ORCID Profile
0000-0002-8818-2958
Current Organisations
Singular
,
Monash University
,
Latrobe University
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Publisher: Oxford University Press (OUP)
Date: 09-2015
DOI: 10.2522/PTJ.20140245
Abstract: Most inspiratory muscle training (IMT) interventions in patients with chronic obstructive pulmonary disease (COPD) have been implemented as fully supervised daily training for 30 minutes with controlled training loads using mechanical threshold loading (MTL) devices. Recently, an electronic tapered flow resistive loading (TFRL) device was introduced that has a different loading profile and stores training data during IMT sessions. The aim of this study was to compare the efficacy of a brief, largely unsupervised IMT protocol conducted using either traditional MTL or TFRL on inspiratory muscle function in patients with COPD. Twenty patients with inspiratory muscle weakness who were clinically stable and participating in a pulmonary rehabilitation program were randomly allocated to perform 8 weeks of either MTL IMT or TFRL IMT. Participants performed 2 daily home-based IMT sessions of 30 breaths (3–5 minutes per session) at the highest tolerable intensity, supported by twice-weekly supervised sessions. Adherence, progression of training intensity, increases in maximal inspiratory mouth pressure (Pimax), and endurance capacity of inspiratory muscles (Tlim) were evaluated. More than 90% of IMT sessions were completed in both groups. The TFRL group tolerated higher loads during the final 3 weeks of the IMT program, with similar effort scores on the 10-Item Borg Category Ratio (CR-10) Scale, and achieved larger improvements in Pimax and Tlim than the MTL group. A limitation of the study was the absence of a study arm involving a sham IMT intervention. The short and largely home-based IMT protocol significantly improved inspiratory muscle function in both groups and is an alternative to traditional IMT protocols in this population. Participants in the TFRL group tolerated higher training loads and achieved larger improvements in inspiratory muscle function than those in the MTL group.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-040798
Abstract: Interstitial lung diseases are characterised by scarring of lung tissue that leads to reduced transfer of oxygen into the blood, decreased exercise capacity and premature death. Ambulatory oxygen therapy may be used to treat exertional oxyhaemoglobin desaturation, but there is little evidence to support its efficacy and there is wide variation in clinical practice. This study aims to compare the clinical efficacy and cost-effectiveness of ambulatory oxygen versus ambulatory air in people with fibrotic interstitial lung disease and exertional desaturation. A randomised, controlled trial with blinding of participants, clinicians and researchers will be conducted at trial sites in Australia and Sweden. Eligible participants will be randomised 1:1 into two groups. Intervention participants will receive ambulatory oxygen therapy using a portable oxygen concentrator (POC) during daily activities and control participants will use an identical POC modified to deliver air. Outcomes will be assessed at baseline, 3 months and 6 months. The primary outcome is change in physical activity measured by number of steps per day using a physical activity monitor (StepWatch). Secondary outcomes are functional capacity (6-minute walk distance), health-related quality of life (St George Respiratory Questionnaire, EQ-5D-5L and King’s Brief Interstitial Lung Disease Questionnaire), breathlessness (Dyspnoea-12), fatigue (Fatigue Severity Scale), anxiety and depression (Hospital Anxiety and Depression Scale), physical activity level (GENEActive), oxygen saturation in daily life, POC usage, and plasma markers of skeletal muscle metabolism, systematic inflammation and oxidative stress. A cost-effectiveness evaluation will also be undertaken. Ethical approval has been granted in Australia by Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/42) with governance approval at all Australian sites, and in Sweden (Lund Dnr: 2019-02963). The results will be published in peer-reviewed scientific journals, presented at conferences and disseminated to consumers in publications for lay audiences. ClinicalTrials.gov Registry ( NCT03737409 ).
Publisher: BMJ
Date: 06-2018
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.RESP.2013.08.023
Abstract: Optoelectronic plethysmography (OEP) has been used to measure changes in chest wall volume and its compartments. However, literature lacks research on its reliability. The purpose of this study was to evaluate the intra-rater and inter-rater reliability of OEP. Thirty-two healthy subjects were evaluated at rest and during submaximal exercise on a cycle ergometer. The following variables were assessed: chest wall volume (VCW) percentage contribution of the pulmonary rib cage (V(rcp)%), abdominal rib cage (V(rca)%), rib cage (V(rc)%) and abdomen (Vab%) chest wall end-expiratory volume (Vee(cw)) chest wall end-inspiratory volume (Vei(cw)) ratio of inspiratory time to total time of the respiratory cycle (Ti/T(tot)) respiratory rate (f) and mean inspiratory flow (V(cw)/Ti). Intraclass correlation coefficient (ICC) and coefficient of variation of Method Error (CV(ME)) were used to evaluate reliability. Results showed ICC values higher than 0.75 and CV(ME) values less than 10% for most variables at rest and during exercise indicating that OEP is a reliable instrument to assess chest wall volumes at rest and during exercise in healthy subjects.
Publisher: Informa UK Limited
Date: 20-08-2019
Publisher: Elsevier BV
Date: 2021
Publisher: Cold Spring Harbor Laboratory
Date: 16-07-2020
DOI: 10.1101/2020.07.15.20154930
Abstract: To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease. Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric properties. 84 studies were included. Tests used at home were the 6-minute walk test (6MWT, 2 studies), sit-to-stand tests (STS, 5 studies), Timed Up and Go (TUG, 4 studies) and step tests (2 studies). Exercise tests administered remotely were the 6MWT (2 studies) and step test (1 study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (2 studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients .80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported. The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/14799731211046022
Abstract: Objectives: The objectives of this study were to determine the proportion of patients with interstitial lung disease (ILD) referred to pulmonary rehabilitation (PR) and to understand their experiences of participation or non-participation. Methods: Adults ( years old) with a diagnosis of ILD were identified from the Alfred Health ILD registry in Melbourne. Information regarding PR referral and attendance were collected from medical records. Semi-structured interviews with open-ended questions were conducted with patients who had been referred to PR. Results: Of 336 patients eligible for inclusion, PR referral was identified in 137 patients (40.7%). Patients referred to PR had worse respiratory function than those not referred (forced vital capacity mean 64 (SD 23) vs 79 (19) % predicted) and more desaturation during a 6-min walk test (86.6 (7.8%) vs 88.5 (7.0%)). Semi-structured interviews identified three major themes: valued components of PR (supervision and in idualization, improved confidence with exercise, education and peer support) limited knowledge about PR prior to attendance and barriers to attending PR (lack of perceived benefits, fear of exercise and accessibility). Discussion: Over 40% of patients who attended a specialist ILD clinic were referred to pulmonary rehabilitation, with higher referral rates in those with more severe disease. There are opportunities to improve patient knowledge regarding the role and expected benefits of PR in people with ILD.
Publisher: Informa UK Limited
Date: 08-2022
DOI: 10.2147/COPD.S368336
Publisher: Elsevier BV
Date: 05-2018
Publisher: SAGE Publications
Date: 2020
Abstract: To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease. Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric (measurement) properties. 84 studies were included. Tests used at home were the 6-minute walk test (6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go (TUG, 4 studies) and step tests (two studies). Exercise tests administered remotely were the 6MWT (two studies) and step test (one study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (two studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients .80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported. The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.
Publisher: Elsevier BV
Date: 09-2023
Publisher: BMJ
Date: 02-2017
Publisher: Daedalus Enterprises
Date: 28-08-2019
Abstract: Breathing exercises, such as diaphragmatic breathing and pursed-lips breathing, play a role in some in iduals with COPD and might be considered for those patients who are unable to exercise. However, in the literature are reports of some adverse effects of diaphragmatic breathing in patients with COPD. Thus, the purpose of this study was to assess the effects of diaphragmatic breathing and diaphragmatic breathing combined with pursed-lips on chest wall kinematics, breathlessness, and chest wall asynchrony in subjects with COPD, and also to assess whether the combination of both exercises reduces the adverse effects of diaphragmatic breathing while maintaining its benefits. Seventeen subjects with COPD, mean ± SD, 65 ± 7 y of age, with a history of smoking and clinical stability without hospitalization or symptoms of exacerbation in the past 4 wk, were evaluated. On day 1, participants' characteristics were collected, and they learned diaphragmatic breathing and its combination with pursed-lips breathing. On day 2, the participants were evaluated by optoelectronic plethysmography with the participants in the seated position while performing breathing exercises. Diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing promoted a significant increase in chest wall tidal volume and its compartments as well as a reduction in breathing frequency compared with quiet breathing. No significant changes were observed in dyspnea or end-expiratory volume of the chest wall. A significant increase in asynchrony (inspiratory-expiratory phase ratio) was observed during diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing compared with quiet breathing, with no differences observed between the exercises. Despite the increase in asynchrony, both breathing exercises were able to improve chest wall volumes without affecting dyspnea. The combination of exercises maintained the benefits but did not reduce the adverse effects of diaphragmatic breathing.
Publisher: European Respiratory Society (ERS)
Date: 23-08-2022
DOI: 10.1183/16000617.0042-2022
Abstract: There is growing interest in a “treatable traits” approach to pulmonary rehabilitation in chronic airways disease. The frequency with which pulmonary rehabilitation programmes address treatable traits is unknown. Randomised controlled trials of pulmonary rehabilitation compared to usual care in patients with stable chronic airways disease were included. The components of pulmonary rehabilitation delivered were extracted and mapped to treatable traits in pulmonary, extrapulmonary and behavioural/lifestyle domains. Meta-analysis was used to evaluate the impact of addressing treatable trait on exercise capacity and health-related quality of life (HRQoL). 116 trials were included (6893 participants). Almost all pulmonary rehabilitation programmes addressed deconditioning (97% of trials). The most commonly addressed extrapulmonary traits were nutritional status (obesity and cachexia, 18% each) and mood disturbance (anxiety and depression, 10% each). Behavioural/lifestyle traits most frequently addressed were nonadherence (46%), poor inhalation technique (24%) and poor family/social support (19%). Exercise capacity and HRQoL outcomes did not differ between studies that addressed deconditioning alone and those that targeted additional traits, but heterogeneity was high. Aside from deconditioning, treatable traits are infrequently addressed in existing trials of pulmonary rehabilitation. The potential of the treatable traits approach to improve pulmonary rehabilitation outcomes remains to be explored.
Publisher: Elsevier BV
Date: 2022
Publisher: Informa UK Limited
Date: 31-08-2020
DOI: 10.1080/09593985.2020.1805833
Abstract: The properties of a local Intensive Care Unit early mobilization protocol ('Start To Move As Soon As Possible') in critically ill patients, consisting of an objective diagnostic assessment linked to six treatment levels were evaluated. This study aimed to investigate whether the protocol can be reliably applied by different health-care providers (reliability), to examine the associations between prescribed and delivered treatments (feasibility) and to explore safety and patient satisfaction with the protocol. Cross-sectional observational study evaluating the reliability of the protocol between physiotherapist was evaluated with Cohen's kappa, percentage of agreement, and intraclass correlation coefficients in 61 patients. Feasibility was analyzed as agreement between prescribed and delivered treatments with Spearman's rank correlation coefficients in 60 patients. A satisfaction survey was used to evaluate patient satisfaction with the protocol. Excellent agreement was observed between physiotherapists for diagnostic level assignment (Kappa = 0.92), while the majority of the treatment proposals per level showed moderate to substantial agreement between the physiotherapists (Kappa range: 0.40-0.89). Three hundred and thirteen treatments were prescribed. Perfect agreement was observed between prescribed and delivered treatments in level 0 (Spearman's rho 1.00) and excellent associations for levels 1-5 (0.941, 0.995, 0.951, 0.998, and 0.999), respectively. Unwanted safety events rate was 3%. Most patients (92%) were very satisfied with physiotherapy. Excellent inter-rater agreement for diagnostic level assignment and moderate to substantial agreement for proposed treatments support the reliability of the protocol. Perfect to excellent associations between prescribed and delivered treatments supports its feasibility. Complications were rare, and most patients were very positive regarding the care provided by physiotherapists during their stay in the ICU.
Publisher: Wiley
Date: 22-07-2022
Publisher: FapUNIFESP (SciELO)
Date: 06-2012
DOI: 10.1590/S1413-35552012000300008
Abstract: Obesity is a worldwide health problem that may also induce respiratory dysfunction. Literature linking weight loss and maximum respiratory pressures is inconclusive. To evaluate longitudinally the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) of morbidly obese in iduals before and after gastric bypass surgery, and to compare them to a control group matched by sex and age. A vacuum manometer (GeRar®, SP, Brazil) was used to assess the MIP and MEP of 30 morbidly obese participants (24 women), aged 32±8 years and with body mass index (BMI) of 43±4 kg/m², both before and then one and six months after gastric bypass surgery. After an average of 36 months, 17 patients were reevaluated. A control group of 30 in iduals with normal lung function (aged 30±8 with a BMI of 22±2 kg/m²) was also studied. An unpaired t-test and ANOVA for repeated measures were used for statistical analysis, with p<0.05 considered as significant. No significant differences were observed in the baseline evaluation between the two groups. A significant increase was found in MIP after approximately 36 months of surgery in the obese group. A significant decrease in MEP was observed after one month, as well as a significant increase after 36 months compared with one and six months post-surgery. The data showed a significant long-term increase in MIP, as well as a significant decrease in MEP after one month followed by a return to pre-operative values, which indicates that gastric bypass surgery has a positive influence on the strength of inspiratory muscles.
Publisher: SAGE Publications
Date: 06-01-2021
Abstract: To evaluate the efficacy of an inspiratory muscle training protocol on inspiratory muscle function, functional capacity, and quality of life in patients with asthma. A single-blind, randomized controlled clinical trial. Community-based. Patients with asthma, aged between 20 and 70 years old, non-smokers. Participants were randomized into two groups: inspiratory muscle training group performed inspiratory muscle training 5 days a week for 8 weeks, consisting of six sets of 30 breaths per day with a training load ⩾50% of maximal inspiratory pressure, plus an educational program the control group only received the educational program. Maximal inspiratory pressure, inspiratory muscle endurance, and the distance performed on the incremental shuttle walking test were assessed pre-intervention, post-intervention and at follow-up (3 months after the end of the intervention). The asthma quality of life questionnaire was applied pre and post-intervention. Data from 39 participants were analyzed. Maximal inspiratory pressure in percentage of predicted and endurance test duration were significantly higher post-intervention in the inspiratory muscle training group (∆ post–pre: 50.8% vs 7.3% of predicted – P 0.001 and ∆ post–pre: 207.9 seconds vs 2.7 seconds – P 0.001, respectively). There was no significant difference in the incremental shuttle walking distance between groups (∆ post–pre: 30.9 m vs −8.1 m, P = 0.165). Quality of life was perceived as significantly better, without a difference between groups ( P 0.05). About 8 weeks of inspiratory muscle training in patients with controlled asthma significantly increased inspiratory muscle strength and endurance.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.APMR.2018.09.115
Abstract: To examine whether high-intensity home-based respiratory muscle training, that is, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity post-stroke. Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis. Community-dwelling patients. Patients with stroke, who had respiratory muscle weakness (N=38). The experimental group received 40-minute high-intensity home-based respiratory muscle training, 7 days per week, for 8 weeks, progressed weekly. The control group received a sham intervention of similar dose. Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), whereas secondary outcomes were expiratory muscle strength (maximal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (6-minute walk test). Outcomes were measured at baseline, after intervention, and 1 month beyond intervention. Compared to the control, the experimental group increased inspiratory (27cmH High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness post-stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.RESP.2021.103724
Abstract: The relationship between rib cage (RC) motion abnormalities, dynamic hyperinflation (DH), and exercise capacity in people with COPD is controversial. To investigate RC distortion and operational chest wall volumes during moderate and high constant-rate exercises in people with COPD. Seven male participants [median(Q1-Q3) age: 63(60.0-66.0) years FEV PhRIB and PhREB significantly increased during both constant-rate exercise tests, without difference between them. In general, Vei of the chest wall significantly increased in both exercise intensities while Vee did not change. The occurrence of RC distortion seemed not to limit the exercise capacity in people with COPD evaluated, and it was present even in the absence of DH.
No related grants have been discovered for Mariana Hoffman.