Research

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15 pages, 2270 KiB

Open AccessArticle

Effects of Non-Invasive Ventilation Combined with Oxygen Supplementation on Exercise Performance in COPD Patients with Static Lung Hyperinflation and Exercise-Induced Oxygen Desaturation: A Single Blind, Randomized Cross-Over Trial

by Maud Koopman, Martijn A. Spruit, Frits M.E. Franssen, Jeannet Delbressine, Emiel F.M. Wouters, Denny Mathew, Anton Vink and Lowie E.G.W. Vanfleteren

J. Clin. Med. 2019, 8(11), 2012; https://doi.org/10.3390/jcm8112012 - 18 Nov 2019

Cited by 7 | Viewed by 3635

Abstract

The effects of non-invasive ventilation (NIV) in addition to supplemental oxygen on exercise performance in patients with chronic obstructive pulmonary disease (COPD) with hyperinflation and exercise-induced desaturation (EID) remain unclear. We hypothesized that these patients would benefit from NIV and that this effect [...] Read more.

The effects of non-invasive ventilation (NIV) in addition to supplemental oxygen on exercise performance in patients with chronic obstructive pulmonary disease (COPD) with hyperinflation and exercise-induced desaturation (EID) remain unclear. We hypothesized that these patients would benefit from NIV and that this effect would be an add-on to oxygen therapy. Thirteen COPD patients with a residual volume >150% of predicted, normal resting arterial oxygen pressure (P_aO₂) and carbon-dioxide pressure (P_aCO₂) and EID during a six-minute walk test were included. Patients performed four constant work-rate treadmill tests, each consisting of two exercise bouts with a recovery period in between, wearing an oronasal mask connected to a ventilator and oxygen supply. The ventilator was set to the following settings in fixed order with clockwise rotation: Sham (continuous positive airway pressure (CPAP) 2 cm H₂O, FiO₂ 21%), oxygen (CPAP 2 cm H₂O, FiO₂ 35%), NIV and oxygen (inspiratory positive airway pressure (IPAP) 14 cm H₂O/expiratory positive airway pressure (EPAP) 6 cm H₂O, inspired oxygen fraction (FiO₂) 35%), intermittent (walking: Sham setting, recovery: NIV and oxygen setting). During the first exercise, bout patients walked further with the oxygen setting compared to the sham setting (225 ± 107 vs 120 ± 50 meters, p < 0.05), but even further with the oxygen/NIV setting (283 ± 128 meters; p < 0.05). Recovery time between two exercise bouts was shortest with NIV and oxygen. COPD patients with severe static hyperinflation and EID benefit significantly from NIV in addition to oxygen during exercise and recovery. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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17 pages, 2875 KiB

Open AccessArticle

Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD

by Thomas Janssens, Zora Van de Moortel, Wolfgang Geidl, Johannes Carl, Klaus Pfeifer, Nicola Lehbert, Michael Wittmann, Konrad Schultz and Andreas von Leupoldt

J. Clin. Med. 2019, 8(9), 1460; https://doi.org/10.3390/jcm8091460 - 13 Sep 2019

Cited by 12 | Viewed by 4133

Abstract

Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after [...] Read more.

Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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16 pages, 1082 KiB

Open AccessArticle

Physical Activity and Sedentary Behaviour Patterns in 326 Persons with COPD before Starting a Pulmonary Rehabilitation: A Cluster Analysis

by Wolfgang Geidl, Johannes Carl, Samuel Cassar, Nicola Lehbert, Eriselda Mino, Michael Wittmann, Rupert Wagner, Konrad Schultz and Klaus Pfeifer

J. Clin. Med. 2019, 8(9), 1346; https://doi.org/10.3390/jcm8091346 - 29 Aug 2019

Cited by 30 | Viewed by 5289

Abstract

This study applies a cluster analysis to identify typical physical activity (PA) and sedentary behaviour (SB) patterns in people with chronic obstructive pulmonary disease (COPD) before starting pulmonary rehabilitation (PR). We implemented an observational design which assessed baseline data of objectively measured PA [...] Read more.

This study applies a cluster analysis to identify typical physical activity (PA) and sedentary behaviour (SB) patterns in people with chronic obstructive pulmonary disease (COPD) before starting pulmonary rehabilitation (PR). We implemented an observational design which assessed baseline data of objectively measured PA and SB from the STAR (Stay Active after Rehabilitation) study. A total of 355 persons wore an accelerometer (Actigraph wGT3X) for seven days before the start of their PR. Sociodemographic and disease-related parameters were assessed at the start of PR. We applied cluster analysis and compared clusters applying univariate variance analyses. Data was available for 326 persons (31.6% women; age ø = 58 years). Cluster analysis revealed four movement clusters with distinct PA and SB patterns: Sedentary non-movers (28.5%), sedentary occasional movers (41.7%), sedentary movers (19.6%), and sedentary exercisers (10.1%). The four clusters displayed varying levels of moderate PA before rehabilitation (Ø daily min: 9; 28; 38; 70). Notably, all four clusters displayed considerably long average sedentary time per day (Ø daily minutes: 644; 561; 490; 446). The clusters differed significantly in disease-related parameters of GOLD severity, FEV1, CAT, and 6-Min-Walk-Test. In addition to PA promotion, PR programs should consider the reduction of sedentary behaviour as a valuable goal. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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13 pages, 828 KiB

Open AccessArticle

Physical Activity Levels Are Low in Inoperable Lung Cancer: Exploratory Analyses from a Randomised Controlled Trial

by Lara Edbrooke, Catherine L. Granger, Ross A. Clark and Linda Denehy

J. Clin. Med. 2019, 8(9), 1288; https://doi.org/10.3390/jcm8091288 - 23 Aug 2019

Cited by 18 | Viewed by 2862

Abstract

Background: In inoperable lung cancer, evidence is limited regarding physical activity (PA) and associations with other outcomes. Aims: in the usual care (UC) group of an RCT to (1) explore whether baseline PA was associated with improved follow-up outcomes, (2) identify baseline variables [...] Read more.

Background: In inoperable lung cancer, evidence is limited regarding physical activity (PA) and associations with other outcomes. Aims: in the usual care (UC) group of an RCT to (1) explore whether baseline PA was associated with improved follow-up outcomes, (2) identify baseline variables associated with higher follow-up PA and in all RCT participants, to (3) analyse patterns of objectively measured PA, and (4) report on characteristics of those who were able to maintain or increase PA levels. Methods: exploratory analyses of an assessor-blinded RCT. Outcomes, assessed at baseline, nine weeks and six months, included PA (seven-days of accelerometry), six-minute walk distance (6MWD), muscle strength, symptoms, mood and health-related quality of life (HRQoL). Results: 92 participants were randomised, 80 completed baseline accelerometry (39 intervention group (IG), 41 UC), characteristics: mean (SD) age 63.0 (12.3) years, 56% male, 51% stage IV disease. Baseline PA: median (IQR) steps/day 2859.6 (2034.0–3849.2) IG versus 3195.2 (2161.2–4839.0) UC. Associations between baseline PA and six-month outcomes were significant for HRQoL and 6MWD. PA at six months was significantly associated with baseline age, 6MWD and quadriceps strength. Between-group change score (steps/day) mean differences (95% CI) at nine weeks (174.5 (−1504.7 to 1853.7), p = 0.84) and six months (574.0 (−1162.3 to 2310.3), p = 0.52). Conclusions: further research is required to determine patient subgroups deriving the greatest benefits from PA interventions. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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14 pages, 915 KiB

Open AccessArticle

Pulmonary Rehabilitation Reduces Subjective Fatigue in COPD: A Responder Analysis

by Maarten Van Herck, Jeanine Antons, Jan H. Vercoulen, Yvonne M. J. Goërtz, Zjala Ebadi, Chris Burtin, Daisy J. A. Janssen, Melissa S. Y. Thong, Jacqueline Otker, Arnold Coors, Mirjam A. G. Sprangers, Jean W. M. Muris, Judith B. Prins, Martijn A. Spruit and Jeannette B. Peters

J. Clin. Med. 2019, 8(8), 1264; https://doi.org/10.3390/jcm8081264 - 20 Aug 2019

Cited by 25 | Viewed by 4637

Abstract

To date, it remains unknown which patients report a clinically-relevant improvement in fatigue following pulmonary rehabilitation (PR). The purpose of this study was to identify and characterize these responders. Demographics, lung function, anxiety (anxiety subscale of the 90-item symptom checklist (SCL-90-A)), depression (Beck [...] Read more.

To date, it remains unknown which patients report a clinically-relevant improvement in fatigue following pulmonary rehabilitation (PR). The purpose of this study was to identify and characterize these responders. Demographics, lung function, anxiety (anxiety subscale of the 90-item symptom checklist (SCL-90-A)), depression (Beck depression inventory for primary care (BDI-PC)), exercise tolerance (six-minute walking distance test (6MWD)), and health status (Nijmegen clinical screening instrument (NCSI)) were assessed before and after a 12-week PR programme. Fatigue was assessed using the checklist individual strength (CIS)-Fatigue. Patients with a decline ≥ 10 points (minimally clinically important difference, MCID) on the CIS-Fatigue were defined as responders. Chronic obstructive pulmonary disease (COPD) patients (n = 446, 61 ± 9 years, 53% male, forced expiratory volume in 1 s (FEV1) 43% ± 18% predicted, 75% severe fatigue) were included. Mean change in fatigue after PR was 10 ± 12 points (p < 0.01) and exceeded the MCID. In total, 56% were identified as fatigue responders. Baseline CIS-Fatigue (45 ± 7 vs. 38 ± 9 points, respectively, p < 0.001) and health-related quality-of-life (HRQoL; p < 0.001) were different between responders and non-responders. No differences were found in demographics, baseline anxiety, depression, lung function, 6MWD, and dyspnoea (p-values > 0.01). Responders on fatigue reported a greater improvement in anxiety, depression, 6MWD, dyspnoea (all p-values < 0.001), and most health status parameters. PR reduces fatigue in COPD. Responders on fatigue have worse fatigue and HRQoL scores at baseline, and are also likely to be responders on other outcomes of PR. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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14 pages, 3937 KiB

Open AccessArticle

Is Two Better Than One? The Impact of Doubling Training Volume in Severe COPD: A Randomized Controlled Study

by Mara Paneroni, Ioannis Vogiatzis, Stefano Belli, Gloria Savio, Dina Visca, Elisabetta Zampogna, Maria Aliani, Vito De Carolis, Mauro Maniscalco, Carla Simonelli and Michele Vitacca

J. Clin. Med. 2019, 8(7), 1052; https://doi.org/10.3390/jcm8071052 - 18 Jul 2019

Cited by 1 | Viewed by 2973

Abstract

Patients with severe chronic obstructive pulmonary disease (COPD) are unable to exercise at high intensities for sufficiently long periods of time to obtain true physiological training effects. It therefore appears sensible to increase training duration at sub-maximal exercise intensities to optimize the benefit [...] Read more.

Patients with severe chronic obstructive pulmonary disease (COPD) are unable to exercise at high intensities for sufficiently long periods of time to obtain true physiological training effects. It therefore appears sensible to increase training duration at sub-maximal exercise intensities to optimize the benefit of exercise training. We compared the effects on exercise tolerance of two endurance cycloergometer submaximal exercise protocols with different cumulative training loads (one (G1) versus two (G2) daily 40 min training sessions) both implemented over 20 consecutive days in 149 patients with COPD (forced expiratory volume at first second (FEV₁): 39% predicted) admitted to an inpatient pulmonary rehabilitation program. Patients in G2 exhibited greater improvement (p = 0.011) in submaximal endurance time (from 258 (197) to 741 (662) sec) compared to G1 (from 303 (237) to 530 (555) sec). Clinically meaningful improvements in health-related quality of life, 6MWT, and chronic dyspnea were not different between groups. Doubling the volume of endurance training is feasible and can lead to an additional benefit on exercise tolerance. Future studies may investigate the applicability and benefits of this training strategy in the outpatient or community-based pulmonary rehabilitation settings to amplify the benefits of exercise interventions. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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15 pages, 1565 KiB

Open AccessArticle

Maintenance Negative Pressure Ventilation Improves Survival in COPD Patients with Exercise Desaturation

by Hung-Yu Huang, Chun-Yu Lo, Lan-Yan Yang, Fu-Tsai Chung, Te-Fang Sheng, Horng-Chyuan Lin, Chang-Wei Lin, Yu-Chen Huang, Chee-Jen Chang, Kian Fan Chung and Chun-Hua Wang

J. Clin. Med. 2019, 8(4), 562; https://doi.org/10.3390/jcm8040562 - 25 Apr 2019

Cited by 3 | Viewed by 3582

Abstract

Negative pressure ventilation (NPV), when used as an adjuvant to pulmonary rehabilitation, improves lung function, increases exercise capacity, and reduces exacerbations. The aim of this study was to determine whether maintenance NPV improves long-term clinical outcomes and reduces mortality in patients with chronic [...] Read more.

Negative pressure ventilation (NPV), when used as an adjuvant to pulmonary rehabilitation, improves lung function, increases exercise capacity, and reduces exacerbations. The aim of this study was to determine whether maintenance NPV improves long-term clinical outcomes and reduces mortality in patients with chronic obstructive pulmonary disease (COPD). Between 2003 and 2009, 341 patients were treated for COPD either with or without hospital-based NPV. We measured forced expiratory volume in one second (FEV₁), 6-min walking distance (6MWD), and oxygen saturation by pulse oximetry (SpO₂) during a 6-min walk test (6MWT) every 3–6 months. Desaturation (D) during the 6MWT was defined as a reduction in SpO₂ of ≥10% from baseline. The NPV group had a better survival outcome than the Non-NPV group. The 8-year survival probabilities for the NPV and Non-NPV groups were 60% and 20%, respectively (p < 0.01). Baseline desaturation was a significant risk factor for death, and the risk of death increased with desaturation severity (SpO₂ 80~89: hazard ratios (HR) 2.7, 95% confidence interval (CI) 1.4–5.3; SpO₂ < 80: HR 3.1, 95% CI 1.3–7.4). The NPV group had a slower decline in lung function and 6MWD. The NPV + D and Non-NPV+D had a threefold and fourfold increase in the risks of all-cause mortality compared with the NPV-ND, respectively. Maintenance non-invasive NPV reduced long-term mortality in COPD patients. The desaturating COPD patients had an increased mortality risk compared with non-desaturating COPD patients. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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11 pages, 656 KiB

Open AccessArticle

The Effects of High- Versus Moderate-Intensity Exercise on Fatigue in Sarcoidosis

by Anita Grongstad, Nina K. Vøllestad, Line M. Oldervoll, Martijn A. Spruit and Anne Edvardsen

J. Clin. Med. 2019, 8(4), 460; https://doi.org/10.3390/jcm8040460 - 05 Apr 2019

Cited by 8 | Viewed by 3520

Abstract

Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from [...] Read more.

Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from a single session of moderate-intensity continuous training (MICT). Methods: Forty-one patients with pulmonary sarcoidosis were recruited to a cross-over study. All patients completed one treadmill session of HIIT (85% of peak heart rate (HRpeak)) and one of MICT (70% of HRpeak). Fatigue was assessed with the Visual Analogue Scale 0–100 mm, before (T0), after (T1), and 24 hours after (T2) each exercise session. Paired sample t-test was used to compare changes in fatigue from T0 to T1 and from T0 to T2 between HIIT and MICT. Results: No statistically significant difference in fatigue levels was found between HIIT and MICT, either at T1 (3.6 (13.5) and 1.4 (13.5)) or at T2 (8.2 (17.0) and 2.1 (17.1)). Conclusions: A single session of HIIT did not affect fatigue differently than a single session of MICT. These preliminary findings support the need for further research on the long-term effect of HIIT on fatigue in patients with sarcoidosis. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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14 pages, 427 KiB

Open AccessArticle

Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD

by Wai-Yan Liu, Kenneth Meijer, Jeannet M. Delbressine, Paul J. Willems, Emiel F. M. Wouters and Martijn A. Spruit

J. Clin. Med. 2019, 8(4), 459; https://doi.org/10.3390/jcm8040459 - 05 Apr 2019

Cited by 14 | Viewed by 3683

Abstract

Pulmonary rehabilitation (PR) improves lower-limb muscle function in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear whether patients improve gait characteristics, in particular stride-to-stride fluctuations that are associated with fall risks. This study aims to identify whether, and to what [...] Read more.

Pulmonary rehabilitation (PR) improves lower-limb muscle function in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear whether patients improve gait characteristics, in particular stride-to-stride fluctuations that are associated with fall risks. This study aims to identify whether, and to what extent, PR affects positively gait characteristics in COPD. In this prospective observational study, 44 COPD patients (aged: 62 ± 7 years; Forced expiratory volume in 1 s 56 ± 20% predicted) performed self-paced, treadmill 6-min-walk tests (Gait Real-time Analysis Interactive Lab) before and after PR, while spatiotemporal parameters and center of mass position were recorded (100 Hz, Vicon Nexus). Standard deviation, coefficient of variation, predictability (sample entropy), and consistency in organization (local divergence exponent) were calculated. Sub-analysis was performed to identify gait differences between good and poor responders (<30 m change in a 6-min-walk distance). Patients demonstrated shorter stride times (p = 0.001) and improved lower-limb muscle function (p < 0.001) following PR. The good responders had a greater increase in stride length (p < 0.001) and a greater decrease in stride time (p < 0.001) compared to the poor responders. Current PR improved stride time in patients, while movement patterns within stride-to-stride fluctuations did not change. Training programs specifically targeting balance issues and gait function may be beneficial in improving gait characteristics in COPD. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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13 pages, 751 KiB

Open AccessArticle

Effects of a Combined Community Exercise Program in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial

by Rodrigo Torres-Castro, Jordi Vilaró, Joan-Daniel Martí, Onintza Garmendia, Elena Gimeno-Santos, Bárbara Romano-Andrioni, Cristina Embid and Josep M. Montserrat

J. Clin. Med. 2019, 8(3), 361; https://doi.org/10.3390/jcm8030361 - 14 Mar 2019

Cited by 16 | Viewed by 4398

Abstract

Physical activity is associated with a decreased prevalence of obstructive sleep apnea and improved sleep efficiency. Studies on the effects of a comprehensive exercise program in a community setting remain limited. Our objective was to investigate the effects of a combined physical and [...] Read more.

Physical activity is associated with a decreased prevalence of obstructive sleep apnea and improved sleep efficiency. Studies on the effects of a comprehensive exercise program in a community setting remain limited. Our objective was to investigate the effects of a combined physical and oropharyngeal exercise program on the apnea-hypopnea index in patients with moderate to severe obstructive sleep apnea. This was a randomized clinical trial where the intervention group followed an eight-week urban-walking program, oropharyngeal exercises, and diet and sleep recommendations. The control group followed diet and sleep recommendations. A total of 33 patients were enrolled and randomized and, finally, 27 patients were included in the study (IG, 14; CG, 13) Obstructive sleep apnea patients were analyzed with a median age of 67 (52–74) and median apnea-hypopnea index of 32 events/h (25–41). The apnea-hypopnea index did not differ between groups pre- and post-intervention. However, in intervention patients younger than 60 (n = 6) a reduction of the apnea-hypopnea index from 29.5 (21.8–48.3) to 15.5 (11–34) events/h (p = 0.028) was observed. While a comprehensive multimodal program does not modify the apnea-hypopnea index, it could reduce body weight and increase the walking distance of patients with moderate to severe obstructive sleep apnea. Patients younger than 60 may also present a decreased apnea-hypopnea index after intervention. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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10 pages, 777 KiB

Open AccessArticle

“Can do” versus “do do”: A Novel Concept to Better Understand Physical Functioning in Patients with Chronic Obstructive Pulmonary Disease

by Eleonore H. Koolen, Hieronymus W. van Hees, Rob C. van Lummel, Richard Dekhuijzen, Remco S. Djamin, Martijn A. Spruit and Alex J. van ’t Hul

J. Clin. Med. 2019, 8(3), 340; https://doi.org/10.3390/jcm8030340 - 11 Mar 2019

Cited by 54 | Viewed by 5848

Abstract

Background: Physical capacity (PC) and physical activity (PA) represent associated but separate domains of physical function. It remains unknown whether this framework may support a better understanding of the impaired physical function in patients with chronic obstructive pulmonary disease (COPD). The current study [...] Read more.

Background: Physical capacity (PC) and physical activity (PA) represent associated but separate domains of physical function. It remains unknown whether this framework may support a better understanding of the impaired physical function in patients with chronic obstructive pulmonary disease (COPD). The current study had two aims: (1) to determine the distribution of patients with COPD over the PC-PA quadrants, and (2) to explore whether differences exist in clinical characteristics between these quadrants. Methods: In this retrospective study, PC was measured using the six-minute walk distance (6MWD), and PA was assessed with an accelerometer. Moreover, patients’ clinical characteristics were obtained. Patients were divided into the following quadrants: (I) low PC (6MWD <70% predicted), low PA, using a step-defined inactivity index (<5000 steps/day, ”can’t do, don’t do” quadrant); (II) preserved PC, low PA (“can do, don’t do” quadrant); (III) low PC, preserved PA (“can’t do, do do” quadrant); and (IV) preserved PC, preserved PA (“can do, do do” quadrant). Results: The distribution of the 662 COPD patients over the quadrants was as follows: “can’t do, don’t do”: 34%; “can do, don’t do”: 14%; “can’t do, do do”: 21%; and “can do, do do”: 31%. Statistically significant differences between quadrants were found for all clinical characteristics, except for educational levels. Conclusions: This study proves the applicability of the PC-PA quadrant concept in COPD. This concept serves as a pragmatic clinical tool, that may be useful in the understanding of the impaired physical functioning in COPD patients and therefore, may improve the selection of appropriate interventions to improve physical function. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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16 pages, 1954 KiB

Open AccessArticle

Intermittent Use of Portable NIV Increases Exercise Tolerance in COPD: A Randomised, Cross-Over Trial

by Ioannis Vogiatzis, Nikolaos Chynkiamis, Matthew Armstrong, Nicholas D. Lane, Tom Hartley, William K. Gray and Stephen C. Bourke

J. Clin. Med. 2019, 8(1), 94; https://doi.org/10.3390/jcm8010094 - 15 Jan 2019

Cited by 12 | Viewed by 5059

Abstract

During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip [...] Read more.

During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip breathing (PLB) on exercise tolerance. Twenty-four COPD patients were randomised to a high-intensity (HI: 2-min at 80% peak work rate (WRpeak) alternated with 2-min recovery; n = 13), or a moderate-intensity (MOD: 6-min at 60% WRpeak alternated with 2-min recovery; n = 11) protocol, and within these groups two tests were performed using pNIV and PLB during recovery in balanced order. Upon completion, patients were provided with pNIV; use over 12 weeks was assessed. Compared to PLB, pNIV increased exercise tolerance (HI: by 5.2 ± 6.0 min; MOD: by 5.8 ± 6.7 min) (p < 0.05). With pNIV, mean inspiratory capacity increased and breathlessness decreased by clinically meaningful margins during recovery compared to the end of exercise (HI: by 140 ± 110 mL and 1.2 ± 1.7; MOD: by 170 ± 80 mL and 1.0 ± 0.7). At 12 weeks, patients reported that pNIV reduced anxiety (median: 7.5/10 versus 4/10, p = 0.001) and recovery time from breathlessness (17/24 patients; p = 0.002); 23/24 used the device at least weekly. pNIV increased exercise tolerance by reducing dynamic hyperinflation and breathlessness in COPD patients. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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Review

Jump to: Research

46 pages, 6973 KiB

Open AccessReview

Exercise Training in Patients with Chronic Respiratory Diseases: Are Cardiovascular Comorbidities and Outcomes Taken into Account?—A Systematic Review

by Ana Machado, Kirsten Quadflieg, Ana Oliveira, Charly Keytsman, Alda Marques, Dominique Hansen and Chris Burtin

J. Clin. Med. 2019, 8(9), 1458; https://doi.org/10.3390/jcm8091458 - 13 Sep 2019

Cited by 5 | Viewed by 5803

Abstract

Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and [...] Read more.

Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = −0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC. Full article

(This article belongs to the Special Issue Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders)

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