strategies specifically targeting myogenesis and hypertrophy in these patients. 10.21037/jtd.2018.02.67
    The Integrative Physiology of Exercise Training in Patients with COPD. Neder J Alberto,Marillier Mathieu,Bernard Anne-Catherine,James Matthew D,Milne Kathryn M,O'Donnell Denis E COPD Supervised exercise training (EXT) as part of pulmonary rehabilitation is arguably the most effective intervention for improving exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). In the current review, we focus on the physiological rationale for EXT and the expected physiological benefits that can be achieved in patients who can be exposed to sufficiently high training stimuli. Thus, after a brief consideration of the mechanisms of exercise limitation and their sensory consequences, we expose the potential beneficial effects of EXT on respiratory mechanical and peripheral muscular adaptations to exercise. The available evidence indicates that changes in exertional ventilation, breathing pattern, operating lung volumes and static respiratory muscle strength after EXT are modest and often inconsistent. Inspiratory muscle training may have a role in patients showing inspiratory weakness pre-rehabilitation. Beneficial changes in peripheral muscles can be seen in those who can tolerate higher training intensity, particularly using combined resistance and dynamic (including interval) exercise. It should be recognised, however, that it might not be feasible to reach meaningful physiological training effects in many frail elderly patients with advanced respiratory mechanical and pulmonary gas exchange derangements with serious co-morbidities (such as cardiac and peripheral vascular disease). These potential shortcomings should not discourage the use of pulmonary rehabilitation as an effective strategy to improve patients' capacity to tolerate physical activity. Currently, the greatest challenge is to develop effective strategies to ensure that these important gains in functional capacity are translated into sustained increases in daily physical activity for patients with COPD. 10.1080/15412555.2019.1606189
    Locomotor Muscles in COPD: The Rationale for Rehabilitative Exercise Training. Marillier Mathieu,Bernard Anne-Catherine,Vergès Samuel,Neder J Alberto Frontiers in physiology Exercise training as part of pulmonary rehabilitation is arguably the most effective intervention to improve tolerance to physical exertion in patients with chronic obstructive pulmonary disease (COPD). Owing to the fact that exercise training has modest effects on exertional ventilation, operating lung volumes and respiratory muscle performance, improving locomotor muscle structure and function are key targets for pulmonary rehabilitation in COPD. In the current concise review, we initially discuss whether patients' muscles are exposed to deleterious factors. After presenting corroboratory evidence on this regard (e.g., oxidative stress, inflammation, hypoxemia, inactivity, and medications), we outline their effects on muscle macro- and micro-structure and related functional properties. We then finalize by addressing the potential beneficial consequences of different training strategies on these muscle-centered outcomes. This review provides, therefore, an up-to-date outline of the rationale for rehabilitative exercise training approaches focusing on the locomotor muscles in this patient population. 10.3389/fphys.2019.01590
    Survival prediction in patients with chronic obstructive pulmonary disease following a pulmonary rehabilitation programme in Hong Kong. Hong Kong journal of occupational therapy : HKJOT BACKGROUND AND OBJECTIVE:Pulmonary rehabilitation programme (PRP) is an important component in the management of chronic obstructive pulmonary disease (COPD). However, to date so far there has been limited literature on the survival outcomes of patients with COPD after a PRP in Hong Kong. This study aimed to investigate the outcomes of a pulmonary rehabilitation programme on the survival rates of a retrospective cohort of patients with COPD. METHODS:This was a retrospective study that included subjects who participated in the PRP in a rehabilitation hospital from the year 2003 to 2015. A total of 431 patients with chronic obstructive pulmonary disease were identified from the electronic record system of the hospital. The dataset were split into two age groups for reporting and analysis using the mean age of 72 as the cut-off. Their median survival times were calculated using Kaplan-Meier analysis. Cox-proportional regression model was used to explore factors that predicted better survival. The most significant predictors were used as strata, and their respective effects on survival functions were analysed with Kaplan-Meier analysis again. RESULTS:The overall median survival of the cohort was 4.3 years. The median survival times of the younger patient group (aged <72) and the older patient group (aged ≥72) were 5.3 and 3.6 years, respectively. For the patients, aged <72 years old, Moser's Activities of Daily Living class and the pulmonary rehabilitation programme completion rate were the most significant survival predictors. For the patients aged ≥72 years old, Monitored Functional Task Evaluation score was the most significant survival predictor. CONCLUSION:Moser's Activities of Daily Living class ≥2 and non-completion of PRP for younger group, low exercise capacity with Monitored Functional Task Evaluation score <17 for older group were identified as significant predictors of poor survival. The findings of this study helped identifying those patients with COPD who have the needs to be more intensively treated and closely monitored. 10.1177/1569186119882772
    Minimal important difference for London Chest Activity of Daily Living scale in patients with chronic obstructive pulmonary disease. Almeida Gulart Aline,de Araujo Cintia Laura Pereira,Bauer Munari Anelise,Schneider Bárbara Ferreira,Dal Lago Pedro,Mayer Anamaria Fleig Physiotherapy OBJECTIVES:To determine the minimal important difference (MID) for the London Chest Activity of Daily Living scale (LCADL) in patients with chronic obstructive pulmonary disease (COPD), focusing on the percentage of the total score (LCADL), using an anchor-based method in addition to distribution-based methods. DESIGN:Non-controlled before-and-after study. SETTING:Two outpatient centres. PARTICIPANTS:Seventy-seven patients with COPD (GOLD II-IV, 47 males, forced expiratory volume in 1second mean 37 (SD 14) % predicted). INTERVENTIONS:Aerobic training and localised training for upper and lower limbs was conducted for 24 sessions, three times per week. MAIN OUTCOME MEASURES:The main outcome was LCADL score pre- and post-exercise training. The MID was established using distribution and anchor-based methods. The modified Saint George Respiratory Questionnaire was the anchor for the analysis of sensitivity and specificity of the MID. RESULTS:The established MIDs ranged from -2.1 to -5.9 points for LCADL and from -2 to -6 points for LCADL. The receiver operating characteristic curve indicated a cut-off point of -3 points for LCADL (sensitivity 51%, specificity 82%; P=0.01) and -4 points for LCADL (sensitivity 56%, specificity 82%; P=0.04). CONCLUSIONS:The present findings suggest -3 points and -4 points as the MIDs for LCADL and LCADL, respectively. CLINICAL TRIAL REGISTRATION NUMBER:ClinicalTrials.gov NCT03251781. 10.1016/j.physio.2019.08.007
    Effects of land- and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial. de Castro Larissa A,Felcar Josiane M,de Carvalho Débora R,Vidotto Laís S,da Silva Rubens A,Pitta Fabio,Probst Vanessa S Physiotherapy OBJECTIVE:To investigate the effects of water-based exercise training on postural balance in individuals with chronic obstructive pulmonary disease (COPD), and compare the effects of two similar protocols of land- and water-based exercise programmes on postural balance in this population. DESIGN:Randomised clinical trial. SETTING:University-based, outpatient, physical therapy clinic. SUBJECTS:Fifty individuals with COPD. INTERVENTIONS:Participants were assigned at random to the land group (LG; n=27) or the water group (WG; n=23), and underwent high-intensity endurance and strength training three times per week for 3months. MAIN OUTCOME MEASURES:Functional balance was assessed by the timed up and go test (TUG), and static balance was assessed with a force platform in the following conditions: standing with feet hip-width apart and eyes open; standing with feet hip-width apart and eyes closed; standing on a short base; and one-legged stance. RESULTS:Seventeen subjects completed the intervention in the LG {nine males, mean age 64 [standard deviation (SD) 8] years, mean forced expiratory volume in 1 second (FEV) 48 (SD 17) %predicted} compared with 14 subjects in the WG [nine males, mean age 65 (SD 8) years, FEV 51 (SD 15) %predicted]. Water-based exercise training had a positive effect on functional balance [TUG: mean difference -1.17 (-1.93 to -0.41 95% confidence interval) seconds; P=0.006], whereas static balance remained unaltered for both groups. There was no between-group difference in postural balance after exercise training; however, a higher proportion of participants who had a clinically relevant improvement in the TUG were in the WG (LG 35%, WG 64%; P<0.001). CONCLUSION:Functional balance improved after 3months of high-intensity exercise training performed in water. Despite the environment, non-specific training seems to be insufficient to improve static balance. CLINICAL TRIAL REGISTRATION NUMBER:clinicalTrials.gov NCT01691131. 10.1016/j.physio.2019.08.001
    [«Patient education in the context of rehabilitation» Self-management interventions and patient coaching integral components of pulmonary rehabilitation (PR)]. Steurer-Stey Claudia Therapeutische Umschau. Revue therapeutique «Patient education in the context of rehabilitation» Self-management interventions and patient coaching integral components of pulmonary rehabilitation (PR) Integration of effective self management interventions to pulmonary rehabilitation may not be considered as an option but as an integral part to make sustainable changes to patient behavior which will positively affect the maintenance of PR treatment effects. While it is well established that pulmonary rehabilitation (PR) improves functional / exercise capacity and health-related quality of life, one recognized important goal of PR is to influence health behaviors (smoking cessation, physical activity, breathing management, medication adherence, recognizing and supported self-managing exacerbations) in chronic pulmonary disease that promote successful disease management and better prognosis . With the integration of effective self- management interventions to PR programs there is an increased likelihood to not only improve typical PR outcomes but to make sustainable changes to patient behavior which will positively affect the maintenance of PR treatment effects. However, an evolution of traditional patient education from giving information only to effective self- management coaching is necessary as an evidence based integral part of best practice and quality in PR. Crucially this demands a healthcare system that 1) support self-management; 2. provide flexible access to professional advice; 3. ideally ensure continuity of care and 4. Pay for effective self-management interventions. 10.1024/0040-5930/a001119
    Tai Chi Movements for Wellbeing - evaluation of a British Lung Foundation pilot. Perspectives in public health AIMS:In breathless individuals with respiratory disease, pulmonary rehabilitation (PR) can improve exercise capacity, symptoms and ability to cope with their condition. However, access is often limited, and adherence can be poor. Thus, there is interest in developing alternative and complementary forms of exercise intervention and tai chi may be effective in this context. METHOD:The British Lung Foundation worked in collaboration with 'Tai Chi Movements for Wellbeing' Training to train leaders to run community-based tai chi groups in the UK. Leaders received funding to run 3 months of once-a-week classes consisting of a 12 movement sequence of tai chi. Participants completed a questionnaire survey to evaluate the service at the start of their first session and again after 3 months. RESULTS:Ten tai chi groups recruited 128 participants, 65% women, mean (standard deviation (SD)) age 70.1 (7.4) years at baseline. Seventy individuals completed the follow-up questionnaire at 3 months. Participants demonstrated an improvement in Medical Research Council (MRC) Dyspnoea Score pre 3 (interquartile range (IQR) = 1.8), post 2 (IQR = 1),  = .013 and disease burden; chronic obstructive pulmonary disease (COPD) assessment test score pre 19.4 (8.7), post 17.9 (9.4), mean change -1.5 (confidence interval (CI): -2.89 to -0.127),  = .033. Those who completed the programme had a worse baseline COPD assessment test (CAT) score and were more likely to have participated in maintenance exercise previously. Qualitative feedback suggested that participants felt the classes had helped with breathlessness and relaxation. CONCLUSION:Establishing a tai chi for wellbeing programme for people with respiratory disease is feasible, with a reasonable level of compliance, and is perceived to be helpful by participants. 10.1177/1757913919872515
    Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Chen Haixia,Li Peijun,Li Ning,Wang Zhengrong,Wu Weibing,Wang Jihong Medicine BACKGROUND:We sought to synthesize the evidence about aerobic exercise intervention during pulmonary rehabilitation, and to further explore the difference in rehabilitation effects between water and land-based aerobic exercise. This review's purpose is to provide a basis by which practitioners and therapists can select and create appropriate therapeutic programs. METHODS:Data of randomized and quasi-randomized controlled trials comparing training group (TG, aerobic exercise in water or land) and control group (CG, usual care) in chronic obstructive pulmonary disease (COPD) patients (January 1, 2000-December 28, 2019) were obtained from the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases. Two researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. Review Manager software (Rev Man 5.3; Cochrane, London, UK) was used for meta-analysis. The rehabilitation effect of water- or land based aerobic exercise was evaluated by subgroup analysis. The proposed systematic review details were registered in PROSPERO (CRD 42020168331). RESULTS:Eighteen studies (1311 cases of COPD) were included. Meta-analysis results show that compared with the control group, the dyspnea level and functional and endurance exercise capacity in COPD patients were significantly improved after aerobic exercise (P < .05), but there was no significant change in lung function (P > .05). Compared with land-based aerobic exercise, water-based aerobic exercise significantly improved the endurance exercise capacity in COPD patients (mean difference [MD]: 270.18, 95% CI: 74.61-465.75). CONCLUSION:Medium to high-quality evidence shows that aerobic exercise can effectively improve dyspnea and exercise capacity in COPD patients. Compared with land-based aerobic exercise, water-based aerobic exercise had a significant additional effect in improving the endurance exercise capacity of COPD patients. 10.1097/MD.0000000000026976