ORCID Profile
0000-0002-6082-6352
Current Organisations
Curtin University
,
Genesis Healthcare
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Publisher: Springer Science and Business Media LLC
Date: 11-12-2020
DOI: 10.1007/S00408-019-00297-2
Abstract: To determine the effects of providing a wheeled walker (WW) for use in the home and community, on daily physical activity (PA) and sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD). A randomised cross-over study in which participants with COPD characterised by a 6-min walk distance ≤ 450 m, who had recently finished pulmonary rehabilitation, completed two 5-week phases. During one phase, participants were provided a WW to use, whereas during the other phase, the WW was not available. The order of the phases was randomised. For the final week of each phase, measures of PA and ST were collected using wearable devices and health-related quality of life was measured using the Chronic Respiratory Disease Questionnaire (CRDQ). Wheeled walker use was also measured using an odometer attached to the device. 17 participants [FEV These data demonstrated that, when provided to selected patients with COPD, WWs increased daily step count. ACTRN12609000332224.
Publisher: Springer Science and Business Media LLC
Date: 04-02-2016
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.APMR.2012.01.009
Abstract: To (1) evaluate whether the use of a rollator changed metabolic cost during a controlled walking task, and (2) explore relationships between the difference in dyspnea and metabolic cost associated with rollator use. Single-group interventional study in which patients completed 2 corridor walks: 1 without and 1 with a rollator, at the same in idualized constant speed. Rehabilitation hospital. Patients with chronic obstructive pulmonary disease (N=15 10 men median age [interquartile range IQR]=69 [12]y forced expiratory volume in 1 second=42 [20]% predicted). Rollator use. Oxygen uptake, converted to metabolic equivalent units (METs), and minute ventilation were measured throughout both tasks using a portable gas analysis system dyspnea and arterial oxygen saturation (SpO(2)) were collected on completion. Median [IQR] walk speed [IQR] was 48 (10)m/min. Walking with a rollator, compared with walking without, reduced dyspnea (median [IQR]=1.0 [1.5] vs 2.0 [2.0] P=.01) without changing energy expenditure (median [IQR]=2.8 [1.2] vs 3.2 [0.9] METs P=.65), minute ventilation (median [IQR]=30.3 [9.6] vs 27.7 [9.9]L/min P=.50), or SpO(2) (median [IQR]=92 [8]% vs 94 [10]% P=.41). The association between the reduction in dyspnea and any difference in energy expenditure related to rollator use was of borderline significance (r(s)=.50 P=.06). Six of the 8 participants who experienced a reduction in dyspnea also demonstrated a reduction in the metabolic cost of walking. The mechanism responsible for the amelioration in dyspnea during rollator-assisted walking is multifactorial. A reduction in the metabolic cost of walking may play a part in some, but not all, patients.
Publisher: Wiley
Date: 04-2013
DOI: 10.1111/J.1445-5994.2012.02928.X
Abstract: There has been a recent increase in the research available to guide physiotherapy management of patients who require surgical resection for lung cancer. It is unclear whether this evidence has influenced clinical practice. To describe physiotherapy practice patterns in the preoperative and postoperative management of patients who undergo surgical resection for lung cancer. Physiotherapists involved in the management of patients who require surgical resection for lung cancer at hospitals across Australia and New Zealand were mailed a purpose-designed questionnaire. The response rate was 91% (43/47). Prior to surgery, 40% (n = 17) of the respondents indicated that patients were not assessed by a physiotherapist. In most hospitals (n = 39 91%), patients did not participate in supervised exercise training before surgery. Most commonly, physiotherapy was commenced on the day following surgery (n = 39 91%), with walking-based exercise being the treatment that was most frequently implemented in all patients (n = 40 93%). Seventy-two per cent of respondents referred less than 25% of patients to pulmonary rehabilitation on discharge from hospital. Physiotherapy assessment and treatment choices were influenced predominantly by established practice in the hospital and personal experience rather than research findings. In people who undergo surgical resection for lung cancer, physiotherapy services focused on reducing or preventing postoperative pulmonary complications. Despite recent data suggesting that exercise training is beneficial in this population, our data indicate that referral to pulmonary rehabilitation was uncommon.
Publisher: Springer Science and Business Media LLC
Date: 13-03-2021
Publisher: Elsevier BV
Date: 10-2016
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.JCRC.2013.02.012
Abstract: This study aimed to report mortality, morbidity, and the relationship between these outcomes with physical function in patients who survived prolonged mechanical ventilation during an intensive care unit (ICU) admission. Records were reviewed for Western Australian residents admitted to an ICU in 2007 or 2008 who were ventilated for 7 days or longer and survived their acute care stay. Records were linked with data maintained by the Department of Health. A total of 181 patients (aged 52 ± 19 years) were included in this study. In the 12 months after discharge, 159 (88%) survived and 148 (82%) had been hospitalized. Compared with those who were ambulating independently when discharged from acute care, those who were not had more admissions (incident rate ratio, 1.81 95% confidence interval, 1.28-2.57) and a greater cumulative length of hospital stay (10 [37] vs 57 [115] days, P < .001) over the first 12 months after discharge. Time between admission to ICU and when the patient first stood correlated with the number of admissions (Rs = 0.320, P < .001) and cumulative length of stay (Rs = 0.426, P < .001) in the 12 months after discharge. For survivors of prolonged mechanical ventilation, physical function during acute care was associated with hospitalization over the following 12 months.
Publisher: Oxford University Press (OUP)
Date: 09-2011
DOI: 10.2522/PTJ.20100241
Abstract: Severe injuries sustained during combat may classify in iduals as undeployable for active service. It is imperative that every effort is made to optimize physical function following such injuries. A 38-year-old man sustained a gunshot wound during armed combat. The bullet entered via the left axilla and exited from the right side of the abdomen, resulting in severe thoracic and abdominal injuries. Five months later, he continued to describe severe dyspnea on exertion. During a cardiopulmonary exercise test on a cycle ergometer, he achieved a maximum rate of oxygen uptake of 2,898 mL·min(-1) (114% predicted) and maximum power of 230 W (114% predicted). His maximum forced inspiratory flow was 5.95 L·s(-1), and inspiratory reserve volume at test end was ∼80 mL. The test was terminated by the patient due to dyspnea that was too severe to tolerate. Video fluoroscopy demonstrated impaired right hemidiaphragm function. The main goals of therapy were to reduce dyspnea on exertion and to enable return to full work duties. A program of high-intensity, interval-based threshold inspiratory muscle training (IMT) was undertaken. An average of 5 sessions of IMT were completed each week for 10 weeks. During a repeat cardiopulmonary exercise test, the patient achieved a similar power and maximum rate of oxygen uptake. His maximum forced inspiratory flow increased by 48% to 8.83 L·s(-1), and he was limited by leg fatigue. High-intensity IMT was safe and well tolerated. It was associated with improvements in maximum forced inspiratory flow and changed the locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.
Publisher: S. Karger AG
Date: 04-2011
DOI: 10.1159/000308464
Abstract: i Background: /i Prescription of an appropriate exercise training intensity is critical to optimise the outcomes of pulmonary rehabilitation however, prescribing cycle ergometry training is challenging if peak work is unknown. Recently two studies reported regression equations which allow estimation of peak cycle work rate from the 6-minute walk distance (6MWD) in chronic obstructive pulmonary disease (COPD). i Objectives: /i To compare estimates of peak work and target training work rate (60% peak) obtained from these equations. i Methods: /i Sixty-four (38 male) subjects, mean ± SD age 70 ± 8 years and FEV sub /sub 49 ± 18% predicted with COPD performed the 6-minute walk test according to a standardised protocol. Estimates of peak work were obtained using the published equations and agreement was examined using Bland and Altman plots. i Results: /i Mean 6MWD was 376 ± 86 m compared to 464 ± 110 m and 501 ± 83 m in s les used to derive the equations. There was substantial variation in estimates of peak work between equations (range 1–75 Watts difference) with a coefficient of variation of 35%. Differences were greater in men than in women (p 0.001). The Luxton equation predicted higher peak work than the Hill equation in younger subjects and at work rates over 50 Watts. Estimated training work rate differed by more than 20 Watts in 18 subjects (28%). i Conclusions: /i This comparison of reference equations for predicting peak cycle work rate from 6MWD indicates substantial variation between methods that differs systematically across the range of work rates. Further research is required to validate the equations and assess their utility for exercise prescription in pulmonary rehabilitation.
Publisher: European Respiratory Society (ERS)
Date: 11-2019
Publisher: Wiley
Date: 12-11-2016
DOI: 10.1111/RESP.12680
Abstract: People with chronic obstructive pulmonary disease (COPD) engage in low levels of physical activity (PA). Given the evidence for the health benefits associated with participating in 150 min of moderate-to-vigorous intensity PA each week, there is considerable interest in methods to increase PA in people with COPD. Studies to date have focused largely on exercise training and behavioural approaches, and many have demonstrated minimal, if any effect. An intermediate goal that focuses on reducing time spent in sedentary behaviour (SB) and increasing participation in light intensity PA is a more realistic goal in this population and offers a gateway to higher intensity PA. Although strategies that are capable of reducing time spent in SB in COPD are unknown, studies that have shown some increase in PA in this population often provide in idualized goal setting, motivational interviewing and frequent contact with health-care professionals to provide advice regarding strategies to overcome barriers. Therefore, these approaches should be considered in interventions to reduce time in SB. There are a range of devices available to monitor time in SB for use in both clinical and research settings. To move this area forward, a theoretically informed and systematic approach to behaviour change is needed. The theoretical model, the 'behaviour change wheel', is described and an ex le is provided of how it can be applied to a person with COPD.
Publisher: Wiley
Date: 20-07-2017
DOI: 10.1111/RESP.13130
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-09-2021
Publisher: Wiley
Date: 21-01-2020
Abstract: With increasing demands for safe, high capacity energy storage to support personal electronics, newer devices such as unmanned aerial vehicles, as well as the commercialization of electric vehicles, current energy storage technologies are facing increased challenges. Although alternative batteries have been intensively investigated, lithium (Li) batteries are still recognized as the preferred energy storage solution for the consumer electronics markets and next generation automobiles. However, the commercialized Li batteries still have disadvantages, such as low capacities, potential safety issues, and unfavorable cycling life. Therefore, the design and development of electromaterials toward high-energy-density, long-life-span Li batteries with improved safety is a focus for researchers in the field of energy materials. Herein, recent advances in the development of novel organic electrolytes are summarized toward solid-state Li batteries with higher energy density and improved safety. On the basis of new insights into ionic conduction and design principles of organic-based solid-state electrolytes, specific strategies toward developing these electrolytes for Li metal anodes, high-energy-density cathode materials (e.g., high voltage materials), as well as the optimization of cathode formulations are outlined. Finally, prospects for next generation solid-state electrolytes are also proposed.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JCRC.2011.12.020
Abstract: The purposes were to assess the functional recovery of those who survived a prolonged intensive care unit (ICU) stay by reporting the proportion who were able to ambulate independently at hospital discharge and also to examine if the time duration between admission and when the patient first stood impacted on their capacity to ambulate at discharge. A retrospective review was conducted of medical records of ICU patients in 2007 to 2008, who were mechanically ventilated for 168 hours or more, and survived their acute care stay. Main outcome measures were (1) ambulation status before admission and at time of hospital discharge and (2) time between admission to the ICU and when the patient first stood. A total of 190 patients were included. Before admission, 189 (99% 95% confidence interval [CI], 98%-100%) were ambulating independently, of whom 180 (95%) did not require a gait aid. On discharge from acute care, 89 (47% 95% CI, 40%-54%) were ambulating independently, of whom 54 (61%) did not require a gait aid. Compared with those who stood within 30 days of ICU admission, a delay in standing of between 30 and 60 days increased the odds 5-fold (95% CI, 2-11) of being unable to ambulate independently at the time of discharge. After a prolonged ICU admission, more than 50% of patients were unable to ambulate independently by hospital discharge, with the time between admission and first stand, being an important predictor of this outcome.
Publisher: Wiley
Date: 06-02-2017
DOI: 10.1111/DMCN.13398
Publisher: Elsevier BV
Date: 09-2012
Abstract: Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary, comprehensive intervention that can be integrated into the management of in iduals with chronic lung disease. It aims to reduce symptoms, optimize function, increase participation in daily life, and reduce health-care resource utilization. In this review, we summarize the new developments in PR over the past 5 years. Issues related to patient assessment include a comparison of cycle- and walking-based measures of exercise capacity, the emergence of multidimensional indices, the refinement of the minimal clinically important difference, and the importance of assessing physical activity. Issues related to exercise training focus on strategies to optimize the training load. We also comment on the acquisition of self-management skills, balance training, optimizing access, and maintaining gains following completion of PR.
Publisher: Wiley
Date: 09-2020
DOI: 10.1111/IMJ.14443
Abstract: Within Australian and New Zealand cystic fibrosis (CF) centres, exercise testing and exercise training are common components of clinical care, but current practices regarding these components have not been reported. To determine the extent, scope and importance placed on exercise testing and exercise training within CF centres across Australia and New Zealand. Information pertaining to exercise testing and training practices was sought by administering a survey to health professionals working in CF centres across Australia and New Zealand. The survey comprised five sections (46 questions) and was sent via an online link (Qualtrics). Response rate was optimised using the Dillman approach. Approval for this study was granted from the Human Research Ethics Committee at Curtin University (HRE2018-074). Completion of the survey was taken as informed consent. A response rate of 80% (n = 32/40) was achieved. Each state/territory in Australia, except the Northern Territory was represented in the survey responses. Eight of the 12 major regions in New Zealand were also represented. Regarding tests of exercise capacity, field-based tests were performed more commonly than laboratory-based tests (n = 28/32 88% vs n = 11/32 centres 34% difference: 54% 95% confidence interval 31-70%). Most (89%) respondents perceived field tests to be at least 'somewhat' important, whereas 91% of respondents perceived laboratory tests to be 'a little' to 'somewhat' important. Physical activity and/or exercise were discussed by at least one health professional in the CF team at every clinic appointment and/or annual review. Most centred offered outpatient exercise training each year to their patients (n = 24/32 75%). This survey captures the current practices of exercise testing and training in CF centres across Australia and New Zealand.
Publisher: Wiley
Date: 30-07-2018
DOI: 10.1111/RESP.13128
Abstract: In patients with COPD, this study evaluated the effect on health-related quality of life (HRQoL) of adding ongoing feedback to a 12-month unsupervised maintenance walking programme. Participants were randomized to either an intervention group (IG) or control group (CG). Both groups completed the same 2-month supervised, walking training programme followed by a 12-month unsupervised maintenance walking programme. During the maintenance programme, the IG received ongoing feedback (telephone calls, biofeedback and progressive goal setting) and the CG received no feedback. A total of 75 participants completed the study (mean (SD): age 69 (8) years forced expiratory volume in 1 s (FEV Following a 2-month supervised walking training programme, ongoing feedback was no more effective than no feedback in maintaining HRQoL during a 12-month unsupervised walking programme.
Publisher: Elsevier BV
Date: 02-2012
Abstract: The aims of this study were to determine which tests of exercise capacity relate to average daily energy expenditure (DEE) and to quantify aerobic reserve during daily life in people with COPD. A cross-sectional study was undertaken in 26 people with COPD (16 men FEV(1), 50% ± 16%). Six-min walk distance (6MWD) and incremental shuttle walk distance (ISWD) measures were collected, and peak oxygen uptake (VO(2) peak) was measured during a symptom-limited r cycle ergometry test. The SenseWear Armband was worn during the waking hours for 4.4 ± 1.1 days to measure DEE. The intensity at which activities of daily living were undertaken was expressed as a percentage of VO(2) peak. DEE was associated with 6MWD (r = 0.40, P = .046) and ISWD (r = 0.52, P = .007) but not VO(2) peak (mL/kg per min) (r = 0.07, P = .74). Stronger associations were observed between DEE and the body weight-walking distance product for the 6MWD (r = 0.73, P < .001) and ISWD (r = 0.75, P < .001). The average intensity of daily activity was equivalent to 58% ± 11% of VO(2) peak, leaving an average aerobic reserve of 42%. Both 6MWD and ISWD, but not VO(2) peak, were related to DEE. Because activities of daily living were performed at a high percentage of VO(2) peak, it may be more realistic to optimize habitual DEE in COPD by increasing the frequency or duration rather than the intensity of physical activity.
Publisher: American Thoracic Society
Date: 15-10-2013
Publisher: Springer Science and Business Media LLC
Date: 14-08-2019
Publisher: Springer Science and Business Media LLC
Date: 06-04-2018
Publisher: SAGE Publications
Date: 11-08-2018
Abstract: In cystic fibrosis, exacerbations impair lung function and health-related quality of life, increase healthcare costs and reduce survival. Delayed reporting of worsening symptoms can result in more severe exacerbations and worse clinical outcomes therefore there is a need for a novel approach to facilitate the early identification and treatment of exacerbations in this population. This study investigated the usability of a smartphone application to report symptoms in adults with cystic fibrosis, and the observer agreement in clinical decision-making between senior clinicians interpreting smartphone application responses. Adults with cystic fibrosis used the smartphone application weekly for four weeks. The application comprised 10 yes/no questions regarding respiratory symptoms and two regarding emotional well-being. Usability was measured with the System Usability Scale Observer agreement was tested by providing a cystic fibrosis physician and a nurse practitioner with 45 clinical scenarios. For each scenario the clinicians, who were blinded to each other's responses, were asked to indicate whether or not they would: (i) initiate telephone contact, and/or (ii) request a clinic visit for the in idual. Ten participants (five female), aged mean (SD) 33 (11) years, FEV1 49 (27)% predicted completed the study. The mean (SD) System Usability Scale score was 94 (6). There was perfect agreement between clinicians for initiating contact with the participant ( κ = 1.0, p 0.001), and near-perfect for requesting a clinic visit ( κ = 0.86, p 0.001). The use of a smartphone application for reporting symptoms in adults with cystic fibrosis has excellent usability and near-perfect agreement between senior clinicians when interpreting the application responses.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.RMED.2018.11.013
Abstract: In people with moderate-to-severe chronic obstructive pulmonary disease (COPD), the minimal detectable difference (MDD) in endurance shuttle walk test (ESWT) performance following exercise training is unclear. We sought to determine the MDD for ESWT performance following supervised ground-based walking training using anchor- and distribution-based approaches and report whether these values exceeded random variation in test performance. Participants with COPD trained for 30-45 min, 2-3 times weekly for 8-10 weeks. The ESWT was performed before and after the training period. Immediately after training, participants rated their change in walking ability using a Global Rating of Change scale. Receiver Operating Characteristic curves were used to derive the value that best separated those who perceived their improvement in walking ability to be at least 'a little' better from 'almost the same, hardly any change'. These values were compared with those calculated using a distribution-based method. Random variation in test performance was defined as the minimal detectable change (MDC), calculated using the standard error of measurement. 78 participants (aged 70 ± 8 yr and FEV The MDD established using the anchor- and distribution-based approaches differed considerably. Large variation in test performance cautions against using the MDD to interpret changes in an in idual. Australian New Zealand Clinical Trials Registry (ACTRN12609000472279).
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.JCF.2013.05.005
Abstract: Exercise is important for patients with cystic fibrosis (CF). Interactive gaming consoles are a new trend in exercise. This study sought to determine the exercise intensity of training using the Xbox Kinect(™). Participants with CF completed two sessions separated by ≤10 days. The first session involved a cardiopulmonary exercise test (CPET) to measure peak exercise capacity. The second session involved 20 min of exercise using the Xbox Kinect™. Ten participants (median [interquartile range] FEV1 58 [46]%, 29 [6] years, 6 males) completed the study. The average heart rate over the final 10 min of exercise using the Xbox Kinect™, expressed as a percentage of the peak heart rate achieved on the CPET, was 86% (95% confidence interval, 81 to 92%). Training using the Xbox Kinect™ represents high intensity exercise for adults with CF and may be a suitable alternative to conventional exercise modalities.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
Publisher: Informa UK Limited
Date: 15-12-2015
DOI: 10.3109/09638288.2014.993436
Abstract: Rett syndrome is a pervasive neurological disorder with impaired gait as one criterion. This study investigated the capacity of three accelerometer-type devices to measure walking activity in Rett syndrome. Twenty-six participants (mean 18 years, SD 8) wore an Actigraph, ActivPAL and StepWatch Activity Monitor (SAM) during a video-taped session of activities. Agreement was determined between step-counts derived from each accelerometer and observation. Repeatability of SAM-derived step counts was determined using pairs of one-minute epochs during which the same participant was observed to walk with the same cadence. The mean difference (limit of agreement) for the Actigraph, ActivPAL and SAM were -41 (SD 33), -16 (SD 21) and -1 (SD 16) steps/min, respectively. Agreement was influenced by a device/cadence interaction (p < 0.001) with greater under-recording at higher cadences. For SAM data, repeatability of step-count pairs was excellent (intraclass correlation coefficient 0.91, 95% CI 0.79-0.96). The standard error of measurement was 6 steps/min and we would be 95% confident that a change ≥17 steps/min would be greater than within-subject measurement error. The capacity of the SAM to measure physical activity in Rett syndrome allows focus on participation-based activities in clinical practice and clinical trials. Implications for Rehabilitation Many girls and women with Rett syndrome are able to walk on their own or with assistance but with altered movement patterns. Validated measures of physical activity, such as step counts, have potential to monitor function during daily life. Compared with other forms of accelerometer-type devices, such as ActiGraph and ActivPAL, the StepWatch Activity Monitor (SAM) measured step counts with good accuracy and repeatability. The capacity of the SAM to measure physical activity in Rett syndrome allows focus on participation-based activities in clinical practice and clinical trials.
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.PEC.2009.09.035
Abstract: To examine the effect of brief disease-specific education delivered in primary care on objective measures of knowledge in in iduals recently diagnosed with chronic obstructive pulmonary disease (COPD). A randomized control trial was undertaken during which an experimental group received 2h of education delivered by a certified COPD educator and a control group received usual care. The Bristol COPD Knowledge Questionnaire (BCKQ) was self-administered at the time of randomization and approximately three months later. Of the 93 in iduals that completed the study, 50 (forced expiratory volume in 1s [FEV(1)]=60.0+/-14.3% predicted 22 males) and 43 (FEV(1)=58.2+/-14.4% predicted 20 males) participants were randomized to the experimental and control groups, respectively. The BCKQ increased from 27.6+/-8.7 to 36.5+/-7.7 points (p<0.001) in the experimental group, which was greater than any seen in the control group (between-group difference 8.3, 95% confidence interval 5.5-11.2 points). As little as 2h of education delivered in primary care was effective at increasing objective measures of disease-specific knowledge. A program of brief education delivered in the primary care setting, represents an important approach for many in iduals with COPD who are unlikely to access pulmonary rehabilitation.
Publisher: Elsevier BV
Date: 04-2015
Publisher: Elsevier BV
Date: 2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-04-2021
Publisher: Elsevier BV
Date: 2011
Abstract: The study aimed to evaluate the effect of upper extremity resistance training for patients with COPD on dyspnea during activity of daily living (ADL), arm function, arm exercise capacity, muscle strength, and health-related quality of life (HRQL). Patients were randomly assigned to an intervention or control group. The intervention group underwent arm resistance training. The control group performed a sham. Both groups exercised three times a week for 6 weeks. Dyspnea during ADL and HRQL were measured using the Chronic Respiratory Disease Questionnaire (CRDQ). Arm function and exercise capacity were measured using the 6-min pegboard and ring test (6PBRT) and the unsupported upper limb exercise test (UULEX), respectively. Muscle strength for the biceps, triceps, and anterior and middle deltoids was obtained using an isometric dynamometer. Thirty-six patients with COPD (66 ± 9 years) participated in the study. Compared with the control group, the magnitude of change in the intervention group was greater for the 6PBRT (P = .03), UULEX (P = .01), elbow flexion force (P = .01), elbow extension force (P = .02), shoulder flexion force (P = .029), and shoulder abduction force (P = .01). There was no between-group difference in dyspnea during ADL, HRQL, or symptoms during the 6PBRT or UULEX (all P values > .08). Resistance-based arm training improved arm function, arm exercise capacity, and muscle strength in patients with COPD. No improvement in dyspnea during ADL, HRQL, or symptoms was demonstrated.
Publisher: BMJ
Date: 12-01-2017
DOI: 10.1136/THORAXJNL-2016-208900
Abstract: Sleep disturbances are common in patients with chronic obstructive pulmonary disease (COPD) with a considerable negative impact on their quality of life. However, factors associated with measures of sleep in daily life have not been investigated before nor has the association between sleep and the ability to engage in physical activity on a day-to-day basis been studied. To provide insight into the relationship between actigraphic sleep measures and disease severity, exertional dyspnoea, gender and parts of the week and to investigate the association between sleep measures and next day physical activity. Data were analysed from 932 patients with COPD (66% male, 66.4±8.3 years, FEV Actigraphic estimates of sleep impairment were greater in patients with worse airflow limitation and worse exertional dyspnoea. Patients with better sleep measures (ie, non-fragmented sleep, sleeping bouts ≥225 min, sleep efficiency ≥91% and time spent awake after sleep onset <57 min) spent significantly more time in light (p<0.01) and moderate-to-vigorous physical activity (p<0.01). There is a relationship between measures of sleep in patients with COPD and the amount of activity they undertake during the waking day. Identifying groups with specific sleep characteristics may be useful information when designing physical activity-enhancing interventions.
Publisher: Oxford University Press (OUP)
Date: 09-2015
DOI: 10.2522/PTJ.20140282
Abstract: People who have had a prolonged admission to an intensive care unit (ICU) commonly have profound debilitation and weakness. For the delivery of effective exercise training, an accurate assessment of exercise capacity is essential. The study objectives were to investigate how much ground-based walking is undertaken by inpatients recovering from critical illness within 1 week of discharge from an ICU and to evaluate the feasibility and safety of the Six-Minute Walk Test (6MWT) for this population. This was an observational study. Within 1 week of discharge from the ICU, functional exercise capacity was measured with the 6MWT. The maximum distance ambulated on the ward in a single session as part of usual clinical management was extracted from the medical notes. The distance achieved during the 6MWT and the maximum distance ambulated on the ward were compared. The participants (N=23) were survivors of a critical illness their mean age was 57 years (SD=11). The median length of ICU stay was 11 days (interquartile range [IQR]=7). The mean 6-minute walk distance (6MWD) was 179 m (SD=101), and the maximum distance ambulated on the ward was 30 m (IQR=65). There was a moderate association between the distance participants ambulated on the ward and the 6MWD (r=.54). The maximum distance ambulated on the ward, expressed as a percentage of the 6MWD, was 29% (IQR=34%). Five participants (22%) experienced oxygen desaturation (oxygen saturation of & %) and recovered within 1 minute of resting. The maximum distance ambulated on the ward was estimated with premeasured distances. Most participants ambulated at a low percentage of their measured exercise capacity. The 6MWT appears to be a safe and useful test for inpatients recently discharged from the ICU.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
Publisher: Wiley
Date: 05-2015
DOI: 10.1111/IMJ.12570
Abstract: In health and disease, the benefits of regular participation in moderate to vigorous intensity physical activity are well documented. However, in iduals with chronic conditions, such as those with chronic obstructive pulmonary disease (COPD), typically do very little activity at a moderate or vigorous intensity. Much of their day is instead spent in sedentary behaviour, such as sitting or reclining, which requires very little energy expenditure. This high level of time spent in sedentary behaviour can have serious health consequences, including increased risk of diabetes, cardiovascular disease and premature mortality. There is emerging evidence to suggest that participation in light intensity physical activities (e.g. standing or slow walking) may have benefits for cardio-metabolic health. Given the low aerobic capacity of in iduals with moderate to severe COPD, increasing light intensity activity (through reducing sedentary time) may be a feasible additional strategy to improve health in this population, alongside traditional recommendations to increase the time spent in moderate to vigorous intensity physical activity. This review provides an overview of physical activity and sedentary behaviour, with a particular emphasis on these behaviours for people with COPD. It provides suggestions for the measurement of these behaviours within the clinical setting, as well as for interventions that may be effective at increasing physical activity and reducing sedentary behaviour in this population.
Publisher: Canadian Science Publishing
Date: 10-2011
DOI: 10.1139/H11-075
Abstract: We sought to describe responses to the 6-min walk test (6MWT) in healthy Canadian adults in order to facilitate interpretation of its results in patient populations. Seventy-seven healthy Canadians aged 45 to 85 years (65 ± 11 years, 40 females) completed this study. During a single visit, three 6MWTs were undertaken. The main outcome measure was 6-min walk distance (6MWD). Age, gender, height, and weight were recorded. In 61 (79%) participants, cardiorespiratory variables were collected during the third 6MWT using a calibrated portable gas analysis system. The 6MWD increased between the first and second test (615 ± 96 to 639 ± 98 m p 0.001) with no further improvement on the third test (638 ± 99 m p = 0.945). The best 6MWD from the first 2 tests was 640 ± 99 m (range 416 to 880 m). A greater 6MWD was achieved by males compared with females (672 ± 94 vs. 611 ± 93 m p = 0.005). The following equation accounted for 49% of the variance in 6MWD: 6MWD = 970.7 + (–5.5 × age) + (56.3 × gender), where females = 0, males = 1. The 6MWT elicited large cardiorespiratory responses with minimal symptoms. The rate of oxygen uptake measured at test-end was associated with the 6MWD (r = 0.802 p 0.001). These data allow the 6MWD achieved in Canadian adults to be expressed as a percentage of the predicted value and provide researchers and clinicians with values for the expected cardiorespiratory responses in a healthy adult population for the purpose of comparison with patient populations.
Publisher: Elsevier BV
Date: 06-2014
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.RMED.2015.08.015
Abstract: The aim of this study was to compare measures of exercise capacity, health-related quality of life (HRQoL), muscle force, lung function and feelings of anxiety and depression in people after curative intent treatment for NSCLC with age and gender-matched healthy controls. This cross-sectional study included 23 participants (68 ± 10yr 16 females), 6-10 weeks after lobectomy for NSCLC or, for those who received adjuvant chemotherapy, 4-8 weeks after their last cycle. The study also included 20 age and gender-matched healthy controls (69 ± 5yr 13 females). All participants underwent measurements of exercise capacity (cycle-ergometry test [CPET] and 6-min walk test [6MWT]), HRQoL (Short-Form 36 general health survey [SF-36]), handgrip force, quadriceps torque, lung function and feelings of anxiety and depression. When compared with data collected in healthy controls, those in the NSCLC group demonstrated impairments in the peak rate of oxygen consumption (15 ± 3 versus 24 ± 7 ml kg(-1)·min(-1) p < 0.001) and maximum work rate (75 ± 25 versus 127 ± 51Watts p < 0.001) measured during the CPET, and 6-min walk distance (494 ± 77 versus 649 ± 61 m p < 0.001). Similarly, impairments were demonstrated in all domains of the SF-36 (p < 0.01 for all), isometric handgrip force (28 ± 7 versus 34 ± 10 kg p = 0.02), and all measures of lung function (p ≤ 0.001 for all). A higher score for depression was also seen (3.0 ± 2.5 versus 1.5 ± 1.6 p = 0.03). There was no difference between the groups in isometric quadriceps torque or feelings of anxiety. After curative intent treatment for NSCLC, compared to healthy controls, impairments were demonstrated in laboratory and field-based measures of exercise capacity, HRQoL, isometric handgrip force and lung function. Although people after curative intent treatment for NSCLC reported greater feelings of depression, these levels were below those considered clinically relevant. These findings suggest that people after curative intent treatment for NSCLC may benefit from rehabilitative strategies to optimise exercise capacity and HRQoL.
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.APMR.2010.06.010
Abstract: Reduced inspiratory muscle strength is common in people with chronic obstructive pulmonary disease (COPD) and is associated with dyspnea and decreased exercise capacity. Most studies of inspiratory muscle training (IMT) in COPD have demonstrated increased inspiratory muscle strength. Many have also shown improvements in dyspnea and exercise capacity. However, a persisting challenge when translating and applying the findings of these studies in clinical practice is the disparity in training loads, modalities, and outcomes measures used in the different studies. This commentary summarizes our clinical and research experience with a threshold IMT device with the aim of providing clinicians interested in prescribing IMT in this population with practical recommendations regarding patient selection, assessment, and implementation of training. We propose using an interval-based high-intensity threshold IMT program for people who are unable to participate fully in whole-body exercise training because of comorbidities such as severe musculoskeletal problems. Initial training loads equivalent to at least 30% of a person's maximum inspiratory pressure (PImax) are required for all people undertaking IMT. Supervision, which includes monitoring of oxygen saturation throughout the first training session, is recommended, and patients are warned to expect transient delayed-onset muscle soreness, a consequence of muscle adaptation to an unaccustomed activity. We recommend training be undertaken 3 times a week for 8 weeks, with loads progressively increased as symptoms permit. It is prudent to exclude people at risk of pneumothorax or spontaneous rib fracture. Evaluation of IMT should include measures of PImax, dyspnea, health-related quality of life, and exercise capacity.
Publisher: Elsevier BV
Date: 03-2016
Publisher: University of Toronto Press Inc. (UTPress)
Date: 2013
DOI: 10.3138/PTC.2011-49
Abstract: Purpose: To determine (1) the relationship among three common upper-limb tests for patients with chronic obstructive pulmonary disease (COPD): unsupported upper limb exercise test (UULEX), 6-minute pegboard and ring test (6PBRT), and a muscle-strength test using a hand-held dynamometer and (2) the responsiveness of these three tests to changes after pulmonary rehabilitation that included a resistance arm-training programme. Methods: The study was a secondary analysis of a randomized controlled trial (RCT). The UULEX and the 6PBRT were used to measure peak arm exercise capacity and arm function, respectively. A handheld dynamometer was used to measure elbow and shoulder flexion force. We analyzed baseline data for all participants in the RCT, as well as baseline and post-PR data for those who completed 6-week follow-up testing. Results: 36 patients with COPD (mean forced expiratory volume in 1 second [FEV 1 ]=35% [SD 15%] predicted age 66 [9] y) participated, of whom 13 completed an arm-training programme. The correlations among the test results ranged from 0.41 to 0.81 (p .0001). Standardized response means were 1.0 for muscle force of elbow flexion, 1.2 for shoulder flexion, and 1.8 for the 6PBRT and UULEX. Conclusions: Although the three tests (UULEX, 6PBRT, and muscle-strength test using a hand-held dynamometer) are intended to measure different constructs, they were moderately to highly correlated with one another. The 6PBRT, UULEX, and muscle-strength test were demonstrated to be responsive to the resistance arm-training programme.
Publisher: SAGE Publications
Date: 10-2005
Publisher: European Respiratory Society (ERS)
Date: 30-08-2013
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.RMED.2012.08.011
Abstract: The original method for determining endurance shuttle walk test (ESWT) speed involves components that are time consuming for clinicians. We sought to determine: (i) whether components described in the original method for determining ESWT speed held true and (ii) the agreement between speeds derived using the original method and that equivalent to 85% of the peak speed achieved during the incremental shuttle walk test (ISWT). Patients with chronic obstructive pulmonary disease (COPD) performed two ISWTs and one ESWT on separate days, wearing a calibrated portable gas analysis unit. A retrospective analysis of these data allowed us to determine whether: (i) the peak rate of oxygen uptake (V˙O₂peak) can be accurately estimated from the incremental shuttle walk distance (ISWD) and (ii) ESWTs performed at a speed derived using the original method elicited 85% of V˙O₂peak. Agreement between walks speeds was determined using Bland-Altman analysis. Twenty-two participants (FEV₁ 48 ± 13% predicted, age 66 ± 8 yr) completed the study. The V˙O₂peak estimated from the ISWD was less than that measured during the ISWT (mean difference -4.4 95% confidence interval (CI), -6.0 to -2.9 ml· kg⁻¹·min⁻¹). The ESWT and ISWT elicited similar V˙O₂peak (mean difference -0.2 95% CI, -1.5 to 1.2 ml·kg⁻¹·min⁻¹). The mean difference (±limits of agreement) between ESWT speeds was 0.15 (±0.34) km·h⁻¹. Components of the original method for determining the ESWT speed did not hold true in our s le. ESWT speed can be derived by calculating 85% of the peak speed achieved during the ISWT.
Publisher: Springer Science and Business Media LLC
Date: 02-11-2020
DOI: 10.1186/S12890-020-01322-4
Abstract: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterised by dyspnoea during daily life. As the disease progresses, people with COPD can experience poor quality of life, reduced exercise capacity, worsening of symptoms and increased hospital admissions. Pulmonary rehabilitation, which includes exercise training, optimises both psychological and physical function, reduces symptoms and mitigates healthcare utilisation in people with COPD. There is, however, a gap in implementation of pulmonary rehabilitation programs, with global access limited to a small fraction of people with COPD. The overall aim of this study is to gather evidence that will optimise the implementation of pulmonary rehabilitation in people with COPD living in Perth, Western Australia. This is a mixed methods study protocol informed by a critical realist perspective. The study will comprise four phases. In Phase 1, we will quantify target behaviours of healthcare professionals and people with COPD which are related to the implementation of pulmonary rehabilitation at three tertiary hospitals. In Phase 2, we will conduct semi-structured interviews to explore the determinants of these target behaviours from the perspectives of healthcare professionals, people with COPD and their primary support person. In Phase 3, knowledge gained in Phases 1 and 2 will be used by healthcare professionals and people with COPD to co-create, field test and apply strategies that optimise these target behaviours. In Phase 4, we will re-quantify these target behaviours to determine the influence of co-created strategies. The cost effectiveness of implementing the co-created strategies will be explored by an economic analysis. Understanding current clinical practice and the determinants of target behaviours pertaining to the implementation of pulmonary rehabilitation is crucial when developing strategies that successfully bridge the pulmonary rehabilitation implementation gap. If co-created strategies are effective, more people with COPD living in Perth, Western Australia will have access to pulmonary rehabilitation enabling them to derive the health benefits associated with this intervention.
Publisher: Wiley
Date: 26-10-2010
DOI: 10.1111/J.1440-1843.2010.01849.X
Abstract: Pulmonary rehabilitation plays an essential role in the management of symptomatic patients with COPD. The benefits of rehabilitation include a decrease in dyspnoea and fatigue, and improvements in exercise tolerance and health-related quality of life. Importantly, rehabilitation reduces hospitalization for acute exacerbations and is cost-effective. Although most of the evidence for pulmonary rehabilitation has been obtained in patients with COPD, symptomatic in iduals with other respiratory diseases have been shown to benefit. In this review we outline a stepwise approach to establish, deliver and evaluate a pulmonary rehabilitation program (PRP) that would be feasible in most settings. Throughout the review we have specified the minimum requirements for a PRP to facilitate the establishment of programs using limited resources. Recommendations for staffing and other resources required for a PRP are presented in the first section. Exercise training is a focus of the section on program delivery as this is the component of rehabilitation that has the strongest level of evidence for benefit. Program considerations for patients with respiratory conditions other than COPD are described. Different approaches for delivering the education component of a PRP are outlined and recommendations are made regarding topics for group and in idual sessions. The problems commonly encountered in pulmonary rehabilitation, together with recommendations to avoid these problems and strategies to assist in their resolution, are discussed. The review concludes with recommendations for evaluating a PRP.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.CCM.2014.02.003
Abstract: Despite the well-established benefits of exercise training in people with chronic respiratory disease, there are a group of people in whom it confers minimal gains. Furthermore, there is increasing recognition of the prevalence of comorbid conditions among people with chronic obstructive pulmonary disease and other respiratory diseases, such as musculoskeletal disorders, which make participation in traditional exercise training programs challenging. This article focuses on several adjuncts or strategies that may be implemented by clinicians during exercise training, with the goal of optimizing the proportion of pulmonary rehabilitation participants who achieve significant and meaningful gains on program completion.
Publisher: SAGE Publications
Date: 17-12-2022
Abstract: To compare the physical function on ICU discharge in adults who survived an ICU admission for acute lung injury (ALI) with those admitted for a critical illness other than ALI. Two groups were recruited, (i) those who survived an ICU admission for ALI and, (ii) those who survived an ICU admission for a critical illness other than ALI. Within 7 days of discharge from ICU, in all participants, measures were collected of peripheral muscle strength, balance, walking speed and functional exercise capacity. Recruitment was challenging and ceased prior to achieving the desired s le size. Participants with ALI (n = 22) and critical illness (n = 33) were of similar median age (50 vs. 57 yr, p = 0.09), sex proportion (males %, 45 vs. 58, p = 0.59) and median APACHE II score (21.5 vs. 23.0, p = 0.74). Compared with the participants with critical illness, those with ALI had lower hand grip (mean ± SD, 18 ± 9 vs. 13 ± 8 kg, p = 0.018) and shoulder flexion strength (10 ± 4 vs. 7 ± 3 kg, p = 0.047), slower 10-meter walk speed (median [IQR], 1.03 [0.78 to 1.14] vs. 0.78 [0.67 to 0.94] m/s, p = 0.039) and shorter 6-minute walk distance (265 [71 to 328] vs. 165 [53 to 220] m, p = 0.037). The Berg balance scores were similar in both groups. Compared with survivors of a critical illness that is not ALI, those with ALI are likely to have greater physical impairment when measured shortly after discharge to the ward.
Publisher: Informa UK Limited
Date: 15-02-2021
DOI: 10.1080/09593985.2021.1885088
Abstract: Reducing sedentary behavior (SB) in in iduals with chronic obstructive pulmonary disease (COPD) is being increasingly recognized as a novel health target. Understanding healthcare professionals (HCPs) behavior that influences a reduction in SB in this population could facilitate achieving this target. To explore the determinants of behavior related to HCPs targeting a reduction in SB in people with COPD. We used a qualitative semi-structured interview approach informed by the Theoretical Domains Framework (TDF). Sixteen HCPs were interviewed. Interview transcripts were mapped against the relevant TDF domain(s) and then higher order themes were generated. Directed content analysis resulted in mapping 949 quotes to the TDF domains with environmental context and resources being the most coded domain. Three higher order themes were identified: 1) HCPs need more knowledge on reducing SB 2) Strategies suggested to include in pulmonary rehabilitation (PR) to reduce SB and 3) Barriers to adding SB to PR. Domains of environmental context and resources, knowledge, social rofessional role and identity, reinforcement, social influences, skills and beliefs about capabilities were relevant to the study population to reduce SB in people with COPD. Knowledge of SB varied across participants. This study provided information on potential behavioral targets for future interventions that involve HCPs and aim to reduce SB among people with COPD.
Publisher: Elsevier BV
Date: 09-2011
Publisher: CMA Joule Inc.
Date: 06-04-2010
DOI: 10.1503/CMAJ.091784
Publisher: University of Toronto Press Inc. (UTPress)
Date: 08-2021
Abstract: Purpose: The purpose of this study was to determine which admission clinical assessment or assessments best predict independent walking at discharge (IW-DC) among adults with unilateral impairments hospitalized for rehabilitation post-stroke. Method: On admission, we collected measures of balance (Berg Balance Scale [BBS]), physical function (Chedoke McMaster Stroke Assessment – Activity Inventory), postural and leg motor control (Chedoke McMaster Stroke Assessment – Impairment Inventory), functional independence (FIM), sensation and proprioception, and pushing behaviour (Four-Point Pusher Score). Logistic regression determined which measures influenced the odds of IW-DC. A receiver operating characteristic (ROC) curve determined the cut-points for variables retained in a multivariable model. Results: Data were available for 68 participants, aged a median of 57 (interquartile range [IQR] 16) years, who had received inpatient rehabilitation for a median of 8 (IQR 10) weeks. The odds of IW-DC were reduced with greater impairments in motor control, sensation, or proprioception and with pusher behaviour and increased with lesser impairments in balance, physical function, and functional independence. Only the BBS was retained in the multivariable model (OR 1.23 95% CI: 1.02, 1.49). An admission BBS score of 14 or more points (sensitivity 0.73 specificity 0.89) predicted IW-DC (area under the ROC curve 0.81 95% CI: 0.71, 0.92). Conclusions: Among adult stroke survivors, a BBS score of 14 or more provides information on the odds of achieving IW-DC.
Publisher: Medknow
Date: 2015
Publisher: SAGE Publications
Date: 24-02-2017
Abstract: We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men age, 67 years forced expiratory volume in the first second [FEV 1 ], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed. Daily physical activity measures and hourly patterns were analysed based on data from a multisensor armband. Principal component analysis (PCA) and cluster analysis were applied to physical activity measures to identify clusters. Age, body mass index (BMI), dyspnoea grade and ADO index (including age, dyspnoea and airflow obstruction) were associated with physical activity measures and hourly patterns. Five clusters were identified based on three PCA components, which accounted for 60% of variance of the data. Importantly, couch potatoes (i.e. the most inactive cluster) were characterised by higher BMI, lower FEV 1 , worse dyspnoea and higher ADO index compared to other clusters ( p 0.05 for all). Daily physical activity measures and hourly patterns are heterogeneous in COPD. Clusters of patients were identified solely based on physical activity data. These findings may be useful to develop interventions aiming to promote physical activity in COPD.
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.APMR.2007.11.032
Abstract: To characterize the daily utility and satisfaction with rollators in patients with chronic obstructive pulmonary disease (COPD). Cross-sectional observational study. Community. COPD patients describing dyspnea during activities of living, who had been provided with a rollator by a health care professional within the preceding 5-year period. Not applicable. Three questionnaires were administered in random order. The St. George's Respiratory Questionnaire was used to measure health-related quality of life, version 2.0 of the Quebec User Evaluation of Satisfaction with Assistive Technology was used to assess satisfaction with the rollator, and a structured questionnaire was used to obtain information regarding daily utility of the device and barriers to its use. Demographic data were obtained through patient interview. Anthropometric data, measurements of resting lung function, and 6-minute walk distance were extracted from the medical records. Twenty-seven (10 men) patients (forced expiratory volume in 1 second, 35.1%+/-22.3% predicted) completed the study. Sixteen (59%) patients reported daily rollator use. All patients used the rollator to assist with ambulation outdoors, but 16 (59%) patients stated that they did not use the rollator for any activity in their home. Although satisfaction with the rollator was high, women were less satisfied with the weight of the device than men (P=.008). Thirteen (48%) patients reported being embarrassed while using the device. COPD patients provided with a rollator for use during daily life were most satisfied with its effectiveness and least satisfied with its weight. Daily use was generally high with over half the patients using the rollator on a daily basis. Rollators were more often used outdoors than indoors.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Wiley
Date: 23-06-2015
DOI: 10.1111/DMCN.12838
Abstract: The aim of this study was to investigate the validity of using a Bouchard activity record (BAR) in in iduals with Rett syndrome to measure physical activity, as compared with pragmatic criterion standard measures of walking status and step counts recorded using the StepWatch activity monitor (SAM). During the waking hours of 1 day, 43 females (mean age 21y, SD 9y) wore a SAM whilst a proxy completed a modified BAR. Responses to the BAR were compared among participants, who were grouped according to walking status, using the Mann-Whitney two-s le rank-sum test. Relationships were sought between BAR responses and step counts using linear regression. According to the proxy-reported BAR responses, those who needed assistance with walking spent more time sitting (median [interquartile range] 9h 15min [8h 8min-10h 30min] vs 6h 15min [4h 15min-8h 30min] p<0.001) and less time standing (1h [38min-1h 30min] vs 2h 15min [45min-3h 45min] p=0.04) than those who could walk independently. In those who could walk independently, time classified as 'uptime' (standing and walking) using the BAR was associated with increased step count (r(2) =0.58 p<0.001). These data support the validity of proxy-reported BAR responses. In those who could walk independently, uptime, classified using the BAR, could be used to estimate daily step count. This tool offers an inexpensive method for clinicians to gain insights into physical activity levels in in iduals with Rett syndrome.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.AUCC.2017.01.002
Abstract: Suctioning is an integral component of care for patients who are intubated and ventilated in an intensive care unit (ICU). There appears to be no published data of physiotherapy suctioning practices in Australia or New Zealand. To describe suctioning practices and the factors which have shaped these practices, of experienced physiotherapists working with adults who are intubated and ventilated in an ICU across Australia and New Zealand. Areas of investigation focused on: (i) suctioning approach (i.e. open vs. closed system) (ii) use of adjuncts to suctioning such as hyperoxygenation, hyperinflation and saline lavage (iii) use of subglottic suctioning and (iv) factors influencing suctioning practices. Electronic surveys were emailed to experienced physiotherapists working in ICUs across Australia and New Zealand which had the capacity to intubate and ventilate adult patients for ≥24h. The participation rate was 84.8% (112/132). Closed suction system was used in most ICUs (97/112, 86.6%). Hyperoxygenation was commonly performed on 'all' or 'most' patients before suctioning (71/112, 63.4%), but less frequently after suctioning (38/112, 33.9%). Hyperinflation was infrequently performed on 'all' or 'most' patients before (22/112, 19.6%) or after suctioning (22/112, 19.6%). Saline lavage and subglottic suctioning were infrequently performed on 'all' or 'most' patients (3/112, 2.7% 17/112, 15.2%, respectively). 'Personal experience' and 'established practice in the ICU' had the greatest influence on suctioning practices. Most ICUs in Australia and New Zealand are equipped for closed system suctioning. As hyperoxygenation minimises desaturation during suctioning, there may be scope for a larger proportion of physiotherapists to use this adjunct. The practice of hyperinflation before and after suctioning was uncommon despite the emerging evidence for improved lung compliance with this procedure. Subglottic suctioning was infrequently available as a choice for physiotherapists despite the strong evidence, which suggests an evidence-practice gap.
Publisher: Wiley
Date: 14-02-2018
DOI: 10.1111/RESP.13262
Abstract: There is increased use of the 2-min walk test (2MWT) to assess functional exercise capacity. However, the distance achieved during this test may be difficult to interpret in the absence of reference values from a local population. Regression equations to estimate the 2-min walk distance (2MWD) only exist for American and Brazilian populations. The objective of this study was to develop regression equations to estimate the 2MWD in Malaysian adults who were free from major health problems. Eighty-seven adults (43 males mean ± SD age: 57.1 ± 9.6 years) performed two 2MWT using a standardized protocol. Heart rate (HR) was recorded every 30 s during the test. Stepwise multiple regression analysis was performed using age, gender, height, weight and change in HR (ΔHR) as independent variables, and better of the two 2MWD as the dependent variable. A second regression equation, without ΔHR, was planned if ΔHR was retained as one of the predictors of the 2MWD in the first equation. The better of the two 2MWD was 200 ± 34 m. Males walked 33 ± 6 m further than females (P < 0.001). The two regression equations were 196 - 1.1 × age, years + 1.0 × ΔHR, bpm + 31.2 × gender (R The equations derived in this study may facilitate the interpretation of the 2MWD in clinical populations in Malaysia, as well as in countries with similar cultural backgrounds to Malaysia.
Publisher: American Thoracic Society
Date: 15-03-2012
Publisher: Elsevier BV
Date: 04-2018
Publisher: Wiley
Date: 29-05-2018
Publisher: SAGE Publications
Date: 30-08-2018
Abstract: Exercise-induced oxygen desaturation (EID) is prevalent in people with chronic obstructive pulmonary disease (COPD). This article reports a sub-analysis from a randomized controlled trial (RCT) in people with COPD and EID (COPD/EID). The primary aim, in people with COPD/ EID, was to determine the repeatability of the distance and time walked in the incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT), respectively. A secondary aim was to determine whether any participant characteristics predicted those who did not demonstrate improvements on a repeat ISWT or ESWT. Participants with nadir oxygen saturation (SpO 2 ) 90% on the 6-minute walk test were recruited to the RCT. Two ISWTs and two ESWTs were then performed as part of the baseline assessments, and participants were included in this sub-analysis if their nadir SpO 2 was % during the better of two ISWTs. Repeatability of the tests was analysed using Bland–Altman plots and paired t-tests. Participant characteristics of age, lung function, level of nadir SpO 2 and end-test dyspnoea were used to predict those who were not likely to demonstrate improvements on a repeat test using receiver operating curves. Eighty-seven participants (mean age (standard deviation, SD) 70 (7) years forced expiratory volume in one second (FEV 1 ) 47 (17)% predicted) were included. The mean differences (coefficient of repeatability) for the ISWTs and ESWTs were 9 m (55 m) and 19 seconds (142 seconds) respectively ( p 0.05). No participant characteristic predicted the absence of improvement on the second ISWT (area under the curve (AUC) ranged from 0.49 to 0.58, all p 0.2) or the second ESWT (AUC ranged from 0.43 to 0.52, all p 0.3). Although repeating the tests showed only small improvements in distance (ISWT) and time (ESWT) walked in people with COPD/EID, the variability was large making definite conclusions about test repeatability in these in iduals difficult.
Publisher: European Respiratory Society (ERS)
Date: 09-2007
DOI: 10.1183/09031936.00095406
Abstract: The aim of the present study was to determine the relative value of incremental and constant load tests in detecting changes in inspiratory muscle endurance following high-intensity inspiratory muscle training (H-IMT) in chronic obstructive pulmonary disease. In total, 16 subjects (11 males forced expiratory volume in one second (FEV(1)) 37.4+/-12.5%) underwent H-IMT. In addition, 17 subjects (11 males FEV(1) 36.5+/-11.5%) underwent sham inspiratory muscle training (S-IMT). Training took place three times a week for 8 weeks. Baseline and post-training measurements were obtained of maximum threshold pressure sustained during an incremental load test (P(th,max)) and time breathing against a constant load (t(lim)). Breathing pattern was unconstrained. H-IMT increased P(th,max) and t(lim) relative to baseline and to any change seen following S-IMT. The effect size for P(th,max) was greater than for t(lim). Post-training tests were accompanied by changes in breathing pattern, including decreased duty cycle, which may have served to decrease inspiratory work and thereby contribute to the increase in P(th,max) and t(lim) in both groups. When assessing inspiratory muscle function in chronic obstructive pulmonary disease via tests in which the pattern of breathing is unconstrained, the current authors recommend incremental load tests be used in preference to constant load tests. However, to attribute changes in these tests to improvements in inspiratory muscle endurance, breathing pattern should be controlled.
Publisher: Saudi Medical Journal
Date: 05-2018
Publisher: Elsevier BV
Date: 04-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
Publisher: Wiley
Date: 27-11-2013
Publisher: Wiley
Date: 05-2013
DOI: 10.1111/RESP.12129
Abstract: Oxyhaemoglobin saturation of arterial blood is commonly measured using a finger sensor attached to a pulse oximeter (SpO(2)). We sought to compare SpO(2) measured using finger and forehead sensors with oxyhaemoglobin saturation in arterialized capillary s les (ACS) in people with chronic obstructive pulmonary disease (COPD) during exercise. During aerobic exercise, SpO(2) was measured continuously by two pulse oximeters: one connected to a finger sensor and to a forehead sensor. Before and after the task, ACS were collected to provide a minimally invasive reference measure of oxyhaemoglobin saturation. Patients with COPD were eligible for inclusion if they desaturated when walking by >4% from resting levels to <90%. Current smokers and those prescribed supplemental oxygen were excluded. Fourteen participants completed the study (forced expiratory volume in 1 s = 35 ± 10% predicted). Compared with ACS, SpO(2) measured via the finger sensor was 2% lower (limit of agreement 3%), and SpO(2) measured via the forehead sensor was 2% higher (limit of agreement 4%). Differences were not systematic. The change in oxygen saturation during exercise was similar among the finger sensor (-7 95% confidence interval (CI): -4 to -10%), forehead sensor (-7 95% CI: -3 to -10%) and ACS (-6 95% CI: -3 to -9%). Oxygen saturation measured using the forehead sensor was higher than that measured in ACS. Assuming that oxygen saturation in ACS is slightly less than arterial blood, forehead sensors may yield measures more concordant with arterial blood. Both sensors detected exercise-induced desaturation.
Publisher: Elsevier BV
Date: 2017
Publisher: Elsevier BV
Date: 2004
DOI: 10.1016/S0004-9514(14)60155-0
Abstract: Chronic obstructive pulmonary disease (COPD) is a progressive, common and costly condition. Dyspnoea frequently limits activity and reduces health-related quality of life. In addition to impaired lung function, peripheral muscle deconditioning and respiratory muscle dysfunction also contribute to dyspnoea and reduced exercise capacity. Pulmonary rehabilitation using whole body exercise training improves peripheral muscle function and reduces dyspnoea but does not improve respiratory muscle function. Providing that adequate training intensities are utilised, specific loading of the inspiratory muscles with commercially available hand-held devices can improve inspiratory muscle strength and endurance. Several studies have investigated the effects of inspiratory muscle training on dyspnoea in COPD subjects. Results of these studies are conflicting, most likely reflecting methodological shortcomings including insufficient training load, insensitive outcome measures, and inadequate statistical power. This paper describes the origin of dyspnoea in COPD, with particular attention given to the role of inspiratory muscle dysfunction in its genesis and its possible amelioration through inspiratory muscle training.
Publisher: Wiley
Date: 17-06-2019
Publisher: Daedalus Enterprises
Date: 19-03-2019
Abstract: This study sought to explore factors in adults with cystic fibrosis (CF) that predicted whether (i) someone was engaged in full-time paid work, and (ii) those engaged in paid work reported problems with absenteeism and/or presenteeism. Adults with cystic fibrosis who live in Western Australia completed absenteeism and presenteeism questions from the World Health Organization's Health Performance Questionnaire. The participants were grouped by work status (full time vs part time or unemployed) and by self-reported absenteeism and presenteeism (evidence of vs no evidence of). We explored whether factors such as air-flow obstruction, level of education, health-related quality of life (measured by using the Cystic Fibrosis Questionnaire-Revised), and treatment adherence predicted group membership. Of the 50 participants for whom data were available (median [interquartile range] age 30 [25-36] y mean ± SD FEV In this study, the majority of adults with cystic fibrosis worked full time and a low percentage of the s le reported problems with absenteeism and presenteeism.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.APMR.2010.07.228
Abstract: To examine the incidence of resting during the 6-minute-walk test (6MWT) in patients with chronic lung disease (CLD) and to explore differences in functional exercise capacity and response to pulmonary rehabilitation (PR) between resters and nonresters. Retrospective chart review. Inpatient PR program. In iduals (N=211) who performed the 6MWT at admission and discharge from PR. Not applicable. Primary outcomes were total distance walked (6-minute walk distance [6MWD]) and rest frequency and duration. Secondary outcomes were walking speed, end-test dyspnea, and the Chronic Respiratory Questionnaire (CRQ). At admission, 45 people (21%) rested 1 to 4 times during the 6MWT (total duration, 105±80s) and 166 people walked continuously. At discharge, 9 people continued to rest (total duration, 28±55s). At admission, nonresters walked 315±93m, whereas resters walked 197±83m (P<.0001), and 6MWD increased in both groups after PR (P<.0001). Nonresters increased their walking speed at discharge, but resters did not (interaction P<.001). At admission, the mastery domain of the CRQ was 0.8 point lower in resters (3.7±1.2) compared with nonresters (4.5±1.7 P=.01). Resters' end-test dyspnea scores decreased from 5.7±0.3 to 4.3±0.2 from admission to discharge, whereas nonresters' end-test dyspnea scores did not significantly change from 4.5±0.2 to 4.2±0.2 at discharge (interaction P<.05). One in 5 in iduals with CLD rest during the 6MWT. Decreasing rest duration or increasing walking speed reflects different strategies used to improve 6MWD after rehabilitation, both suggesting a positive effect of PR. This may be related to improvements in an in idual's sense of control over dyspnea. Future work should investigate potential factors related to resting during the 6MWT.
Publisher: European Respiratory Society (ERS)
Date: 19-08-2014
DOI: 10.1183/09031936.00078014
Abstract: This study was designed to determine the effect of ground-based walking training on health-related quality of life and exercise capacity in people with chronic obstructive pulmonary disease (COPD). People with COPD were randomised to either a walking group that received supervised, ground-based walking training two to three times a week for 8–10 weeks, or a control group that received usual medical care and did not participate in exercise training. 130 out of 143 participants (mean± sd age 69±8 years, forced expiratory volume in 1 s 43±15% predicted) completed the study. Compared to the control group, the walking group demonstrated greater improvements in the St George’s Respiratory Questionnaire total score (mean difference -6 points (95% CI -10– -2), p .003), Chronic Respiratory Disease Questionnaire total score (mean difference 7 points (95% CI 2–11), p .01) and endurance shuttle walk test time (mean difference 208 s (95% CI 104–313), p .001). This study shows that ground-based walking training is an effective training modality that improves quality of life and endurance exercise capacity in people with COPD.
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.RMED.2009.06.008
Abstract: Preliminary evidence suggests in iduals with COPD exhibit deficits in balance. Further investigation of balance and risk of falls is warranted in these patients. The objective of this study was to determine the clinical measures that discriminate fallers from non-fallers among patients with COPD. A cross-sectional study design was used. Subjects>60 years with COPD attended a single assessment session. A one-year incidence of falls was collected via self-report questionnaire. Risk of falls and balance were determined using the Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and the Activity-Specific Balance Confidence (ABC) Scale. Exercise tolerance was determined from the Six-Minute Walk Test and functional limitation attributable to dyspnea from the Medical Research Council (MRC) dyspnea scale. Of the 39 COPD subjects (FEV(1)=41.5+/-17.0% predicted age: 71.1+/-6.8 years) who completed the study, 46% (n=18) reported at least one fall in the preceding year. Significant differences between fallers and non-fallers were found for the ABC (65.8+/-18.2 vs. 81.7+/-11.1 p=0.002), TUG (17.0+/-4.9 vs. 14.0+/-3.1s p=0.024), BBS (45.2+/-5.4 vs. 48.8+/-5.0 p=0.042), use of supplemental oxygen (72% vs. 24% p=0.002), and MRC dyspnea scale (median 4, range 3 vs. median 3, range 4 p=0.046). Patients with COPD fall frequently. Standard clinical balance measures discriminate self-reported fallers from non-fallers. These observations draw attention to an important secondary impairment in COPD.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.RESP.2011.04.001
Abstract: The functional outcomes of respiratory muscle loading by chemical (e.g. hypercapnia), mechanical (i.e. external mechanical loading) or ventilatory (e.g. exercise) factors can be either positive, such as through an increase in pressure-generating capacity of the inspiratory muscles or detrimental, such as by fatigue. Neurophysiological responses to respiratory muscle loading can occur at one or more points along the pathway from motor cortex to muscle. This paper describes the respiratory pump and upper airway motoneuron responses to the imposition of acute loads including processes of pre-activation, respiratory reflexes, potentiation and fatigue. It also considers changes suggestive of adaptation to chronic loading either from specific respiratory muscle training programs or as part of disease processes such as chronic obstructive pulmonary disease or obstructive sleep apnoea.
Publisher: SAGE Publications
Date: 21-03-2014
Abstract: The objective of this study was to derive and validate an equation to estimate the speed for the endurance shuttle walk test (ESWT) using results from the six-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD). Participants with diagnosed COPD ( n = 84) performed two incremental shuttle walk tests (ISWTs) and two 6MWTs. ESWT speed was calculated from the ISWT results using the original published method. An equation was derived, which directly related six-minute walk distance (6MWD) to ESWT speed. The derived equation was validated in a different group of people with COPD ( n = 52). There was a strong correlation between average 6MWD and the calculated ESWT speed ( r = 0.88, p 0.001). The ESWT speed (kilometre per hour) was estimated using the following equation: 0.4889 + (0.0083 × 6MWD). The mean difference (±limits of agreement) between ESWT speeds was calculated using the original published method and found to be 0.03 (±0.77) km/hour. When the ISWT is not the test of choice for clinicians, the 6MWT can be used to accurately estimate the speed for the ESWT.
Publisher: Springer Science and Business Media LLC
Date: 30-03-2020
DOI: 10.1186/S13102-020-00167-Y
Abstract: Exercise training is important in the management of adults with chronic pulmonary conditions. However, achieving high intensity exercise may be challenging for this clinical population. There has been clinical interest in applying interval-based training as a strategy to optimise the load that can be tolerated during exercise training. Evidence for such an approach is limited in most chronic pulmonary populations. In this narrative review, we provide an appraisal of studies investigating whole-body high intensity interval training (HIIT) in adults with chronic obstructive pulmonary disease (COPD). This is the first review to also include studies investigating HIIT in people with conditions other than COPD. Studies undertaken in adults with a chronic pulmonary condition were reviewed when participants were randomised to receive (i) HIIT or no exercise or, (ii) HIIT or moderate intensity continuous exercise. Data were extracted on peak rate of oxygen uptake (VO 2peak ‘cardiorespiratory fitness’) and maximal work rate (W max ‘exercise capacity’). In people with COPD, two studies demonstrated between-group differences favouring HIIT compared with no exercise. There appears to be no advantage for HIIT compared to continuous exercise on these outcomes. In people with cystic fibrosis (CF), no studies have compared HIIT to no exercise and the two studies that compared HIIT to continuous exercise reported similar benefits. In people prior to resection for non-small cell lung cancer, one study demonstrated a between-group difference in favour of HIIT compared with no exercise on VO 2peak . In people with asthma, one study demonstrated a between-group difference in favour of HIIT compared with no exercise on VO 2peak and one that compared HIIT to continuous exercise reported similar benefits. No studies were identified non-CF bronchiectasis or interstitial lung diseases. High intensity interval training increases cardiorespiratory fitness and exercise capacity when compared with no exercise and produces a similar magnitude of change as continuous exercise in people with COPD. There is a paucity of studies exploring the effects of HIIT in other chronic pulmonary conditions.
Publisher: Springer Science and Business Media LLC
Date: 03-2017
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/15412550701480224
Abstract: Patients with chronic obstructive pulmonary disease (COPD) frequently describe limitations in functional performance. These limitations predict mortality, adversely affect health-care burden and impair health-related quality of life. The optimal method for quantifying the functional performance in COPD subjects has not been established. This paper discusses the (i) nature of limited functional performance reported by in iduals with COPD, (ii) mechanisms that contribute to these limitations, (iii) assessment techniques available to provide markers of functional performance and (iv) areas for further research in measuring functional performance of COPD subjects.
Publisher: Elsevier BV
Date: 09-2008
DOI: 10.1016/J.APMR.2008.01.020
Abstract: To develop a predictive equation to permit estimation of the maximum work rate (Wmax) achieved during an incremental cycle ergometry test from the measurement of 6-minute walk distance (6MWD) and its derivative, 6-minute walk work, which is the product of 6MWD and body weight. Cross-sectional observational study. Outpatient physiotherapy and pulmonary physiology clinics in a tertiary hospital. Patients (N=50 36 men) with chronic obstructive pulmonary disease (forced expiratory volume in 1 second [FEV(1)]=37%+/-11% of predicted). Not applicable. Measurements were obtained of 6MWD and Wmax achieved during a laboratory-based, symptom-limited incremental cycle ergometry test. Linear regression analyses were performed using 6MWD, height, weight, and FEV(1) and using 6-minute walk work, height, and FEV(1) to determine their contribution to Wmax and to develop predictive equations for estimating Wmax. The equations derived to estimate Wmax using 6MWD and 6-minute walk work, respectively, were as follows: Wmax (W)=(0.122 x 6MWD)+(72.683 x height [m])-117.109 (r(2)=.67, standard error of the estimate [SEE]=10.8W) and Wmax (W)=17.393+(1.442 x 6-minute walk work) (r(2)=.60, SEE=11.8W). Wmax can be estimated from equations based on measurements of 6MWD or 6-minute walk work. The estimate of Wmax derived from either equation may provide a basis on which to prescribe cycle ergometry training work rates that comply with the current guidelines for pulmonary rehabilitation.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.RMED.2017.10.008
Abstract: This study explored the effects of ground-based walking training on physical activity (PA) and sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD). Participants were randomised to a walk group (WG) [supervised, ground-based walking training, two or three times per week for 8-10 weeks] or a control group (CG) [usual medical care]. Before and after the intervention period, PA and ST were measured using the SenseWear
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
Publisher: BMJ
Date: 06-2010
Abstract: The SenseWear armband (SAB) is designed to measure energy expenditure (EE). In people with chronic obstructive pulmonary disease (COPD), EE estimated using the SAB (EE(SAB)) is a popular outcome measure. However, a detailed analysis of the measurement properties of the SAB in COPD is lacking. To examine the sensitivity of EE(SAB), agreement between EE(SAB) and EE measured via indirect calorimetry (EE(IC)), and its repeatability in COPD. 26 people with COPD (forced expiratory volume in 1 s (FEV(1))=49+/-18% predicted 15 males) spent 6 min in five standardised tasks that comprised supine, sitting, standing and two walking speeds. A subgroup (n=12) walked using a rollator. Throughout each task, measurements of EE(SAB) and EE(IC) were collected. The protocol was repeated on a second day. EE(SAB) increased between standing and slow walking (2.4, metabolic equivalents (METs) 95% CI 2.2 to 2.7) as well as slow and fast walking (0.5 METs, 95% CI 0.3 to 0.7). Considering all tasks together, the difference between EE(SAB) and EE(IC) was -0.2 METs (p=0.21) with a limit of agreement of 1.3 METs. The difference between days in EE(SAB) was 0.0 METs with a coefficient of repeatability of 0.4 METs. Rollator use increased the variability in EE(SAB), compromising its repeatability and agreement with EE(IC). EE(SAB) was sensitive to small but important changes. There was fair agreement between EE(SAB) and EE(IC), and measurements of EE(SAB) were repeatable. These observations suggest that the SAB is useful for the evaluation of EE in patients with COPD who walk without a rollator.
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/478528
Abstract: BACKGROUND: In addition to symptoms, such as dyspnea and fatigue, patients with chronic obstructive pulmonary disease (COPD) also experience mood disturbances. OBJECTIVE: To explore the relationships between health-related quality of life measures collected from patients with stable COPD and a commonly used measure of depression and anxiety. METHODS: The present analysis was a retrospective study of patients with COPD enrolled in a pulmonary rehabilitation program. Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Disease Questionnaire (CRQ), Medical Research Council dyspnea scale and 6 min walk test data were collected. Statistical analyses were performed using Spearman’s correlations, and categorical regression and categorical principal component analysis were interpreted using the biplot methodology. RESULTS: HADS anxiety scores retrieved from 80 patients were grouped as ‘no anxiety’ (n=43 [54%]), ‘probable anxiety’ (n=21 [26%]) and ‘presence of anxiety’ (n=16 [20%]). HADS depression scores were similarly grouped. There was a moderate relationship between the anxiety subscale of the HADS and both the emotional function (r=−0.519 P .01) and mastery (r=−0.553 P .01) domains of the CRQ. Categorical regression showed that the CRQ-mastery domain explained 40% of the total variation in anxiety. A principal component analysis biplot showed that the highest distance between the groups was along the mastery domain, which separated patients without feelings of anxiety from those with anxiety. However, none of the CRQ domains were able to discriminate the three depression groups. CONCLUSIONS: The CRQ-mastery domain may identify symptoms of anxiety in patients with COPD however, the relationship is not strong enough to use the CRQ-mastery domain as a surrogate measure. None of the CRQ domains were able to discriminate the three depression groups (no depression, probable and presence) therefore, specific, validated tools to identify symptoms of depression should be used.
Publisher: BMJ
Date: 04-2018
Publisher: European Respiratory Society (ERS)
Date: 17-03-2019
DOI: 10.1183/13993003.02429-2018
Abstract: Almost half the patients referred to pulmonary rehabilitation with chronic obstructive pulmonary disease (COPD) desaturate during exercise. Although oxygen supplementation may ameliorate oxygen desaturation, the effects on outcomes of exercise training have not been rigorously evaluated. This study aimed to determine whether supplemental oxygen during exercise training was more effective than medical air in improving exercise capacity and health-related quality of life (HRQoL) in people with COPD. People with COPD who demonstrated oxygen desaturation % during the 6-min walk test were recruited to this multicentre trial with randomisation (independent, concealed allocation) to either an Oxygen group or Air group, blinding (participants, exercise trainers and European Respiratory Journal assessors) and intention-to-treat analysis. Both groups received the respective gas from concentrators via nasal prongs at 5 L·min −1 during exercise training consisting of treadmill and cycle exercise, three times per week for 8 weeks. Primary outcomes were the endurance shuttle walk test (ESWT) time and Chronic Respiratory Disease Questionnaire (CRQ)-Total score. 111 participants (60 males), mean± sd age 69±7 years, with moderate to severe COPD were recruited and 97 completed (Oxygen group n=52 Air group n=45). At the end of the 8-week training programme there were no between-group differences in change in ESWT (mean difference 15 s (95% CI −106–136 s) or change in CRQ-Total (0.0 points (95% CI −0.3–0.3 points)). Within-group changes at end-training were significant for ESWT and CRQ-Total (all p .01). Exercise capacity and HRQoL improved in both groups, with no greater benefit from training with supplemental oxygen than medical air.
Publisher: Informa UK Limited
Date: 26-12-2012
DOI: 10.3109/09638288.2011.641666
Abstract: To evaluate the measurement properties of the StepWatch(™) Activity Monitor (SAM) and ActivPAL in COPD. Whilst wearing both monitors, participants performed walking tasks at two self-selected speeds, with and without a rollator. Steps obtained using the monitors were compared with that measured by direct observation. Twenty participants aged 73 ± 9 years (FEV(1) = 35 ± 13% pred 8 males) completed the study. Average speeds for the slow and normal walking tasks were 34 ± 7 m·min(-1)and 46 ± 10 m·min(-1), respectively. Agreement between steps recorded by the SAM with steps counted was similar irrespective of speed or rollator use (p = 0.63) with a mean difference and limit of agreement (LOA) of 2 steps·min(-1) and 6 steps·min(-1), respectively. Agreement for the ActivPAL was worse at slow speeds (mean difference 7 steps·min(-1) LOA 10 steps·min(-1)) compared with normal speeds (mean difference 4 steps·min(-1) LOA 5 steps·min(-1)) (p = 0.03), but was unaffected by rollator use. The change in step rate between slow and normal walking via direct observation was 12 ± 7 steps·min(-1) which was similar to that detected by the SAM (12 ± 6 steps·min(-1)) and ActivPAL (14 ± 7 steps·min(-1)). The SAM can be used to detect steps in people who walk very slowly including those who use a rollator. Both devices were sensitive to small changes.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.CHEST.2022.01.006
Abstract: Pulmonary rehabilitation programs (PRP) are important for people with symptomatic COPD. What proportion of people with COPD who are suitable for a PRP go on to be referred? Do clinical or sociodemographic characteristics influence the odds of whether those who are suitable for a PRP go on to be referred? What factors influence people's interest in participating in a pulmonary rehabilitation program? People with COPD who appeared appropriate for a PRP were sequentially recruited from three tertiary hospitals in Australia. Variables such as age, sex, lung function, smoking status, and interest in participating in a PRP were collected through interviews and reviewing the medical records. Referrals to PRPs were prospectively tracked through the electronic referral system, medical records, and discussion with the participant or the physiotherapists responsible for coordinating the PRPs. Six hundred eighty-two people with COPD were approached, 468 consented, and data were available on 391 (No. [%] or mean ± SD 215 males [55%], age 69 ± 10 years, FEV Among people with COPD who were suitable for a PRP, referral from the tertiary hospital setting was suboptimal. Suitable participants who were not referred showed lower interest in attending a PRP. There were novel complex in idual barriers that reduced one's interest in participating in a PRP.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2019
DOI: 10.1007/S00408-019-00216-5
Abstract: This multi-centred, randomised controlled trial explored the effects of adding ongoing feedback to a 12-month unsupervised maintenance walking program, on daily physical activity (PA) in people with chronic obstructive pulmonary disease. Participants were randomised to either an intervention group (IG) or a usual care group (UCG). During the maintenance program, the IG received ongoing feedback (telephone calls, biofeedback provided via pedometer and progressive goal setting) and the UCG received no feedback. The SenseWear® Pro3 Armband was used to measure PA. Of the 86 participants {IG = 42, (mean [SD]: age 70 [7] years FEV
Publisher: Hindawi Limited
Date: 2009
DOI: 10.1155/2009/368010
Abstract: BACKGROUND: The Canadian Thoracic Society (CTS) has developed a clinical practice guideline (CPG) regarding the management of patients with chronic obstructive pulmonary disease (COPD). Implementation of this CPG in the primary care setting requires an effective dissemination strategy. OBJECTIVES: To examine the change in knowledge, participant satisfaction and perceived changes in clinical practice among health care professionals working in the primary care setting following attendance at a workshop to disseminate the CTS CPG for COPD. METHODS: A 2.5 h workshop was conducted in three community health sites within Ontario. Each workshop comprised a didactic presentation and interactive case study discussions. Before, and one month following the workshop, a structured knowledge assessment questionnaire was administered. A structured satisfaction questionnaire and evaluative form that examined the impact of the workshop on the clinical management of COPD patients were administered immediately and three months following completion of the workshop, respectively. RESULTS: Sixty-nine participants attended the workshop. The mean score for the structured knowledge assessment questionnaire increased from 8.5±2.7 to 10.6±2.0 following the workshop (P=0.008). Eighty-nine per cent and 96% of participants indicated that they would recommend the workshop to a colleague and had greater confidence in their management of COPD patients, respectively. Following attendance of the workshop, 73%, 69% and 46% described increased patient education, patient monitoring and the use of objective testing in clinical practice, respectively. CONCLUSIONS: Workshop attendance was associated with high levels of satisfaction and important self-reported changes in clinical practice, which may reflect improved knowledge of the CTS CPG for COPD.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 10-2010
Abstract: Purpose: To describe the provision of weekend physiotherapy (PT) services in tertiary-care hospitals in Canada. Methods: A prospective cross-sectional survey was conducted across tertiary-care hospitals, defined as those with university affiliation and at least one intensive care unit (ICU). Data were collected via telephone-administered questionnaires addressing hospital demographics, weekend staffing, workload, and weekend referral criteria. Results: A response rate of 84% (n=36) was obtained. Of facilities providing weekend PT services (97%), 35 (100%) provided care on Saturdays, 32 (91%) on Sundays, and 33 (94%) on statutory holidays. Weekend services were staffed using permanent full-time (n=35 100%) or part-time (n=28 80%) in-patient staff or outsourced staff (n=1 3%). The number of physiotherapists available on the weekend was smaller than the number available during the week (p .001). Common weekend referral criteria included cardiorespiratory problems (n=35 100%), postoperative assessment of patients at risk for deterioration (n=32 91%), and patients scheduled for discharge pending PT assessment (n=30 86%). Conclusion: Both the scope and the number of staff available to provide PT services were less on the weekend than during the week. Despite the use of common criteria for weekend referral, variability in this service exists. Knowledge pertaining to current weekend PT services provides opportunities for harmonization of service delivery.
Publisher: SAGE Publications
Date: 31-12-2016
Abstract: This study aimed to compare patterns of sedentary behaviour (SB) and physical activity (PA) in people following curative intent treatment for non-small cell lung cancer (NSCLC) with healthy controls. Participants 6–10 weeks following lobectomy for NSCLC and healthy controls wore two activity monitors for 7 days. Waking hours were ided into time spent in SB ( .5 metabolic equivalent of tasks (METs)), light intensity PA (LIPA ≥ 1.5 to .0METs) and moderate-to-vigorous intensity PA (≥3.0METs). Daily steps were also recorded. Data were available in 20 participants with NSCLC (13 females 68 ± 10 years) and 20 healthy controls (13 females 69 ± 5 years). The NSCLC group accumulated a greater percentage of time in SB in uninterrupted bouts ≥30 minutes (49% vs. 42% p = 0.048). Further, the NSCLC group spent a lower percentage of waking hours in LIPA (21 ± 9% vs. 26 ± 8% p = 0.04) and accumulated a lower percentage of time in this domain in uninterrupted bouts ≥10 minutes (13% vs. 19% p = 0.025). The NSCLC group also had a lower daily step count (8863 ± 3737 vs. 11,856 ± 3024 steps/day p = 0.009). Time spent in moderate-to-vigorous intensity PA was similar in both groups ( p = 0.92). People following curative intent treatment for NSCLC spend more time in prolonged bouts of SB at the expense of LIPA.
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.SOARD.2013.10.012
Abstract: Engaging in low levels of physical activity (PA) and accumulating prolonged periods of sedentary behavior (SB) during daily life have been associated with deleterious health outcomes. The objective of this study was to undertake an analysis of the way in which PA and SB were accumulated after bariatric surgery. Adults 12 to 18 months after laparoscopic adjustable gastric banding or 6 to 18 months after laparoscopic sleeve gastrectomy wore 2 activity monitors during the waking hours for 7 days. Anthropometric and demographic data were recorded. Data were available on 40 participants (30 females median ± interquartile range: age 46 ± 16 years, time since surgery 14 ± 8 months, body mass index 36 ± 9 kg/m(2)). The proportion of waking hours spent in SB, light PA, moderate PA, and vigorous PA was 72% ± 12%, 22% ± 9%, 5% ± 3% and 0% ± 0%, respectively. Half of the time in SB was accumulated in uninterrupted bouts ≥ 30 minutes. Almost all PA was accumulated in bouts 70% of time in SB, half of which was accumulated in uninterrupted bouts ≥ 30 minutes. Very little time was spent in moderate or vigorous PA (5%), and this was accumulated in short bouts (<10 minutes). Healthcare professionals should target not just overall time in SB and PA, but also aim to reduce prolonged periods of SB and increase sustained periods of PA.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.AUCC.2011.06.001
Abstract: Falling among adults in acute care is an important problem with falls rates in tertiary hospitals ranging from 2% to 5%. Factors that increase the risk of falling, such as advanced age, altered mental status, medications that act on the central nervous system and poor mobility, often characterise in iduals who survive a prolonged intensive care unit (ICU) admission. To measure the incidence of falls and describe the characteristics of fallers among intensive care survivors. A comprehensive retrospective chart review was undertaken of 190 adults who were intubated and ventilated for ≥ 168 h and survived their acute care stay. Using a standardised form, several variables were extracted including falls during hospitalisation and risk factors such as age, severity of illness, and length of stay in intensive care and hospital. Thirty-two (17%, 95% confidence interval 11.5-22.2%) patients fell at least once on the in-patient wards following their ICU stay. Compared with non-fallers, fallers were younger (53.2 ± 17.9 vs. 44.1 ± 18.3 years p=0.009) and had a shorter duration of inotropic support in ICU (84 ± 112 vs. 56 ± 100 h p=0.040). The majority of fallers were aged less than 65 years (84%). Both fallers and non-fallers had similar APACHE II scores (20 ± 8 vs. 21 ± 7 p=0.673), length of stay in intensive care (14.2 ± 8.7 vs. 14.0 ± 9.7 days p=0.667) and hospital length of stay (43.9 ± 33.1 vs. 41.0 ± 38.8 days p=0.533). Falling during hospitalisation is common in intensive care survivors. Compared with non-fallers, fallers were younger and required inotropes for a shorter duration. Those who survive a prolonged admission to an ICU may benefit from specific assessment of balance and falls risk by the multidisciplinary team.
Publisher: Informa UK Limited
Date: 22-11-2012
DOI: 10.3109/09638288.2011.630773
Abstract: In girls and women with Rett syndrome, we assessed the accuracy of the StepWatch Activity Monitor™ and investigated relationships between daily step counts, gross motor skills and age. Twelve subjects (age 12.9 ± 8.0 years) participating in the Australian Rett Syndrome Database wore a StepWatch during a videoed session of activities to assess agreement with the criterion method of observation. Physical activity data were also collected over the course of 6 ± 1 whole days. Relationships between agreement, gross motor skills, average daily step count and age were analyzed. The number of steps obtained using the StepWatch was similar to that viewed on video (mean difference = 0 steps per minute) and agreement did not differ with the level of general (p = 0.389) or complex gross motor skills (p = 0.221). Subjects were less active than their healthy peers (difference 6086 steps per day p = 0.001), and physical activity was significantly greater in those who were younger and with greater levels of motor skill. The StepWatch provided accurate information on the physical activity of girls and women with Rett syndrome regardless of their level of gross motor function. Physical activity reduced with age despite the ability to walk. Advocacy for pro-active lifestyles is justified.
Publisher: SAGE Publications
Date: 22-12-2012
Abstract: A systematic review and meta-analysis was conducted to examine the effect of exercise training on daily physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). MEDLINE, PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials were searched from their inception to week 27 of 2010, using the keywords ‘COPD,’ ‘exercise,’ ‘therapy’ and ‘physical activity.’ All studies except case reports were eligible for inclusion provided they investigated the effects of ≥4 weeks of supervised exercise training on PA in patients with COPD. Study quality for the randomised trials (RTs) and single-group interventional studies was rated using the PEDro scale and Downs and Black Tool, respectively. No randomised controlled trials met our study criteria. The two RTs had a mean PEDro score of 5. The 5 single-group studies had a mean Downs and Black score of 19 ± 3. When combined, a small effect on PA outcomes was demonstrated (overall mean effect = 0.12 p = 0.01). Taken together, the RTs and single-group studies demonstrate that exercise training may confer a significant but small increase in PA.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 04-2010
Abstract: Purpose: The aims of this study were (1) to describe the cardiorespiratory physiotherapy weekend service (PWS) at three tertiary hospitals in the Greater Toronto Area (GTA) and (2) to compare measures of staff burden among the clinical service areas in one of the hospitals that had a programme-based management structure. Method: Two focus-group meetings were held with physiotherapists from hospitals within the GTA. Thereafter, variables characterizing the PWS were collected over 8 months, using a standardized data-collection form. Results: A total of 632 data-collection forms were received. Response rates exceeded 75% at each hospital. Workload variables, including the number of patient visits, new referrals per hour, and the proportion of staff completing unpaid overtime, differed between the hospitals (p .002). There was no difference in any variable when data were compared between Saturday, Sunday, and statutory holidays (p .13). Workload measures varied between clinical service areas at the hospital that provided PWS using a programme-based approach. Conclusions: These findings highlight the important shortcomings of a programme-based management approach to providing PWS and may constitute a catalyst for change.
Publisher: SAGE Publications
Date: 15-09-2017
Abstract: This study aimed to validate measures of sedentary time in in iduals with Rett syndrome. Twenty-six in iduals (median [IQR] age 16.0 (9.4-20.6) years) wore an activPAL accelerometer during video-taped activities and agreement was determined between sedentary time determined by the activPAL and observation. For 11 in iduals (median [IQR] age 14.5 (11.5-25.6) years), linear regression was used to determine the relationship between sedentary time recorded on the modified Bouchard activity record diary card and measured using the activPAL. In comparison to observation, the activPAL accurately measured duration of sedentary time with a mean difference (limit of agreement) of –1.0 (6.3) minutes. The duration of Bouchard activity record downtime accounted for 73% of the variance of sedentary time measured by the activPAL (coefficient 0.762, 95% CI 0.413 to 1.111). These data provide clinicians and caregivers with capacity to investigate strategies that would aim to increase activity in the nonexercise component of the activity continuum.
Publisher: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.ORCP.2017.11.001
Abstract: To explore participants' ability to participate in physical activity (PA), and barriers and facilitators to PA, at 12 months following restrictive bariatric surgery, and how these differed from participants' pre-surgery perceptions. Motivators for PA post-surgery were also explored. Qualitative one-on-one in-depth interviews were conducted pre- and 12 months post-surgery. Data were analysed using inductive thematic analysis. Fourteen adults (12 females), with a mean (range) age of 41.4 years (25.0-56.0), body mass index (BMI) of 31.7kg/m At 12 months following surgery, many participants reported residual obesity and non-obesity related barriers to PA. These barriers may explain the small, if any, pre- to post-surgery change in PA levels reported by earlier research. Facilitators to PA did not change and post-surgery motivators for PA were mostly esteem-related. These data are relevant to shape interventions aimed at optimising PA in this population.
Publisher: American Thoracic Society
Date: 15-04-2012
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.CTRV.2013.11.001
Abstract: To determine the effects of exercise training on exercise capacity, health-related quality of life (HRQoL), lung function (forced expiratory volume in one second (FEV1)) and quadriceps force in people who have had a recent lung resection for non-small cell lung cancer (NSCLC). We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SciELO and PEDro up to February 2013. We included randomised controlled trials (RCTs) in which study participants with NSCLC, who had recently undergone lung resection, were allocated to receive either exercise training or no exercise training. Two review authors screened and identified the studies for inclusion. We identified three RCTs involving 178 participants. On completion of the intervention period, exercise capacity, as measured by the six-minute walk distance, was statistically greater in the intervention group compared to the control group (mean difference (MD) 50.4m 95% confidence interval (CI) 15.4-85.2m). No between-group differences were observed in HRQoL (standardised mean difference (SMD) 0.17 95% CI -0.16-0.49) or FEV1 (MD -0.13L 95% CI -0.36-0.11L). Differences in quadriceps force were not demonstrated on completion of the intervention period. Evidence from our review suggests that exercise training may potentially increase the exercise capacity of people following lung resection for NSCLC. The findings of this review should be interpreted with caution due to disparities between the studies, methodological limitations, some significant risks of bias and small s le sizes.
Publisher: Elsevier BV
Date: 02-2012
Publisher: European Respiratory Society (ERS)
Date: 03-2008
DOI: 10.1183/09031936.00125707
Abstract: Although feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), estimates of their prevalence vary considerably. This probably reflects the variety of scales and methods used to measure such symptoms. Regardless of whether anxiety and depression are considered separately or as a single construct, their impact on COPD patients is important. A heightened experience of dyspnoea is likely to be a contributing factor to anxiety. Feelings of depression may be precipitated by the loss and grief associated with the disability of COPD. Smoking has been associated with nicotine addiction, and the factors that contribute to smoking may also predispose to anxiety and depressive disorders. Randomised controlled trials indicate that exercise training and carefully selected pharmacological therapy are often effective in ameliorating anxiety and depression. Most medical illnesses are influenced by the psychological responses and coping mechanisms that patients use. However, anxiety and depression are associated with dyspnoea, fatigue and altered sleep, all of which also occur in COPD. An understanding of the psychological history and coping mechanisms of patients and the role of anxiety and depressive reactions to illness may enable clinicians to reduce these symptoms and improve quality of life among patients with chronic obstructive pulmonary disease.
Publisher: SAGE Publications
Date: 11-2012
Abstract: This is a retrospective analysis of data in which we explored the association between energy expenditure (EE) and lung function in patients with chronic obstructive pulmonary disease (COPD). A total of 36 participants ( 20 males forced expiratory volume in 1 second (FEV 1 ) of 48 ± 15% predicted) underwent measures of indirect calorimetry whilst performing five simple activities of daily living. Maximal voluntary ventilation was the only lung function parameter associated with EE. These data highlight the limited extent to which the FEV 1 is related to the functional performance of patients with COPD.
Publisher: Hindawi Limited
Date: 2009
DOI: 10.1155/2009/393941
Abstract: BACKGROUND AND OBJECTIVE: The importance of the multidisciplinary approach to the management of chronic obstructive pulmonary disease is increasingly emphasized. The present study aimed to examine the current practice patterns of physical therapists involved in the management of patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease. METHOD: A self-administered postal survey was distributed to the rehabilitation departments of all Canadian acute care hospitals with more than 250 beds. The survey addressed patient assessment, treatment, education and discharge planning for intensive care unit and/or ward admissions. RESULTS: In total, 66% of hospitals (n=109) participated in the study, with provincial representation mainly from Ontario (n=36 [33%]) and Quebec (n=36 [33%]). Assessment and treatment techniques did not differ greatly between the ward and the intensive care unit. Assessment focused on patient observation, pulse oximetry and auscultation, and was reported to be used ‘always or frequently’ by 76%, 76% and 69% of respondents, respectively. Less than 18% of respondents used a measure of functional capacity, and health-related quality of life measures were rarely used. Treatment focused on ambulatory techniques, with 78% and 75% of respondents using mobility and transfer training ‘always or frequently’, respectively. The most common educational topics were breathing exercises and positioning, which were addressed by 68% and 67% of respondents, respectively. CONCLUSION: Patient assessment focused on physical impairments, with little use of measures of function or health-related quality of life, whereas treatment focused on mobility, with a lesser focus on airway clearance. Further study is needed to identify the factors that impact these practice patterns.
Publisher: SAGE Publications
Date: 09-09-2020
Abstract: To investigate feasibility of aquatic high intensity interval training for adolescents with cerebral palsy, who can ambulate independently but may choose a mobility aid in some circumstances. Pilot randomised controlled trial. Following baseline assessments, participants were randomised to usual care or ten weeks of twice weekly aquatic high intensity interval training. Each class comprised 10 one-minute exercise intervals separated by one-minute rest. High intensity exercise was defined as the attainment of ⩾80% of peak heart rate measured by telemetry. Tertiary paediatric hospital. Primary outcomes related to the feasibility of the protocol to progress to a definitive trial. Consumer feedback was obtained. Of 119 potential participants, 46 appeared eligible and 17 consented, resulting in a recruitment fraction of 37% (95% CI 23–52). Twelve completed baseline assessments and were randomised (5 males 14 years 7 months SD 2 years 0 months). In the intervention group, of the 1190 exercise stations (across all participants and sessions), heart rate data were available for 1180 stations and high intensity exercise was achieved during 1111 stations (93%, 95% CI 92–95). All randomised participants completed the study and reported that the intervention was fun and provided friendship opportunities. There were no major adverse events or exacerbation of pain. Aquatic high intensity interval training in ambulant adolescents with cerebral palsy is feasible, while maintaining adherence and fidelity. Uncertainty remains on the efficacy of the intervention, highlighting the need for a large definitive trial.
Publisher: European Respiratory Society
Date: 09-2021
Publisher: MDPI AG
Date: 13-11-2021
DOI: 10.3390/JCM10225280
Abstract: This review reports on methods used to evaluate airway clearance techniques (ACT) in adults with CF and examined data for evidence of any effect. Sixty-eight studies described ACT in adequate detail and were included in this review. Frequently reported outcomes were sputum expectoration (72%) and spirometric lung function (60%). Compared with cough alone, following any ACT, there was a trend for greater sputum wet weight, however FEV1 was not different. The mean (95% CI) within-group effect for sputum wet weight following any ACT was 12.43 g (9.28 to 15.58) (n = 30 studies) and for FEV1 was 0.03 L (−0.17 to 0.24) (n = 14 studies). Meta-regression demonstrated that, when compared with cough alone, greater sputum wet weight was reported in groups that received additional ACT by between 2.45 and 3.94 g (F3,66 = 2.97, p = 0.04). These data suggest the addition of ACT to cough alone may optimise sputum clearance however, FEV1 lacked sensitivity to detect this change. Importantly, this review highlights the lack of appropriate measures to assess ACT efficacy.
Publisher: SAGE Publications
Date: 20-07-2017
Abstract: A significant proportion (15%, n = 28) of the adults with cystic fibrosis (CF) in Western Australia (WA) live in rural and remote areas and have difficulty accessing specialist care at the state adult CF centre, located in Perth. We aimed to increase access by offering telehealth clinics, and evaluate the impact on health outcomes. Telehealth clinics were offered via videoconference over a 12-month period, with uptake and satisfaction measured at the end of the intervention. Participants could still attend in person clinics at the CF centre if requested. Other outcomes comprised healthcare utilisation (HCU), spirometry, weight and health-related quality of life. In 21 participants, total clinic visits increased from 46 (median (range) per participant 2 (0–6)) in the 12-month period preceding the study to 100 (5 (2–8), p 0.001) during the intervention. Of the 100 clinics in total, 66 were delivered via telehealth. Satisfaction with telehealth was high and most (94%) participants agreed that telehealth is a good way to deliver CF care. An increase in intravenous antibiotic days (incident rate ratio (IRR) 2.3, p = 0.03) and hospital admission days (IRR 3.7, p = 0.01) was observed. There was an improvement in the vitality domain of the Cystic Fibrosis Questionnaire – Revised ( p 0.05). Telehealth had good uptake and increased clinic attendance in adults with CF living in rural and remote WA, and had high satisfaction amongst participants. The increase in HCU, resulting from increased detection and treatment of exacerbations, may improve long-term outcomes in this population.
Publisher: Elsevier BV
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 09-2016
DOI: 10.1007/S11695-015-1867-4
Abstract: Bariatric surgery candidates engage in less physical activity (PA) and spend longer periods in sedentary behaviour (SB) when compared to the general adult population. The aim of this study was to explore the beliefs about PA and perceived barriers and facilitators to PA in obese adults scheduled for bariatric surgery. Nineteen obese adults (15 females), with a mean (SD) age of 41.6 (12.1) years, weight of 119.2 (20.5) kg and body mass index of 41.6 (6.7) kg/m(2) participated in a one-on-one in-depth qualitative interview before undergoing bariatric surgery. Data were analysed using inductive thematic analysis. Most participants believed that engaging in regular PA confers important health benefits, however reported insufficient PA levels to obtain those benefits. The perceived barriers to PA reported by participants were both obesity related (e.g. bodily pain, physical limitation and self-presentational concerns) and non-obesity related (e.g. lack of motivation, environment and restricted resources). All participants stated weight loss to be the main perceived facilitator to PA, together with social factors, better time management and access to financial resources. In bariatric surgery candidates, many of the perceived barriers and facilitators to PA are not obesity related and are therefore unlikely to change as a result of bariatric surgery. This may explain why earlier research shows little change in PA or SB following surgery. It is likely that an approach that aims to address the barriers and facilitators identified in this study is needed to change the inactive lifestyle adopted in this population.
Publisher: SAGE Publications
Date: 11-02-2016
Abstract: This study is aimed to (i) compare both the magnitude of impairment in exercise capacity and exercise responses measured during the six-minute walk test (6MWT) and the cardiopulmonary exercise test (CPET) and (ii) investigate the effect of test repetition on six-minute walk distance (6MWD) in people following curative intent treatment for non-small cell lung cancer (NSCLC). Twenty participants (67 ± 10 years 14 females), 6–10 weeks following lobectomy, underwent a CPET and two 6MWTs. Peak exercise responses, dyspnoea and leg fatigue, as well as heart rate (HR) and oxygen saturation (SpO 2 ) during the 6MWT, were compared to those during the CPET. Compared with exercise capacity when expressed as peak rate of oxygen consumption (%pred) measured during the CPET, exercise capacity when expressed as 6MWD (%pred) was less impaired (81 ± 10 vs. 63 ± 15 %pred p 0.001). Compared with the CPET, the 6MWT elicited lower peak HR (119 ± 15 vs. 128 ± 18 beats minute −1 p = 0.02), lower SpO 2 (93 ± 2 vs. 95 ± 3% p 0.05), less dyspnoea (3.1 ± 1.6 vs. 6.9 ± 2.6 p 0.01) and less leg fatigue (2.0 ± 1.9 vs. 6.8 ± 2.4 p 0.01). The 6MWD increased 19 ± 19 metre (4 ± 4%) with test repetition ( p 0.001). In people following curative intent treatment for NSCLC, the 6MWT appears to elicit sub-maximal exercise responses when compared with the CPET. There is a significant effect of test repetition on 6MWD.
Publisher: Oxford University Press (OUP)
Date: 07-05-2020
DOI: 10.1093/PTJ/PZAA088
Abstract: Healthy working-aged adults performed the modified Chester Step Test (mCST) to (1) determine the effect of repetition on test duration, (2) report cardiorespiratory and symptom responses, (3) establish a regression equation to estimate duration, and (4) calculate the minimal detectable change of the test. In this observational study conducted in a hospital physical therapy, adult participants aged 25 to 65 years who were healthy performed the mCST twice. This submaximal test required participants to step on and off a 20-cm step at a standardized cadence that increased every 2 minutes. The criteria for test completion were either a heart rate equal to 80% of age-predicted maximum or the onset of intolerable symptoms. The primary measure was time to test completion during the mCST (seconds). Cardiorespiratory and symptom responses were also collected during the mCST. A total of 83 participants (40 men, mean [SD] age = 44 [12] years) completed data collection. There was no systematic effect of test repetition with median test duration of the first test (522 seconds, range = 400–631 seconds) and second test (501 seconds, range = 403–631 seconds). The test elicited moderate symptoms of breathlessness and leg fatigue. In the multivariable model, age, sex, weight, and height were retained as significant predictors of test duration (R2 = 0.48). The minimal detectable change was 119 seconds. The mCST is a reliable and valid clinically applicable test of aerobic capacity in working-aged adults. Independent pretest predictors can be used to estimate the clinical time required to complete the test. The mCST was stable between test repetitions, suggesting no learning effect. For any given in idual, a test duration change of 2 minutes represents change was beyond the natural variability. The mCST has good applicability to clinical settings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2009
Publisher: Wiley
Date: 07-2021
DOI: 10.1111/IMJ.15408
Abstract: Time to symptom limitation ( T lim ) achieved during constant work rate tests is considerably more responsive to change than measures commonly recorded during r ‐based tests, such as peak rate of oxygen uptake and maximal work rate ( W max ). There is limited literature on the use of, and physiological and symptom responses to, constant work rate cycle ergometry tests in people with cystic fibrosis (CF). The results of this study provide evidence that the constant work rate cycle ergometry test, when conducted at 80% of the W max , elicits peak physiological and symptom responses and appears to be safe in adults with CF. For clinicians prescribing exercise at an intensity approaching or equivalent to 80% of the W max in a non‐laboratory‐based setting, consideration needs to be given to the level of supervision and patient monitoring required.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 12-02-2019
DOI: 10.3138/PTC.2017-69
Abstract: Purpose: The authors determined the reliability and validity of the Four-Point Pusher Score (4PPS) among stroke survivors. Method: Stroke survivors were invited to participate within 48 hours of admission to a stroke rehabilitation unit in a tertiary hospital. Intrarater reliability was determined by examining scores assigned to the same patient by the same physiotherapist. Interrater reliability was determined by examining scores assigned to the same patient by two other physiotherapists. Validity was determined by examining associations with the Burke Lateropulsion Scale (BLS), Scale for Contraversive Pushing (SCP), and functional scales. Results: A total of 85 participants who were a median of 13 (interquartile range 9–21) days post-stroke completed this study. The weighted κ statistic for 4PPS intra- and interrater reliability was 0.97 ( p 0.001). Scores on the 4PPS were very strongly associated with scores on the BLS ( r s = 0.95) and the SCP ( r s = 0.86). Strong associations were evident between the 4PPS and the Berg Balance Scale ( r s = –0.77), Chedoke-McMaster Stroke Assessment postural control scale ( r s = –0.76), and FIM Motor sub-scale ( r s = –0.64 all ps 0.001). Conclusion: The 4PPS is a reliable and valid scale to assess lateropulsion and pusher behaviour in stroke survivors in an in-patient rehabilitation setting.
Publisher: SAGE Publications
Date: 08-2018
Abstract: In a non-athletic population, to (1) investigate the effectiveness of high-intensity interval training in an aquatic environment (A-HIIT) on aerobic performance, strength, and body composition and (2) report on safety of this approach. A systematic search was undertaken of six databases until May 2018. Trials were eligible for inclusion if they compared the effect of A-HIIT in a non-athletic population with a control group that received no exercise training. Data were extracted independently by two reviewers and meta-analyses were undertaken using a random effects model to produce standardized mean difference (SMD) and 95% confidence intervals (CIs). Risk of bias was assessed using Cochrane’s risk of bias tool. All studies were graded using Physiotherapy Evidence Database (PEDro) and Consensus for Exercise Reporting Template (CERT) scales to determine quality of reporting. Eight studies reported over 13 papers met study criteria ( n = 377). Compared with a control group, those who completed a program of A-HIIT demonstrated greater aerobic performance (SMD 0.69 (95% CI 0.39–0.98) I 2 = 0% n = 191) and lower limb muscle strength (SMD 0.30 (95% CI 0.04–0.56) I 2 = 0% n = 237). No differences were seen in measures of body composition or the number of adverse events. All studies were at risk of performance bias. The (mean ± SD) PEDro and CERT scores were 4.9 ± 1.5 and 15.1 ± 2.1, respectively. In a non-athletic population, A-HIIT was safe and may have improved aerobic performance and lower limb strength. The exercise interventions were well described and monitoring and reporting of exercise intensity in water was feasible.
Publisher: Elsevier BV
Date: 03-2017
Publisher: Elsevier BV
Date: 07-2013
Abstract: Hyperinflated patients with COPD breathe against an increased elastic load during physical activity. Arm activities are especially demanding. Some pulmonary rehabilitation programs instruct patients to inhale while raising their arms, whereas others recommend the opposite. This study aimed to determine the effect of coordinating breathing with arm movements on the endurance of a lifting task. Participants with COPD and hyperinflation completed two (high intensity and severe intensity) rhythmic, constant load-lifting tasks to intolerance (tlimit) before and after attending four "teaching" sessions. Participants were randomly assigned to one of three groups: (1) taught to inhale during the lift, (2) taught to exhale during the lift, or (3) sham (unconstrained coordination). Thirty-six participants (FEV1 % predicted [SD], 34 [13] FEV1/FVC [SD], 33% [10%] thoracic gas volume % predicted [SD], 179 [44]) completed the study. There was an effect of group on the change in tlimit (P<.01) regardless of task intensity (P=.47). The change in tlimit in the exhalation group was greater than in both the sham (difference [95% CI]: 2.82 [0.21-5.44] min P<.05) and inhalation (difference [95% CI]: 3.29 [0.65-5.92] min P<.05) groups at the high intensity. There was no difference in the change in tlimit between the inhalation and sham groups. A specific breathing strategy, exhalation during the lift, improved task performance. Coordinating exhalation with lifting may be of value to hyperinflated patients with COPD who are engaged in arm and shoulder training exercises or daily activities that involve arm elevation. ClinicalTrials.gov No: NCT00836108 URL: www.clinicaltrials.gov.
Publisher: Elsevier BV
Date: 05-2008
Abstract: The protocol used for the 6-min walk test (6MWT) influences its results. The only study to examine the effect of modifying track layout performed a retrospective analysis and concluded that institutions using continuous tracks yield greater distances than those using straight tracks. Agreement between the distances measured on different tracks could not be examined. We evaluated the effect of modifying track layout on walk distance and examined the agreement and repeatability of distances measured on different tracks. In a prospective, randomized, cross-over study, 27 COPD subjects (FEV(1), 38 +/- 14% [mean +/- SD] 15 men) attended three separate test sessions, completing six 6MWTs. To familiarize all subjects with both tracks, the first two sessions comprised two 6MWTs on either a circular or straight track. During the final session, each subject was tested once on the straight and once on the circular track. The distance walked on the circular track exceeded the straight track by 13 +/- 17 m (p < 0.001). The limit of agreement between tracks was 33 m. Coefficient of repeatability values when the test was completed on different days for the straight and circular tracks were 51 m and 65 m, respectively. When evaluating changes in 6-min walk distance in groups of patients, track layout should be standardized. However, the effect of modifying track layout on an in idual's walking distance is small compared to their daily variability in walk distance. Therefore, standardizing track layout for any given in idual may be inconsequential when evaluating the change in distances from tests performed on different days.
Publisher: Informa UK Limited
Date: 02-01-2020
DOI: 10.1080/15412555.2019.1708883
Abstract: In people with chronic obstructive pulmonary disease (COPD), there is increasing recognition that the prolonged accumulation of sedentary time (ST) is associated with adverse cardio-metabolic health outcomes. Nevertheless, changing this lifestyle, which has evolved over several decades, is likely to be challenging. This study reports the determinants, perceived by in iduals with COPD, as being important for reducing ST. An in-depth understanding of this information is essential when planning an intervention to reduce ST. Fourteen in iduals with COPD completed semi-structured one-on-one interviews, which were audio recorded and transcribed verbatim. Both the interview schedule and mapping of data items extracted from the interview transcripts were informed by the Theoretical Domains Framework (TDF). A total of 867 quotes were mapped to the 14 TDF domains. Seven of the fourteen domains were identified as being important determinants for reducing ST: knowledge, beliefs about consequences, beliefs about capabilities, environmental context and resources, social influences, social rofessional role and identity, and behavioural regulation. There was a lack of knowledge regarding the meaning of sedentary behaviour. Participants' desire to be educated by knowledgeable health professionals in a formal programme was a dominant theme across multiple domains. The most frequently reported barriers to reducing ST related to the domains of social rofessional role and identity and environmental context and resources, while the most frequently reported enablers were related to the domains pertaining to beliefs about consequences and social influences. Potential strategies to reduce ST among people with COPD include education and other determinants identified in this research.
Publisher: American Thoracic Society
Date: 12-2015
Publisher: SAGE Publications
Date: 09-10-2010
Abstract: Answers were sought to the following question: Are techniques, applied predominantly with the aim of clearing secretions from the airways, to patients during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), safe and effective? A systematic review was undertaken of studies that (i) were either randomized controlled or randomized cross-over trials, (ii) recruited patients during an AECOPD, (iii) reported the results of between-group analyses and (iv) investigated the effect of techniques applied primarily with the aim of clearing secretions from the airways. Studies that examined non-invasive positive pressure ventilation (NIPPV) and early rehabilitation were excluded. Data were extracted pertaining to resting lung function, gas exchange, sputum expectoration, symptoms, NIPPV use and hospital stay. Five studies were included with a mean Physiotherapy Evidence Database (PEDro) score of 4.4 ± 1.1 (range: 3—6). The main findings were that (i) airway clearance techniques did not improve measures of resting lung function or produce any consistent change in measures of gas exchange, (ii) the application of 5 min of continuous chest wall percussion reduced forced expiratory volume in 1 second (FEV 1 ), (iii) in people with copious secretions, mechanical vibration, and non-oscillating positive expiratory pressure (PEP) mask therapy increased sputum expectoration and (iv) in patients with hypercapnic respiratory failure, intrapulmonary percussive ventilation (IPV) and PEP mask therapy reduced the need for, and duration of, NIPPV, respectively. With the exception of continuous chest wall percussion, airway clearance techniques were safe in patients during an AECOPD. Vibration and non-oscillating PEP facilitated sputum expectoration in patients characterized by copious airway secretions. In patients with respiratory failure, techniques that apply a positive pressure to the airways may reduce either the need for, or duration of, NIPPV and hospital length of stay.
Publisher: Wiley
Date: 10-2019
DOI: 10.1111/IMJ.14141
Abstract: Participation in regular physical activity decreases the risk of developing cardiometabolic disease. However, the proportion of people who participate in the recommended amount of physical activity is low, with common barriers including competing interests and inclement weather. In people with chronic cardiorespiratory conditions, participation in physical activity is reduced further by disease-specific barriers, time burden of treatment and unpleasant symptoms during physical activity. Addressing these barriers during adolescence and early adulthood may promote greater physical activity participation into older age. The aim of this review was to classify interventions aimed at optimising participation in physical activity as 'promising' or 'not promising' in people aged 15-45 years with chronic cardiorespiratory conditions and categorise the behaviour change techniques (BCT) within these interventions. Nine databases and registries were searched (October 2017) for studies that reported objective measures of physical activity before and after an intervention period. Interventions were classified as 'promising' if a between-group difference in physical activity was demonstrated. Michie et al.'s (2013) v1 Taxonomy was used to unpack the BCT within interventions. Across the six included studies (n = 396 participants), 19 (20%) of 93 BCT were described. The interventions of three studies were classified as 'promising'. The most commonly used BCT comprised goal setting, action planning and social support. Five BCT were solely used in 'promising' interventions. Our review demonstrated that only 20% of BCT have been utilised, and those BCT that were used only in 'promising' physical activity interventions in adolescents and adults with chronic cardiorespiratory conditions were isolated.
Publisher: Wiley
Date: 31-07-2013
Publisher: European Respiratory Society (ERS)
Date: 06-2006
DOI: 10.1183/09031936.06.00105205
Abstract: The aim of the present study was to investigate the effects of an interval-based high-intensity inspiratory muscle training (H-IMT) programme on inspiratory muscle function, exercise capacity, dyspnoea and health-related quality of life (QoL) in subjects with chronic obstructive pulmonary disease. A double-blind randomised controlled trial was performed. Sixteen subjects (11 males, mean forced expiratory volume in one second (FEV(1)) 37.4+/-12.5%) underwent H-IMT performed at the highest tolerable inspiratory threshold load (increasing to 101% of baseline maximum inspiratory pressure). Seventeen subjects (11 males, mean FEV(1 )36.5+/-11.5%) underwent sham inspiratory muscle training (S-IMT) at 10% of maximum inspiratory pressure. Training took place three times a week for 8 weeks and was fully supervised. Pre- and post-training measurements of lung function, maximum inspiratory pressure, maximum threshold pressure, exercise capacity, dyspnoea and QoL (Chronic Respiratory Disease Questionnaire CRDQ) were obtained. H-IMT increased maximum inspiratory pressure by 29%, maximum threshold pressure by 56%, 6-min walk distance by 27 m, and improved dyspnoea and fatigue (CRDQ) by 1.4 and 0.9 points per item, respectively. These changes were significantly greater than any seen following S-IMT. In conclusion, high-intensity inspiratory muscle training improves inspiratory muscle function in subjects with moderate-to-severe chronic obstructive pulmonary disease, yielding meaningful reductions in dyspnoea and fatigue.
Publisher: Wiley
Date: 24-01-2012
DOI: 10.1111/J.1440-1843.2011.02089.X
Abstract: Field and laboratory-based tests are used to measure exercise capacity in people with COPD. A comparison of the cardiorespiratory responses to field tests, referenced to a laboratory test, is needed to appreciate the relative physiological demands. We sought to compare peak and submaximal cardiorespiratory responses to the 6-min walk test, incremental shuttle walk test and endurance shuttle walk test with a r cycle ergometer test (CET) in patients with COPD. Twenty-four participants (FEV(1) 50 ± 14% 66.5 ± 7.7 years 15 men) completed four sessions, separated by ≥24 h. During an in idual session, participants completed either two 6-min walk tests, incremental shuttle walk tests, endurance shuttle walk tests using standardized protocols, or a single CET, wearing a portable gas analysis unit (Cosmed K4b(2)) which included measures of heart rate and arterial oxygen saturation (SpO(2)). Between tests, no difference was observed in the peak rate of oxygen uptake (F(3,69) = 1.2 P = 0.31), end-test heart rate (F(2,50) = 0.6 P = 0.58) or tidal volume (F(3,69) = 1.5 P = 0.21). Compared with all walking tests, the CET elicited a higher peak rate of carbon dioxide output (1173 ± 350 mL/min F(3,62) = 4.8 P = 0.006), minute ventilation (48 ± 17 L/min F(3,69) = 10.2 P < 0.001) and a higher end-test SpO(2) (95 ± 4% F(3,63) = 24.9 P < 0.001). In patients with moderate COPD, field walking tests elicited a similar peak rate of oxygen uptake and heart rate as a CET, demonstrating that both self- and externally paced walking tests progress to high intensities.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.JCF.2019.09.002
Abstract: Respiratory exacerbations impair lung function and health-related quality of life in people with CF, with delayed identification of exacerbations often resulting in worse outcomes. We developed a smartphone application (app) for adults with CF to report symptoms to the CF team, and investigated its impact on antibiotic use and other outcomes. Participants were randomised to intervention (use of the app weekly or sooner if symptoms had worsened) or control (usual care). The app comprised questions relating to symptoms suggestive of an exacerbation. If worsening symptoms were reported, the participant was contacted by the nurse practitioner. The primary outcome measure was the number of courses and days of intravenous (IV) antibiotics. Sixty participants (29 female, aged [mean ± SD] 31 ± 9 years, FEV The use of an app reduced time to detect respiratory exacerbations that required antibiotics, however did not demonstrate a clear effect on the number of courses of IV antibiotics.
Publisher: American Thoracic Society
Date: 15-09-2020
Publisher: Informa UK Limited
Date: 17-12-2013
Publisher: SAGE Publications
Date: 25-09-2020
Abstract: In adults hospitalized with an acute or chronic respiratory condition, to determine what has been reported regarding exercise programmes in terms of content, tolerability, evaluation and adverse events. A systematic search was conducted of electronic databases (PubMed, EMBASE, CINAHL, PEDro, The Cochrane Library), trial registries and conference abstracts (Thoracic Society of Australia and New Zealand Annual Scientific Meeting, the European Respiratory Society Congress, the American Thoracic Society International Conference). Studies were included if they (1) recruited adults hospitalized with an acute or chronic respiratory condition, (2) described an exercise programme that targeted peripheral muscles and (3) reported that ⩾80% of the s le had initiated training within 72 hours of hospitalization. The last search was conducted on 2 June 2019. Of the 6282 records identified, 20 met the study criteria. These described 18 separate studies (2018 participants). Studies were conducted in adults hospitalized with an exacerbation of chronic obstructive pulmonary disease or with community-acquired pneumonia. The content of exercise programmes included aerobic and/or resistance training, neuromuscular electrical stimulation, whole-body vibration or movement out of bed. In eight studies (44%), the initial session was prescribed using objective measures of exercise capacity, peripheral muscle force and the ability to undertake activities of daily living. Across 7420 training sessions, seven adverse events were reported. Methods used to prescribe and titrate exercise programmes in adults hospitalized with an acute or an exacerbation of a chronic respiratory condition were disparate. When reported, programmes were well tolerated and adverse events were infrequent.
Publisher: Daedalus Enterprises
Date: 10-2020
Abstract: In adults hospitalized with community-acquired pneumonia (CAP), increasing ward-based walking may reduce length of stay (LOS). There are few data to describe ward-based walking in this population. In adults hospitalized with CAP, we aimed to report variables of walking and non-walking time, to determine whether demographic or clinical variables influenced daily step count, and to determine whether daily step count influenced LOS. Following admission, daily step count and variables related to walking and non-walking time were quantified using the StepWatch Activity Monitor. Details regarding demographics, clinical characteristics, clinical care, and LOS were extracted from the medical records and hospital electronic data systems. Frailty was calculated via the 7-point Clinical Frailty Scale disease severity was measured via the CURB-65 score. Health care utilization at 30 d following discharge was measured via telephone interview. Two hundred participants completed the study, of whom 121 contributed ≥ 24 h of data from the StepWatch Activity Monitor. The median (interquartile range (IQR)) number of daily steps was 926 (457-1706). These were accumulated over 66 (41-121) min/d, with a usual bout duration of 3 (2-4) min and 1-min peak cadence of 56 (43-74) steps/min. An average of 93% (89-96) of waking hours was spent in non-walking time. In the multivariable model, increased frailty was retained as a predictor of lower step count (incidence rate ratio [IRR] 0.59, 95% CI 0.41-0.85). For every increase in 500 steps/d, LOS reduced by 11% (IRR 0.89, 95% CI 0.80-0.99). Subjects hospitalized with CAP did very little walking, most of which was accumulated in short bouts at a low intensity. Compared with subjects with mild frailty, those with moderate to severe frailty took 59% fewer steps per day. Those with a higher daily step count had a shorter LOS.
Publisher: Elsevier BV
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 03-08-2021
DOI: 10.1186/S40814-021-00893-1
Abstract: Chronic obstructive pulmonary disease (COPD) is a disorder linked with a multitude of extra pulmonary manifestations (also known as treatable traits), including low bone mineral density (BMD). To date, no specific guidelines exist for the management of BMD in this population. Impact loading exercise has been identified as an intervention that improves or maintains BMD in other populations. However, the feasibility of and tolerance to impact loading exercise has not been tested in people with COPD. The aim of the proposed study will be to investigate the feasibility and tolerance of adding impact loading exercise to a standard pulmonary rehabilitation programme (PRP) in people with COPD and report its effects on bone health, balance and falls risk. This is a protocol for a pilot feasibility and tolerance randomised controlled trial (RCT). Fifty-eight people with COPD will be randomly allocated, on a 1:1 ratio, to either the experimental or control group. Initially, participants in both groups will complete a standard 8-week (twice-weekly) PRP followed by a 32-week period of maintenance exercises. Over the initial 8-week period, participants allocated to the experimental group will also undertake targeted lower limb resistance exercises and commence a programme of impact loading exercises (e.g. bounding and drop jumps). On completion of the initial 8-week PRP, in addition to the standard maintenance exercises, participants in the experimental group will continue with home-based impact loading exercises, four times a week, for the extra 32 weeks. The primary outcome of this study is feasibility of and tolerance to impact loading exercises. Feasibility will be measured using data collected pertaining to recruitment, withdrawal and completion. Adherence to the exercises will be collected using exercise logs. Tolerance to the exercises will be determined using outcomes to assess pain, recording any adverse effects such as a fall and feedback from the participants in semi-structured interviews on completing of the trial. The effects of the 40-week experimental intervention on bone health, balance and falls risk will be reported. This pilot RCT will test the feasibility and tolerance of an intervention that has never been trialed in people with COPD. It will also provide initial information regarding the size of the effect this intervention has on outcomes such as BMD, balance and falls risk. These data will be critical when designing a definitive RCT to advance this area of research. Australian and New Zealand Clinical Trials Registry (ANZCTR): 12620001085965 (20/10/2020)
Publisher: BMJ
Date: 08-12-2009
Abstract: In patients with chronic obstructive pulmonary disease (COPD), interval exercise has gained recent attention as a possible means of achieving greater physiological training effects compared with continuous exercise. The primary aim of this systematic review was to compare the effects of interval versus continuous training on peak oxygen uptake, peak power, 6 minute walk test (6MWT) distance and health-related quality of life in in iduals with COPD. Randomised controlled trials comparing the effects of interval versus continuous training in patients with COPD were identified after searches of six databases and reference lists of appropriate studies in May 2009. Two reviewers independently assessed study quality. Weighted mean differences (WMD) with 95% CIs were calculated using a random effects model for measures of exercise capacity and health-related quality of life. Eight randomised controlled trials, with a total of 388 patients with COPD, met the inclusion criteria. No significant differences were found for peak power (WMD 1 W, 95% CI -1 to 3) or peak oxygen uptake (WMD -0.04 l/min, 95% CI -0.13 to 0.05) between interval and continuous training. The WMD for the Chronic Respiratory Questionnaire dyspnoea score was -0.2 units (95% CI -0.5 to 0.0). There was no difference in 6MWT distance between groups (WMD 4 m, 95% CI -15 to 23). Interval and continuous training modalities did not differ in their effect on measures of exercise capacity or health-related quality of life. Interval training may be considered as an alternative to continuous training in patients with varying degrees of COPD severity.
Publisher: Elsevier BV
Date: 2021
Location: Canada
Location: Australia
No related grants have been discovered for Kylie Hill.