ORCID Profile
0000-0003-1369-8981
Current Organisations
West Park Healthcare Centre
,
Weihenstephan-Triesdorf University of Applied Sciences
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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: 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: 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: 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: 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: 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: 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: 27-11-2013
Publisher: Elsevier BV
Date: 02-2012
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: American Thoracic Society
Date: 15-09-2020
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: Wiley
Date: 29-05-2018
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: 09-2011
Location: Germany
No related grants have been discovered for Tom Dolmage.