Comparison of oxygen consumption in performing daily activities between patients with chronic obstructive pulmonary disease and a healthy population

Measuring intensity during free-living physical activities in people with chronic obstructive pulmonary disease: a systematic literature review

BACKGROUND

Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD).

OBJECTIVE

This systematic review identified which outcomes, outcome measures and instruments have been used to assess single free-living PA-related intensity in people with COPD and compared the intensity level (light, moderate, vigorous) obtained by different outcome measures.

METHODS

PubMed, Scopus, Web of Science, Cochrane Library and EBSCO were searched for original studies of COPD and assessing single free-living PA-related intensity were included. Agreement was calculated as the number of agreements between 2 measures [same intensity level]/ number of comparisons using both measures*100.

RESULTS

We included 43 studies (1282 people with COPD, mean age 66 years, 65% men, 49% FEV_1%pred) and identified 13 outcomes, 46 outcome measures and 22 instruments. The most-reported outcomes, outcome measures and instruments were dyspnoea with the Borg scale 0-10; cardiac function, via heart rate (HR) using HR monitors; and pulmonary gas exchange, namely oxygen consumption (VO₂), using portable gas analysers, respectively. The most frequently assessed PAs were walking and lifting, changing or moving weights/objects. Agreement between the outcome measures ranged from 0 (%VO_2peak vs metabolic equivalent of task [MET]; %HR_peak vs Fatigue Borg; MET vs walking speed) to 100% (%HR_reserve vs dyspnoea Borg; fatigue and exertion Borg vs walking speed). %VO_{2peak/reserve} elicited the highest intensity. Hence, Borg scores, %HR_reserve and MET may underestimate PA-related intensity.

CONCLUSIONS

Various methodologies are used to assess single free-living PA-related intensity and yield different intensity levels for the same PA. Future studies, further exploring the agreement between the different outcome measures of PA-related intensity and discussing their advantages, disadvantages and applicability in real-world settings, are urgent. These would guide future worldwide recommendations on how to assess single free-living PA-related intensity in COPD, which is essential to optimise PA interventions and ensure patient safety.

Predicting the rate of oxygen consumption during the 3-minute constant-rate stair stepping and shuttle tests in people with chronic obstructive pulmonary disease

Background

The 3-minute constant-rate stair stepping (3-min CRSST) and constant-speed shuttle tests (3-min CSST) were developed to assess breathlessness in response to a standardized exercise stimulus. Estimating the rate of oxygen consumption (V’O₂) during these tests would assist clinicians to relate the stepping/shuttle speeds that elicit breathlessness to daily physical activities with a similar metabolic demand. This study: (I) developed equations to estimate the V’O₂ of these tests in people with chronic obstructive pulmonary disease (COPD); and (II) compared the newly developed and American College of Sports Medicine (ACSM) metabolic equations for estimating the V’O₂ of these tests.

Methods

This study was a retrospective analysis of people with COPD who completed a 3-min CRSST (n=98) or 3-min CSST (n=69). Multivariate linear regression estimated predictors (alpha <0.05) of V’O₂ to construct COPD-specific metabolic equations. The mean squared error (MSE) of the COPD-specific and ACSM equations was calculated and compared. Bland-Altman analyses evaluated level of agreement between measured and predicted V’O₂ using each equation; limits of agreement (LoA) and patterns of bias were compared.

Results

Stepping rate/shuttle speed and body mass were identified as significant predictors of V’O₂. The MSE of the COPD-specific equations was 0.05 L·min⁻¹ for both tests. Mean difference between measured and predicted V’O₂ was 0.00 L·min⁻¹ (95% LoA −0.46, 0.46) and 0.00 L·min⁻¹ (95% LoA −0.44, 0.44) for the 3-min CRSST and 3-min CSST, respectively. For the ACSM metabolic equations, the MSE was 0.10 L·min⁻¹ and 0.18 L·min⁻¹ for the 3-min CRSST and 3-min CSST, respectively. The ACSM metabolic equations underestimated V’O₂ of the 3-min CRSST by −0.18 L·min⁻¹ (95% LoA −0.68, 0.32), and overestimated V’O₂ of the 3-min CSST by 0.35 L·min⁻¹ (95% LoA −0.14, 0.84).

Conclusions

This study presents metabolic equations to predict V’O2 of the 3-min CRSST and 3-min CSST for people with COPD that are more accurate than the ACSM metabolic equations.

Multitask protocols to evaluate activities of daily living performance in people with COPD: a systematic review

INTRODUCTION

People with chronic obstructive pulmonary disease (COPD) present symptoms such as dyspnea and fatigue, which hinder their performance in activities of daily living (ADL). A few multitask protocols have been developed to assess ADL performance in this population, although measurement properties of such protocols were not yet systematically reviewed. Areas covered: Studies were included if an assessment of the ability to perform ADL was conducted in people with COPD using a (objective) performance-based protocol. The search was conducted in the following databases: Pubmed, EMBASE, Cochrane Library, PEDro, CINAHL and LILACS. Furthermore, hand searches were conducted. Expert commentary: Up to this moment, only three protocols had measurement properties described: the Glittre ADL Test, the Monitored Functional Task Evaluation and the Londrina ADL Protocol were shown to be valid and reliable whereas only the Glittre ADL Test was shown to be responsive to change after pulmonary rehabilitation. These protocols can be used in laboratory settings and clinical practice to evaluate ADL performance in people with COPD, although there is need for more in-depth information on their validity, reliability and especially responsiveness due to the growing interest in the accurate assessment of ADL performance in this population.

Functional capacity assessment of upper limbs in healthy young adult subjects

Abstract Introduction Assessing the functional capacity of the upper limbs (UL) is essential to direct treatments in clinical practice but there is a lack of research on specific methods for this end. Objective To verify the relationship of physical activity, grip strength (GS) and body mass index (BMI) with performance on 6-minute Pegboard and Ring Test (6PBRT) in healthy subjects. Methods Cross-sectional, exploratory and quantitative study. Apparently healthy adults were evaluated, both sexes, according to sociodemographic and anthropometric aspects, health conditions, physical activity level (IPAQ - short version), GS and functional capacity of the upper limbs (6PBRT). The data were analyzed descriptively using means, standard deviations, absolute figures and percentages. Correlations were found between variables using Spearman’s correlation coefficient (p < 0.05). The Statistical Package for Social Sciences (SPSS) for Windows, version 17.0 was used for analysis purposes. Results In total, 50 individuals were evaluated, the majority classified as active (54%). The mean GS was 30.70 ± 9,47kgf and the average number of loops moved during the 6PBRT was 277.6 ± 34.48. There was no correlation between the number of rings moved in 6PBRT and the level of physical activity (r = 0.076; p = 0.602), GS (r = -0.008; p = 0.956) or BMI (r = 0.031; p = 0.829). Conclusion The level of physical activity, GS and BMI did not influence the performance on 6PBRT, demonstrated by the lack of correlation between these variables.

Contributing Causes of Injury or Death in Grain Entrapment, Engulfment, and Extrication

OBJECTIVES

Grain entrapments and engulfments are one of most common hazards associated with grain storage facilities, with over 1,140 such entrapments/engulfments documented since the 1970s. The objective of the study was to determine the factors that contribute to injury or death in grain entrapment, engulfment, and extrication cases.

METHODS

A literature review, including data contained in the Purdue Agricultural Confined Spaces Incident Database (PACSID), was conducted to determine the conditions that the body experiences during an entrapment or engulfment in grains and during extrication efforts.

RESULTS

Based on the review, the conditions a human body faces during an entrapment, engulfment, or extraction can be split into two broad categories-environmental and physiological/psychological. The environmental factors depend on the grain's properties, depth of entrapment or engulfment, position of the victim's body, and characteristics of the storage unit, which include the grain's lateral pressure, vertical pressure, and weight, as well as friction, oxygen availability and diffusion rate, and grain temperature. The physiological and psychological factors are related to the individual's age and physical and psychological conditions, and manifest themselves in terms of oxygen consumption, asphyxiation (including aspiration, lack of oxygen, compression or splinting of the thorax), blood flow, and heart rate.

CONCLUSION

Of all the above factors, a review of fatality data contained in the PACSID indicate that aspiration, asphyxiation, grain weight, and lateral pressure are most likely the primary cause of death for most entrapment victims. Research gaps found by this study include an understanding of the impact of lateral pressure on lung expansion and oxygen availability and consumption rate, and the need for more case studies to accurately determine cause of death.

Relationship of muscle strength with activities of daily living and quality of life in individuals with chronic obstructive pulmonary disease

Abstract Introduction: Few activities of daily living (ADLs) in chronic obstructive pulmonary disease (COPD) are tolerated because they are associated with ventilatory and metabolic changes. Simply lifting the upper limb muscle requires changes, resulting in thoracic abdominal asynchrony, increased dyspnea, and can interfere with quality of life (QoL). Objective: to relate the muscle strength of the shoulder girdle, trunk and hand grip with the degree of dyspnea in ADLs and secondarily correlate them with QoL in individuals with chronic obstructive pulmonary disease. Materials and Methods: Nine male subjects with chronic obstructive pulmonary disease III and IV (COPDG) and nine healthy, sedentary male individuals - control group (CG) were evaluated. All patients underwent the following evaluations: Pulmonary function, muscle strength of shoulder girdle, trunk and hand grip, and questionnaires. Results: In the intergroup analysis found that the spirometric variables of the COPDG were significantly lower compared to the CG. Intragroup analysis for measures of muscle strength, found significant difference for shoulder girdle, trunk and hand grip between both groups (COPDG) with lower mean (CG). Only the shoulder girdle had a positive correlation with ADL's and QoL. Conclusion: COPDG individuals, in addition to having pulmonary compromise, showed a significant decrease in muscle strength of the shoulder girdle, trunk and hand grip when compared to the CG. Only the shoulder girdle strength was positively correlated with the level of dyspnea in ADL's in QoL. Thus, pulmonary rehabilitation is an important tool for strengthening these muscles, possibly providing a positive impact on the degree of dyspnea during ADLs and reflecting on QoL.

Validation of Walking Trails for the Urban Training™ of Chronic Obstructive Pulmonary Disease Patients

Purpose

Accessible interventions to train patients with chronic obstructive pulmonary disease (COPD) are needed. We designed urban trails of different intensities (low, moderate and high) in different types of public spaces (boulevard, beach and park). We aimed to validate the trails’ design by assessing the physiological response to unsupervised walking trails of: (1) different intensities in COPD patients, and (2) same intensity from different public spaces in healthy adults.

Methods

On different days and under standardized conditions, 10 COPD patients walked the three intensity trails designed in a boulevard space, and 10 healthy subjects walked the three intensity trails in three different spaces. We measured physiological response and energy expenditure using a gas analyzer. We compared outcomes across trails intensity and/or spaces using mixed-effects linear regression.

Results

In COPD patients, physiological response and energy expenditure increased significantly according to the trails intensity: mean (SD) peak V˙O₂ 15.9 (3.5), 17.4 (4.7), and 17.7 (4.4) mL/min/kg (p-trend = 0.02), and MET-min 60 (23), 64 (26), 72 (31) (p-trend<0.01) in low, moderate and high intensity trails, respectively. In healthy subjects there were no differences in physiological response to walking trails of the same intensity across different spaces.

Conclusions

We validated the trails design for the training of COPD patients by showing that the physiological response to and energy expenditure on unsupervised walking these trails increased according to the predefined trails’ intensity and did not change across trails of the same intensity in different public space. Walkable public spaces allow the design of trails that could be used for the training of COPD patients in the community.

Measurement of activities of daily living in patients with COPD: a systematic review

BACKGROUND

The objectives of this systematic review were to synthesize the literature on measures of activities of daily living (ADLs) that have been used in individuals with COPD and to provide an overview of the psychometric properties of the identified measures and describe the relationship of the disease-specific instruments with other relevant outcome measures for individuals with COPD and health-care use.

METHODS

Studies that included a measure of ADLs in individuals with COPD were identified using electronic and hand searches. Two investigators performed the literature search. One investigator reviewed the study title, abstract, and full text of the articles to determine study eligibility and performed the data extraction and tabulation. In cases of uncertainty, a second reviewer was consulted.

RESULTS

A total of 679 articles were identified. Of those, 116 met the inclusion criteria. Twenty-seven ADLs instruments were identified, of which 11 instruments were respiratory disease-specific, whereas 16 were generic. Most instruments combined instrumental ADLs (IADLs) with basic ADLs (BADLs). The majority of the instruments were self-reported; only three instruments were performance based. Twenty-one studies assessed psychometric properties of 16 ADLs instruments in patients with COPD.

CONCLUSIONS

Although several ADLs instruments were identified, psychometric properties have only been reported in a few. Selection of the most appropriate measure should focus on the target construct (BADLs or IADLs or both), type of test (disease-specific vs generic and self-reported vs performance-based), depth of information obtained, and psychometric properties of the instruments. Given the relevance of ADLs to the lives of patients with COPD, its assessment should be more frequently incorporated as a clinical outcome in their management.

Oxygen and ventilatory output during several activities of daily living performed by COPD patients stratified according to disease severity

OBJECTIVES

To measure the oxygen and ventilatory output across all COPD stages performing 18 common ADL and identify the activities that present the highest metabolic and ventilatory output as well as to compare the energy expenditure within each disease severity.

MATERIALS AND METHODS

Metabolic (VO2 and VCO2), ventilatory (f and VE), cardiovascular (HR) and dyspnea (Borg score) variables were assessed in one hundred COPD patients during the completion of eighteen ADL grouped into four activities domains: rest, personal care, labor activities and efforts.

RESULTS

The activities with the highest proportional metabolic and ventilatory output (VO2/VO2max and VE/MVV) were walking with 2.5 Kg in each hand and walking with 5.0 Kg in one hand. Very severe patients presented the highest metabolic, ventilatory output and dyspnea than mild patients (p<0.05).

CONCLUSIONS

COPD patients present an increased proportion of energy expenditure while performing activities of daily living. The activities that developed the highest metabolic and ventilatory output are the ones associated to upper and lower limbs movements combined. Very severe patients present the highest proportional estimated metabolic and ventilatory output and dyspnea. Activities of daily living are mainly limited by COPD's reduced ventilatory reserve.

Effects of body mass index on task-related oxygen uptake and dyspnea during activities of daily life in COPD

BACKGROUND

Patients with COPD use a higher proportion of their peak aerobic capacity during the performance of domestic activities of daily life (ADLs) compared to healthy peers, accompanied by a higher degree of task-related symptoms. To date, the influence of body mass index (BMI) on the task-related metabolic demands remains unknown in patients with COPD. Therefore, the aim of our study was to determine the effects of BMI on metabolic load during the performance of 5 consecutive domestic ADLs in patients with COPD.

METHODOLOGY

Ninety-four COPD patients and 20 healhty peers performed 5 consecutive, self-paced domestic ADLs putting on socks, shoes and vest; folding 8 towels; putting away groceries; washing up 4 dishes, cups and saucers; and sweeping the floor for 4 min. Task-related oxygen uptake and ventilation were assessed using a mobile oxycon, while Borg scores were used to assess task-related dyspnea and fatigue.

PRINCIPAL FINDINGS

1. Relative task-related oxygen uptake after the performance of domestic ADLs was increased in patients with COPD compared to healthy elderly, whereas absolute oxygen uptake is similar between groups; 2. Relative oxygen uptake and oxygen uptake per kilogram fat-free mass were comparable between BMI groups; and 3. Borg symptom scores for dyspnea en fatigue were comparable between BMI groups.

CONCLUSION

Patients with COPD in different BMI groups perform self-paced domestic ADLs at the same relative metabolic load, accompanied by comparable Borg symptom scores for dyspnea and fatigue.

Efeitos do exercício resistido de membros superiores na força muscular periférica e na capacidade funcional do paciente com DPOC

INTRODUÇÃO: A disfunção muscular periférica na doença pulmonar obstrutiva crônica (DPOC) contribui diretamente para a intolerância ao exercício físico, porém ainda não há consenso sobre estratégias adequadas de treinamento físico para esses pacientes. OBJETIVO: Avaliar o efeito do exercício resistido de membros superiores (MMSS) em pacientes com DPOC moderada a muito grave no ganho de força e na capacidade funcional. MÉTODOS: Doze pacientes com DPOC foram divididos em dois grupos: controle (GC) e treinado (GT). O GT realizou treinamento de força, três vezes por semana, durante seis semanas, com carga de 80% de uma repetição máxima (RM). Antes e após o tratamento, foram realizados os testes de 1 RM e o Pegboard and Ring Test (PBRT) em ambos os grupos. RESULTADOS: Após o tratamento, verificou-se aumento significativo da força muscular no GT (aumento de 52% no supino sentado e 22% no pulley, com p < 0,05); e quanto ao PBRT, não houve diferença significativa em ambos os grupos. CONCLUSÃO: O treinamento de força de MMSS com duração de seis semanas foi capaz de aumentar a força muscular, mas não a funcionalidade de pacientes com DPOC moderada a muito grave.

Lung function and blood markers of nutritional status in non-COPD aging men with smoking history: a cross-sectional study

Purpose:

Cigarette smoking and advanced age are well known as risk factors for chronic obstructive pulmonary disease (COPD), and nutritional abnormalities are important in patients with COPD. However, little is known about the nutritional status in non-COPD aging men with smoking history. We therefore investigated whether reduced lung function is associated with lower blood markers of nutritional status in those men.

Subjects and methods:

This association was examined in a cross-sectional study of 65 Japanese male current or former smokers aged 50 to 80 years: 48 without COPD (non-COPD group), divided into tertiles according to forced expiratory volume in one second as percent of forced vital capacity (FEV₁/FVC), and 17 with COPD (COPD group).

Results:

After adjustment for potential confounders, lower FEV₁/FVC was significantly associated with lower red blood cell count (RBCc), hemoglobin, and total protein (TP); not with total energy intake. The difference in adjusted RBCc and TP among the non-COPD group tertiles was greater than that between the bottom tertile in the non-COPD group and the COPD group.

Conclusion:

In non-COPD aging men with smoking history, trends toward reduced nutritional status and anemia may independently emerge in blood components along with decreased lung function even before COPD onset.

Physiologic limitations during daily life activities in COPD patients

INTRODUCTION

Patients with COPD are known to be limited in their performance of activities of daily life (ADL). This observational study aims to investigate the ventilatory and metabolic demand of ADL in home settings of patients and evaluate possible mechanisms involved in physiological limitation during ADL in COPD.

METHODS

In their home settings, 21 stable patients with COPD (GOLD II-IV, mean FEV(1) 43% predicted) were asked to perform their most dyspnea causing activities at their usual pace until symptoms discouraged further performance. Ten healthy control subjects, matched for age and gender, performed comparable activities. Ventilatory and metabolic demands of the ADL were studied using a portable breath-by-breath system.

RESULTS

Compared with healthy controls, ADL time was shorter in patients (530 +/- 38 s vs. 318 +/- 37 s respectively) and activities resulted in important complaints of dyspnea. Oxygen consumption (V O(2)) during the activities was higher in patients compared to healthy subjects (957 +/- 51 vs. 768 +/- 63 mL/min resp.). Ventilatory demand (V E) for comparable activity (at isoV O(2)) was higher in patients and went together with complaints of dyspnea in patients, but not in healthy subjects. Ventilatory constraints like low ventilatory reserve and inspiratory reserve volume and dynamic hyperinflation occurred in more than 80% of the patients, especially in (very) severe patients.

CONCLUSION

Patients with COPD experience limitations in the performance of ADL, which lead to reductions in ADL time and dyspnea complaints. There appears to be an important role for ventilatory limitations, which become more prominent as disease progresses.

Limited Functional Performance in Chronic Obstructive Pulmonary Disease: Nature, Causes and Measurement

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 individuals 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.

Funcionalidade do paciente com doença pulmonar obstrutiva crônica e técnicas de conservação de energia

A doença pulmonar obstrutiva crônica é progressiva, debilitante e diagnosticada após longa história de piora gradual. A dispnéia é o sintoma que mais interfere na execução das atividades profissionais, familiares, sociais e da vida diária dos pacientes com doença pulmonar obstrutiva crônica, levando-os ao sedentarismo e à queda na qualidade de vida. O objetivo deste artigo é abordar as limitações funcionais a que esses pacientes estão sujeitos, durante a realização de suas atividades da vida diária, e orientações para que os profissionais da saúde possam cuidar desses pacientes a fim de que obtenham uma maior funcionalidade. As orientações sobre o uso das técnicas de conservação de energia vêm sendo utilizadas nos programas de reabilitação pulmonar e também deveriam ser difundidas nos ambulatórios e hospitais. As atividades funcionais humanas envolvem as pernas e os braços, sendo estes últimos utilizados extensivamente para realizar atividades simples e complexas do cotidiano. Alguns estudos mostraram que os exercícios de braço não sustentados causam assincronia toracoabdominal e dispnéia em tempo mais curto e com menor consumo de oxigênio quando comparados com os exercícios de pernas. Tarefas simples podem apresentar consumo de oxigênio e ventilação minuto altos, justificando a sensação de dispnéia relatada pelos pacientes. Devido a isso, é conveniente adotar uma avaliação do impacto da incapacidade sobre a vida diária dos pacientes com doença pulmonar obstrutiva crônica. São discutidas e indicadas as técnicas de conservação de energia apropriadas como ferramenta para minimizar o desconforto desses pacientes.

The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis

OBJECTIVE

To determine whether aerobic exercise improves aerobic capacity in individuals with stroke.

DESIGN

A systematic review of randomized controlled trials. DATABASES SEARCHED: MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database were searched.

INCLUSION CRITERIA

Design: randomized controlled trials (RCTs).

PARTICIPANTS

individuals with stroke.

INTERVENTIONS

aerobic exercise training aimed at improving aerobic capacity.

OUTCOMES

PRIMARY OUTCOMES

aerobic capacity (peak oxygen consumption (VO2), peak workload).

SECONDARY OUTCOMES

walking velocity, walking endurance.

DATA ANALYSIS

The methodological quality was assessed by the PEDro scale. Meta-analyses were performed for all primary and secondary outcomes.

RESULTS

Nine articles (seven RCTs) were identified. The exercise intensity ranged from 50% to 80% heart rate reserve. Exercise duration was 20-40 min for 3-5 days a week. The total number of subjects included in the studies was 480. All studies reported positive effects on aerobic capacity, regardless of the stage of stroke recovery. Meta-analysis revealed a significant homogeneous standardized effect size (SES) in favour of aerobic exercise to improve peak VO2 (SES 0.42; 95% confidence interval (CI) 0.15-0.69; P=0.001) and peak workload (SES 0.50; 95% CI 0.26-0.73; P<0.001). There was also a significant homogeneous SES in favour of aerobic training to improve walking velocity (SES 0.26; 95% CI 0.05-0.48; P= 0.008) and walking endurance (SES 0.30; 95% CI 0.06-0.55; P= 0.008).

CONCLUSIONS

There is good evidence that aerobic exercise is beneficial for improving aerobic capacity in people with mild and moderate stroke. Aerobic exercise should be an important component of stroke rehabilitation.

Study of Energy Expenditure During Activities of Daily Living Using and Not Using Body Position Recommended by Energy Conservation Techniques in Patients With COPD

STUDY OBJECTIVES

To assess the energy spent by COPD patients using or not using energy conservation techniques (ECTs) during activities of daily living (ADL).

METHOD

The patients were evaluated in two different situations as stated above. For both applications, the following variables were measured during four ADL with or without using postures recommended by ECTs: metabolic (oxygen consumption [V(O2)] and carbon dioxide production [V(CO2)]), ventilatory (minute ventilation), cardiovascular (heart rate [HR] and oxygen pulse), and dyspnea (Borg score).

PARTICIPANTS

Sixteen male COPD patients (mean age, 62 years) with moderate-to-very-severe COPD (mean FEV1, 40%) participated in the study.

MEASUREMENTS AND RESULTS

The use of ECTs during ADL related to personal hygiene reduced V(O2) (13.4%), V(CO2) (12.8%), HR (13.7%), and Borg score (1 point) [p < 0.05]. Putting on and taking off shoes did not change V(O2), V(CO2), and HR but reduced the Borg score (0.6 point) [p < 0.05]. Storing groceries on high shelves reduced V(O2) (12.2%), V(CO2) (9.9%), HR (5.1%), and Borg score (0.75 point). Storing groceries on low shelves reduced V(O2) (28.1%), V(CO2) (24.3%), HR (5.4%), and Borg score (0.8 point) [p < 0.05].

CONCLUSION

The use of energy conservation techniques in COPD patients during ADL reduces energy cost and dyspnea perception.

A field test of functional status as performance of activities of daily living in COPD patients

Patients with chronic obstructive pulmonary disease (COPD) frequently experience activity restrictions and discomfort during activities of daily living (ADL). Functional status refers to the capacity to perform ADL. Available tests only partly measure this domain. Our aim was therefore to establish an assessment tool for functional status in COPD, the Glittre ADL-test. This field test includes a standardised set of ADL-like activities: Walking stairs, carrying, lifting objects, bending down and rising from a seated position. The primary variable was time to complete the test (ADL-time). Validity was investigated in 57 COPD patients by correlating ADL-time to pulmonary function, 6-min walking distance (6MWD) and questionnaires addressing health-related quality of life. Responsiveness was investigated in another 40 patients comparing ADL-time before and after rehabilitation. Median ADL-time was 4.16 min (range 2.57-14.47). Spearman rho=0.93 for test-retest reliability. ADL-time correlated with forced expiratory volume in 1s (rho=-0.61), St. George's Respiratory Questionnaire activity subscore (rho=0.43), dyspnoea during ADL (rho=0.35) and hospitalisation rate (rho=0.35). Despite a close overall correlation with 6MWD (rho=-0.82), variability was substantial, particularly for the more disabled patients. ADL-time improved significantly after rehabilitation. Glittre ADL-test yields information complementary to 6MWD. It is a valid and reliable measure of functional status, useful for assessment of individual patients and rehabilitation programs.

A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial

OBJECTIVES

To examine the effects of a community-based group exercise program for older individuals with chronic stroke.

DESIGN

Prospective, single-blind, randomized, controlled intervention trial.

SETTING

Intervention was community-based. Data collection was performed in a research laboratory located in a rehabilitation hospital.

PARTICIPANTS

Sixty-three older individuals (aged > or = 50) with chronic stroke (poststroke duration > or = 1 year) who were living in the community.

INTERVENTION

Participants were randomized into intervention group (n=32) or control group (n=31). The intervention group underwent a fitness and mobility exercise (FAME) program designed to improve cardiorespiratory fitness, mobility, leg muscle strength, balance, and hip bone mineral density (BMD) (1-hour sessions, three sessions/week, for 19 weeks). The control group underwent a seated upper extremity program.

MEASUREMENTS

Cardiorespiratory fitness (maximal oxygen consumption), mobility (6-minute walk test), leg muscle strength (isometric knee extension), balance (Berg Balance Scale), activity and participation (Physical Activity Scale for Individuals with Physical Disabilities), and femoral neck BMD (using dual-energy x-ray absorptiometry).

RESULTS

The intervention group had significantly more gains in cardiorespiratory fitness, mobility, and paretic leg muscle strength than controls. Femoral neck BMD of the paretic leg was maintained in the intervention group, whereas a significant decline of the same occurred in controls. There was no significant time-by-group interaction for balance, activity and participation, nonparetic leg muscle strength, or nonparetic femoral neck BMD.

CONCLUSION

The FAME program is feasible and beneficial for improving some of the secondary complications resulting from physical inactivity in older adults living with stroke. It may serve as a good model of a community-based fitness program for preventing secondary diseases in older adults living with chronic conditions.

Systemic inflammatory response to exhaustive exercise in patients with chronic obstructive pulmonary disease

Systemic inflammation may be present in patients with chronic obstructive pulmonary disease (COPD). Exercise is known to elicit an inflammatory response. We hypothesized that the systemic inflammatory response to exercise might be exaggerated in COPD patients compared to healthy subjects. Sixteen COPD patients and 11 healthy subjects performed a maximal incremental bicycle test. Before and at maximal exercise arterial blood samples were taken to determine circulating catecholamines, (subsets of) leukocytes, acute phase proteins, creatine kinase and myoglobin. At rest, increased levels of norepinephrine and systemic inflammation were present in COPD. The response of catecholamines to exercise was lower in COPD patients (P<0.01), which in part was due to the lower maximal exercise capacity of these patients (P<0.01). Exercise-induced leukocytosis showed similar responses in both groups, but occurred at higher levels in COPD. Although patients had increased levels of CRP at rest (P<0.001), exercise did not affect acute phase proteins. No systemic signs of muscle damage were found. The present study shows that COPD patients are exposed to systemic inflammation that is intensified by exhaustive exercise. The inflammatory response in COPD is not exaggerated compared to healthy subjects but occurs at a higher level and is observed at lower external workload.

Body care experienced by people hospitalized with severe respiratory disease

AIM

The paper gives a theoretical account of experiences of assisted personal body care (APBC) in hospitalized patients with severe chronic obstructive pulmonary disease (COPD).

BACKGROUND

Body care has been identified as a central but underestimated area of nursing. Hospitalized patients with severe COPD suffer from breathlessness on exertion and are dependent on help with personal body care. Studies have described patient strategies for managing breathlessness and preferences regarding nursing care during hospitalization. Yet the problems that patients can experience because of their inability to manage personal body care by themselves have not previously been explored. This study explored patients' experiences of being assisted with personal body care.

METHODS

A grounded theory methodology was used with a convenience sample of 12 patients. Data were gathered from participant observation of sessions of APBC, in-depth interviews after the observed sessions and measurement of breathlessness perceived by patients before and after the sessions.

FINDINGS

The patients perceived body care as a significant daily activity that needed to be carried out in order to preserve their integrity. Dependency and breathlessness, however, impeded the performance of body care activities and patients were struggling for self-preservation. They managed APBC by using a threefold strategy of not letting go, coping with dependency, and minimizing the risk of escalating breathlessness. Two dilemmas were identified as being inherent to the strategy.

CONCLUSION

Increased knowledge of the complexities involved in providing assistance might improve nurses' ability to facilitate patients in managing APBC. Dependency is a central issue to address in order to support patients' efforts to preserve integrity and resolve dilemmas inherent to the strategy they use.

Exercise training raises daily activity stronger than predicted from exercise capacity in patients with COPD

The 6-min walking (6MWD) and 6-min treadmill distance (6MTD) are often used as measures of exercise performance in patients with COPD. The aim of our study was to assess their relationship to daily activity in the course of an exercise training program. Eighty-eight patients with stable COPD (71m/17f; mean +/- SD age, 60 +/-8 year; FEV1, 43+/-14% pred) were recruited, 66 of whom performed a hospital-based 10-day walking training, whereas 22 were treated as control. On day 16MTD, and on days 8 and 10, 6MTD and 6MWD were determined. In addition, patients used an accelerometer (TriTrac-R3D) to record 24 h-activity, whereby training sessions were excluded. In both groups there was a linear relationship (r > or = 0.84 and P < 0.0001) between 6MTD and 24 h-activity, the slope of which was 2.5-fold greater in the training group (P < 0.01). Similar relationships emerged for 6MWD. There was no association between baseline 6MTD, FEV1 or BMI and any of the other measures. These data suggest that daily activity did not markedly vary with exercise capacity under baseline conditions. Participation in a training program increased activity significantly stronger than predicted from the gain in exercise capacity. This underlines the importance of non-physiological, patient-centered factors associated with training in COPD.