An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease

Effect of high fraction of inspired oxygen and high flow on exercise tolerance in patients with COPD and IPF: A randomized crossover trial

BACKGROUND

The effect of combining high fraction of inspired oxygen (FIO2) and high flow through a high-flow nasal cannula (HFNC) on exercise tolerance in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) remains unclear.

METHODS

This prospective, single-blind, randomized, crossover study included patients with COPD (n = 25) and IPF (n = 25). The patients performed a 6-min walking test (6 MWT) while attached to a battery-supplied portable HFNC device under the following four conditions: FIO2 set to a minimum percutaneous oxygen saturation (SpO2) of 86-88 % during 6 MWT with a flow rate of 10 L/min (LOLF) or 50 L/min (LOHF); and FIO2 set to a minimum SpO2 of 92-94 % with a flow rate of 10 L/min (HOLF) or 50 L/min (HOHF).

RESULTS

In both groups, the 6-min walking distance (6 MWD) was significantly greater for HOHF than for LOLF (COPD: 323.2 ± 77.6 m vs. 268.6 ± 87.3 m, respectively, p < 0.0001 and IPF: 406 ± 50.7 m vs. 372.3 ± 50.9 m, respectively, p < 0.0001). In the analysis of the interaction effects for the 6 MWD, the combination of high FIO2 and high flow resulted in an additional 15.9-m extension of the 6 MWD (95 % confidence interval: 0.34-31.5; p = 0.050). The interaction between IPF and high-flow was -14.0 m, suggesting a less pronounced extension effect compared with COPD (95 % confidence interval: -29.5-1.6; p = 0.085).

CONCLUSION

The combination of high FIO2 and high flow through an HFNC may improve exercise tolerance in patients with COPD and IPF.

Palliative care education as an integrated component of pulmonary rehabilitation: A real-world mixed-methods feasibility study

AIM

To explore the feasibility of integrating palliative care education in pulmonary rehabilitation (PR).

METHODS

A mixed-methods feasibility study was conducted in people with chronic respiratory diseases enrolled in 12-weeks outpatient hospital-based PR. A session about palliative care was integrated in the education content. Feasibility was assessed by attendance to the palliative care session, feasibility and acceptability of outcome assessment, acceptability of the intervention and undesirable effects. After PR, two focus groups were carried out. Descriptive and inductive thematic analyses were performed.

RESULTS

Out of 44 individuals referred to PR, 14 were excluded, six declined to participate and two were referred to another rehabilitation programme. Twenty-two people with chronic respiratory diseases started PR, however, six had discontinued the programme at the time of the palliative care session. Attendance to this session was 81 % (n = 13/16; 11 chronic obstructive pulmonary disease, 1 severe asthma and 1 interstitial lung disease; 77 % men, 65 ± 9 years-old, FEV1 41 ± 21 % of predicted). Outcome assessment was completed in 77 % (n = 10/13) of participants and lasted approximately 90 minutes. Three themes were identified from the focus groups: daily living with a chronic respiratory disease, meaningful care and demystifying misconceptions. Participants found the intervention and outcome assessment acceptable. An improvement in knowledge and change of attitude towards palliative care was considered a major effect of the palliative care session. No undesirable effects were reported.

DISCUSSION

Integrating an education session about palliative care in PR is feasible, meaningful for people with chronic respiratory diseases, and has no undesirable effects. A randomised controlled study is being prepared to strengthen these results.

Exercise-induced oxyhemoglobin desaturation is an independent risk factor for sustained nocturnal hypoxemia in adults with precapillary pulmonary hypertension: A cross-sectional study

BACKGROUND

Nocturnal hypoxemia (NH) negatively impacts the prognosis of several chronic cardiopulmonary diseases.

OBJECTIVES

To assess the risk factors associated with sustained NH in adults with precapillary pulmonary hypertension (pPH).

METHODS

This cross-sectional study was performed between June 2021 and June 2024. Outpatients with a hemodynamic diagnosis of pPH (Groups 1 and 4) were consecutively recruited. Sustained NH was defined as ≥ 30 % of the percentage of time spent with oxygen saturation (SpO2) <90 % during a home sleep apnea test (HSAT). Clinical, laboratory, hemodynamic, echocardiographic, functional, and exercise-related variables were collected blindly regarding the HSAT data. We considered a difference in SpO2 [resting - final] (Δ SpO2) ≥ 3 % as indicative of exercise-induced oxyhemoglobin desaturation (EID) by the six-minute walk test. Multiple logistic regression analysis was used to identify possible predictive factors for the occurrence of NH.

RESULTS

Fifty-two pPH adults were included (71.2 % were females). Thirty-one patients (59.6 %) were classified as having NH. In the univariate logistic regression analysis, four parameters were identified as risk factors for the presence of NH: mean pulmonary artery pressure (p = 0.023), right atrial mean pressure (p = 0.037), systolic pulmonary arterial pressure (p = 0.042) and EID (p = 0.003). However, only EID was an independent predictor for detecting NH with an adjusted odds ratio of 10.590 (95 % confidence interval: 1.095-102.420); p = 0.042.

CONCLUSIONS

EID is an easily implementable risk factor for prolonged NH, suggesting that adults with pPH who experience EID have a high probability of also experiencing NH.

Comparison of Clinically Meaningful Improvements After Center-Based and Home-Based Telerehabilitation in People With COPD

BACKGROUND

Response to pulmonary rehabilitation is not equal for all participants and may vary across health outcomes for any one individual. Alternative methods of pulmonary rehabilitation delivery, for example, telerehabilitation, may improve program access, but also could affect response to rehabilitation.

RESEARCH QUESTION

What is the rate of clinical response to home-based telerehabilitation compared with center-based pulmonary rehabilitation, and are any participant baseline characteristics associated with pulmonary rehabilitation response relative to the model of delivery?

STUDY DESIGN AND METHODS

In this secondary analysis of 2 randomized controlled trials, participants were categorized as responders or nonresponders according to achievement of the minimal important difference (MID) for each outcome of interest at end rehabilitation and after the 12-month follow-up (change from baseline). Outcomes of interest were functional exercise capacity (6-minute walk distance; MID, 30 m), health-related quality of life (chronic respiratory disease questionnaire: MID, 2.5, 2, 3.5, and 2 points for the dyspnea, fatigue, emotion, and mastery domains, respectively; CRQ total score MID, 10 points); and symptoms (modified Medical Research Council: MID, -1 point).

RESULTS

Two hundred sixty-six individuals with COPD were included in the analysis. The proportion of responders was not different between center-based pulmonary rehabilitation and home-based telerehabilitation at either end rehabilitation or 12-month follow-up for any outcome (range, 39%-62%). In a binary logistic regression analysis, baseline outcome values, but not participant demographic characteristics, were associated most commonly with responder status. The relative risk of program noncompletion in the center-based group was nearly 4 times greater than for telerehabilitation (center-based pulmonary rehabilitation: n = 79 [58%] vs home-based telerehabilitation: n = 116 [90%]; relative risk, 3.89; 95% CI, 2.28-6.63).

INTERPRETATION

In this study, responder status to pulmonary rehabilitation was not different between center-based and home-based telerehabilitation. The ability to identify patient characteristics that confer greater potential for rehabilitation response or better suitability for a particular model of rehabilitation remains a challenge.

Characteristics of Cardiac Rehabilitation for Older Patients in a Japanese Rehabilitation Hospital

Background Japan's aging population faces a rising prevalence of cardiovascular disease (CVD), resulting in an increased demand for specialized cardiac rehabilitation (CR). This study investigated the characteristics of older patients and the current status of CR in Japanese convalescent rehabilitation hospitals. Materials and methods This retrospective cohort study enrolled 107 patients who were transferred to a rehabilitation hospital following acute CVD treatment. The patients were divided into an older group (aged ≥80 years) and a control group (aged <80 years). Clinical characteristics, physical and cognitive function, exercise tolerance, activities of daily living (ADL), health-related quality of life (HR-QoL), and CR components were collected and analyzed. Results Despite shorter aerobic exercise duration (median, 9.8 (IQR, 0.4-19.2) vs. 20.6 (11.7-29.8) min, P < 0.001), the older group demonstrated significant improvements in physical function, ADL, and HR-QoL by discharge. Both groups showed gains in functional independence measures, physical performance, strength, gait speed, and endurance. While the older group started with lower baseline physical performance and required a higher level of care at discharge, their improvements in physical function, exercise tolerance, ADL, and HR-QoL were comparable to those in the control group. Conclusion CR programs for older patients in rehabilitation hospitals, although characterized by relatively short durations of aerobic exercise, may contribute to improved functional outcomes. These results highlight the importance of developing and implementing CR programs for older patients and support their potential for broader application in addressing the needs of Japan's aging population.

Modified 1-min sit-to-stand test for evaluating exercise capacity in pulmonary fibrosis

Question

The reference test for the functional evaluation of pulmonary fibrosis (PF) during exercise is the 6-min walk test (6MWT). However, the 6MWT involves temporal and spatial constraints that the 1-min sit-to-stand test (1-MSTST) does not have. Previous studies have not validated 1-MSTST use in this context, mainly because of far less oxygen desaturation. We hypothesise that the modified 1-MSTST (m1-MSTST), taking into account the recovery phase, could compensate this shortcoming.

Patients and methods

This was a randomised, crossover, single-centre trial conducted in 36 patients with PF. A 6MWT and 1-MSTST were performed 30 min apart for each patient in a randomised order. An equivalence test was performed on the peripheral oxygen saturation (S pO2 ) nadir.

Results

The 36 patients comprised eight with idiopathic PF, five with nonspecific idiopathic pneumonia, eight with collagen tissue disease-associated PF, four with hypersensitivity pneumonitis, two with sarcoidosis and nine with other PF. Mean±sd nadir desaturation was 84.9±4.3% for the 6MWT and 88±3.5% for the m1-MSTST, with a strong correlation between both tests. 33 patients (91.7%) had concordant results in the two tests regarding significant desaturation (S pO2 delta >4% or nadir <88%), which is a known prognosis factor.

Conclusion

The m1-MSTST, taking into account the recovery phase, is a sensible compromise to the 6MWT in measuring exercise performance in people with PF. As many clinical endpoints transfer from hospital to outpatient care, the m1-MSTST is technically easier and more practical for patients. Further studies are warranted to determine the minimal clinically important difference and norms in healthy subjects.

Examining recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life in COVID-19 patients treated in ICU: a Swedish prospective cohort study

PURPOSE

To investigate the recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life, as well as potential interaction effects, in individuals with COVID-19 treated in an intensive care unit (ICU).

METHODS

This prospective cohort study included patients with confirmed COVID-19 infection, treated in an ICU. Clinical assessments and self-ratings of functioning, disability and health were performed > 1 month and > 12 months after discharge from hospital.

RESULTS

Among the 65 included individuals (mean age 56.6, SD 11) significant improvements in physical and psychological function were observed over time, although not reaching population norms. Cognition remained unchanged (MoCA median 27, IQR 4). At the 12-month follow-up, physical limitations in activity (RAND-36) were found to be associated with dyspnea (mMRC-Dyspnea), mental and physical fatigue (MFI-20), and walking endurance (6-minute walk test) (r2 0.509 p < 0.001). Role limitations due to physical health (RAND-36) was found to be associated with physical and mental fatigue (MFI-20) and pain (r2 0.530 p < 0.001).

CONCLUSION

Despite improvements in functioning and health in this group of predominantly younger age recovery did not reach population norms. These results highlight persistent impairments and activity limitations that may necessitate long-term healthcare interventions.

Fully remote versus hybrid supervision of pulmonary telerehabilitation in COVID-19: a randomized clinical trial

BACKGROUND

The restrictions imposed by the COVID-19 pandemic have impeded the traditional rehabilitation process, prompting the widespread adoption of remote programs for the recovery of survivors.

AIM

The aim of this study was to evaluate and compare the effectiveness of a pulmonary telerehabilitation program (PTRP) in the exclusively remote modality versus the hybrid modality (remote and face-to-face) in patients with persistent respiratory dysfunction following hospitalization for COVID-19 pneumonia, and to compare the functional capacity of patients who participated in a PTRP with those who did not.

DESIGN

A randomised, interventional, prospective clinical trial was conducted. In parallel, an observational cohort study was conducted.

SETTING

Outpatient rehabilitation clinic and home-based rehabilitation program.

POPULATION

Thirty patients post-COVID-19 were randomised into two groups: G1 (fully remote supervision of PTRP) or G2 (hybrid supervision of PTRP). Thirty-seven post-COVID-19 patients were followed up without participating in PTRP (non-intervention group - NIG).

METHODS

Patients with persistent respiratory dysfunction and reduced functional capacity, as measured by the Six Minute Walk Test (6MWT), after hospitalization for COVID-19 pneumonia, were considered eligible for a PTRP. To assess the efficacy of the PTRP, the primary outcome (I) was distance walked on the 6MWT (6MWD) and the secondary outcome (II) was quality of life as assessed by the SF-36 questionnaire.

RESULTS

Both G1 and G2 demonstrated similar improvement in 6MWD, P<0.001 and quality of life (P<0.05). The IG showed higher 6MWD than the NIG (P<0.001). The increase in 6MWD for the IG was 140.5 m, while for the NIG it was 16.8 m (P=0.002).

CONCLUSIONS

The PTRP was found to be a feasible and highly effective intervention for restoring functional capacity and improving quality of life, regardless of the type of supervision. Furthermore, this functional gain was maintained over the long term. In patients with pulmonary dysfunction, participation in the PTRP improved functional capacity compared with those who were simply advised to resume physical activity during recovery.

CLINICAL REHABILITATION IMPACT

Telerehabilitation has been demonstrated to be a viable and efficacious alternative to traditional in-person programs in low-income contexts.

Feasibility, Usability, and Pilot Efficacy Study of a Software-Enabled, Virtual Pulmonary Rehabilitation with Remote Therapeutic Monitoring

Objective

Fewer than 3% of adults with Chronic Obstructive Pulmonary Disease (COPD) attend in-person, center-based pulmonary rehabilitation (PR) despite demonstrated health benefits and reduction in mortality. This study evaluated the feasibility and usability of a novel home-based, virtual PR (V-PR) intervention compared to center-based PR (C-PR). The virtual PR intervention was supported by remote therapeutic monitoring (V-PR+RTM; Blue Marble Platform, Blue Marble Health, Altadena, CA). Additionally, we collected data on the 6-Minute Walk Test to explore the efficacy of the V-PR compared to C-PR.

Patients and Methods

Adults with stable COPD referred for PR were recruited. The participants self-selected C-PR or V-PR and were provided a 6-8-week personalized exercise and COPD self-management educational program. In addition, weekly phone contacts with the V-PR group were made. Feasibility was measured using qualitative analysis of adherence, reasons for withdrawal, and self-reported barriers to using the software at home. Usability was measured with the System Usability Scale (SUS). Efficacy was evaluated with the 6 minute Walk Test (6MWT) and various functional performance and patient-centered health-related quality of life (HRQoL) questionnaires.

Results

Forty-eight participants were enrolled, and 40 (83.3%) completed the intervention, n=17 in the C-PR group and n=23 in the V-PR group. Four participants from each group withdrew due to reasons related to health issues (appendicitis, thrush, COVID, back pain) or the health status of their spouse, no-shows, and time constraints. Adherence to the exercise dose (3x/week) and educational offerings were >80% in both groups. Participants in the V-PR group scored the software as having high usability. In both groups, 6MWT distance improved significantly, as did scores on the CAT and SGRQ. No adverse events were reported in either group.

Conclusion

A software-enabled virtual PR program with remote therapeutic monitoring is feasible, usable, and effective. It could offer an alternative model that increases PR uptake for those unable or unwilling to attend in-person, center-based PR.

One-minute sit-to-stand test: Reference values for the Chilean population

INTRODUCTION

The one-minute sit to stand test (1min-STST) is a field test used to assess functional capacity. It is easily implementable and of significant clinical utility; however, no reference values are currently available for the Chilean population. The objective of this study was to establish reference values for the 1min-STST in a healthy Chilean population.

METHODS

A multicenter cross-sectional study involving data collection from six locations in Chile was conducted. Healthy adults between 18 and 80 years of age were recruited. The anthropometric variables, levels of physical activity, smoking status, Borg scale ratings, and number of repetitions during the 1min-STST were recorded. Reference values were determined according to sex and age range.

RESULTS

Four hundred ninety-nine healthy subjects (57.5% women, n = 287; median height, 1.63 (0.14) m; weight, 72.8 (20) kg; average BMI, 27.3 ± 4.1 kg/m2) were included in the study. The median (and the lower limit of normality (LLN) values) for the 1min-STST in men ranged from 18-29 years, with 38 (LLN 27) repetitions and 23 (LLN 15) repetitions for 70-80 years. For women aged 18-29 years, 38 (LLN 28) repetitions were performed, and for women aged 70-80 years, 24 (LLN 17) repetitions were performed.

CONCLUSIONS

This study established reference values for the healthy adult Chilean population.

Comparative the impact intraoperative phrenic nerve sacrifice on prognosis patients with thymoma

OBJECTIVES

Complete removal of the tumor and surrounding tissue is the most important prognostic factor such as survival after surgery. When the tumor invades the phrenic nerve, the impact of intraoperative phrenic nerve sacrifice on the short- and long-term prognosis of patients is not clear. This study aims to explore the differences in prognosis between patients with malignant thymoma with and without phrenic nerve sacrifice during surgery, as well as analyze related factors.

METHODS

A total of 209 patients who underwent thymoma resection in the Department of Thoracic Surgery at our hospital from February 2006 to November 2022 were collected for retrospective analysis. The groups were divided into two according to the presence or absence of intraoperative phrenic nerve sacrifice. A comparative analysis was conducted on postoperative complications, long-term survival recurrence between the two groups. Cox regression was used to analyze the factors related to the differences in short- and long-term prognosis between two groups.

RESULTS

29.6% of patients developed phrenic nerve sacrifice during thymoma surgery. Compared to patients without phrenic nerve sacrifice, the long-term survival rate was lower (P = 0.031). The independent risk factors for reduced long-term survival were intraoperative phrenic nerve sacrifice, secondary postoperative complications, and modified Masaoka staging III/IV.

CONCLUSION

Our data show that nearly one-third of patients develop phrenic nerve sacrifice during complete resection of thymoma. Phrenic nerve sacrifice has significant impact on short-term complications and long-term survival. Secondary postoperative complications and modified Masaoka staging III/IV are also risk factors for reduced long-term survival.

Development and Comparison of Reference Equations for the Six-Minute Walk Test in Spanish Healthy Adults Aged 45-85 Years

OBJECTIVES

(i) To develop sex-specific reference equations to predict distance walked (6MWD) in the 6-minute walk test (6MWT), in healthy subjects aged 45-85 years, from different geographic areas of Spain; and (ii) to compare developed equations with previously published in a large sample of COPD patients.

METHODS

First, a cross-sectional multicentre sample of randomly selected healthy subjects from 17 Spanish hospitals and universities performed two 6MWT. Linear regression and fractional polynomial modelling were used to develop the equations. Second, the developed equations were applied to 715 COPD patients from Spanish primary care centres and hospitals, and the % predicted 6MWD obtained was compared with previously published equations using Dunnett's multiple comparisons test.

RESULTS

568 healthy subjects were included (51% females, mean (SD) age 62 (11) years), walked a 6MWD of 615 (113) and 557 (93)m in males and females, respectively. The developed equations included age, weight and height, and explained 43% and 51% of the 6MWD variance for males and females, respectively. In the COPD sample (n=715, 14% females, 68 (9) years, FEV1 61 (18) % predicted, 6MWD 464 (97)m), only 1 out of 9 previously published equations for males, and 6 out of 9 for females predicted 6MWD values similar to those of the newly developed Spanish reference equations.

CONCLUSIONS

The newly developed reference equations provide a more valid prediction of 6MWD in Spanish adults with COPD compared to previously published equations. We suggest their use in future research and clinical practice for the Spanish adult population.

Assessment of sub-maximal aerobic capacity in North African patients with chronic hepatitis B: a pilot case-control study

Background

Studies assessing sub-maximal aerobic capacity in non-cirrhotic chronic hepatitis B (CHB) patients are scarce. This study aimed to evaluate sub-maximal aerobic capacity in CHB patients compared to apparently healthy participants (control-group).

Methods

A 6-min walk test was performed. The 6-min walk distance (6MWD) was recorded, along with heart-rate, oxygen hemoglobin saturation (SpO 2), blood pressure, and dyspnea ( ie ; visual analogue scale) at rest ( Rest) and at the end ( End) of the test. Additionally, 6-min walk work (6MWW), "6MWD × body mass index (BMI), "6MWD × SpO 2End", and "estimated cardiorespiratory and muscular chain age" were calculated. Signs of physical intolerance were determined including abnormal 6MWD ( ie ; 6MWD < lower limit of normal), chronotropic insufficiency ( ie ; heart-rate End < 60% of maximal predicted heart-rate), high dyspnea ( ie ; dyspnea End > 5), and desaturation ( ie ; drop in SpO 2 > 5 points).

Results

Compared to the control-group (n=28), the CHB-group (n=26) exhibited significantly lower 6MWD by 61 meters (13%), lower 6MWW by 5266 m.kg, lower "6MWD × BMI" by 1498 m.kg/m 2, lower "6MWD × SpO 2End" by 5650%, and lower heart-rate End by 26 bpm (12% predicted). The CHB-group included higher percentages of participants with chronotropic insufficiency (23.08% vs. 3.57% in the CG) and abnormal 6MWD (34.61% vs. 3.57% in the CG). CHB accelerated the aging of the "cardiorespiratory and muscular chain" by 11 years.

Conclusion

Non-cirrhotic CHB may contribute to reduced submaximal aerobic capacity and acceleration of "cardiorespiratory and muscular chain" aging. A regular physical activity program could be a valuable intervention to mitigate these effects.

Reproducibility of three 6-min walk tests in patients with COPD referred for pulmonary rehabilitation

INTRODUCTION AND OBJECTIVES

The 6-min walk test (6MWT) is used to assess functional capacity in patients with COPD. A significant number of studies have shown that most patients walk further in a second 6MWT. Research on a further increase in the 6-min walk distance (6MWD) during a 3rd test performed in accordance with current guidelines has not been done. Therefore, this study aimed to investigate 1) the reproducibility of three 6MWTs in patients with COPD referred for pulmonary rehabilitation (PR) and 2) predictors of improvement on a third 6MWT.

MATERIALS AND METHODS

Before the start of PR, 1167 COPD patients (50 % male, age: 62 ± 9 years; FEV1: 42 ± 18%pred) performed three 6MWTs (6MWT1, 6MWT2, and 6MWT3). A predetermined threshold of ≥42m improvement in 6MWD in consecutive 6MWT's was used to identify improvers. Reproducibility between tests was assessed using a Bland-Altman plot and logistic regression analyses were performed to assess effects of sex, age, body mass index, GOLD-stage, 6MWD, use of supplemental oxygen and use of walking aids.

RESULTS

Generally, the 6MWD improved (6MWT1: 343 ± 115m; 6MWT2: 367 ± 115m; 6MWT3: 381 ± 116m). 210 patients (18 %) improved ≥42m from 6MWT2 to 6MWT3. The Bland-Altman plot showed that the 95 % limits of agreement of 6MWT3 vs 6MWT2 exceeded 42m, indicating that 6MWT2 is not reproducible. Predictors of improvement in 6MWT3 were GOLD stage I/II and a low 6MWD (<350m) in the previous two 6MWTs.

CONCLUSIONS

These results indicate that three 6MWTs may be required to obtain the largest pre-PR functional capacity in COPD patients. Patients with a 6MWD <350m and GOLD-stage I/II are more likely to improve ≥42m in a third 6MWT.

The Responsiveness of Exercise Tests in COPD: A Randomized Controlled Trial

BACKGROUND

COPD is characterized by reduced exercise tolerance, and improving physical performance is an important therapeutic goal. A variety of exercise tests are commonly used to assess exercise tolerance, including laboratory and field-based tests. The responsiveness of these various tests to common COPD interventions is yet to be compared, but the results may inform test selection in clinical and research settings.

RESEARCH QUESTION

What exercise test possesses the greatest sensitivity to change from before to after intervention in patients with COPD?

STUDY DESIGN AND METHODS

One hundred fifty-four patients with symptomatic COPD were recruited and randomized (2:1:1) to 6 weeks of long-acting muscarinic antagonist, pulmonary rehabilitation (PR), or usual care. Before and after intervention, participants performed an incremental cycle exercise test and constant work rate cycle test (CWRCT), incremental shuttle walk test and endurance shuttle walk test (ESWT), 6-min walk test, and 4-m gait speed test.

RESULTS

One hundred three participants (mean ± SD age, 67 ± 8 years; 75 male participants [73%]; FEV1, 50.6 ± 16.8% predicted) completed the study. Significant improvements in the incremental cycle exercise test, CWRCT, incremental cycle exercise test, ESWT, and 6-min walk test results were observed after PR (P < .05), with the greatest improvements seen in the constant work rate protocols (percentages change: CWRCT, 42%; ESWT, 41%).

INTERPRETATION

The ESWT and CWRCT seemed to be the most responsive exercise test protocols to long-acting muscarinic antagonist and PR therapy. The magnitude of change was much greater after a program of rehabilitation compared with bronchodilator therapy.

CLINICAL TRIAL REGISTRY

International Standard Randomised Controlled Trial Number (ISRCTN): No. 64759523; URL: https://www.isrctn.com/ISRCTN64759523.

Cardiopulmonary Exercise Testing, Rehabilitation, and Exercise Training in Postpulmonary Embolism

Long-term exercise intolerance and functional limitations are common after an episode of acute pulmonary embolism (PE), despite 3 to 6 months of anticoagulation. These persistent symptoms are reported in more than half of the patients with acute PE and are referred as "post-PE syndrome." Although these functional limitations can occur from persistent pulmonary vascular occlusion or pulmonary vascular remodeling, significant deconditioning can be a major contributing factor. Herein, the authors review the role of exercise testing to elucidate the mechanisms of exercise limitations to guide next steps in management and exercise training for musculoskeletal deconditioning.

Expiratory muscle strength training reduces oxidative stress and systemic inflammation in men with obstructive sleep apnea syndrome: a double-blinded, randomized parallel trial

STUDY OBJECTIVES

This study aimed to evaluate and compare the effects of high and low-intensity expiratory muscle strength training (EMST) on disease severity, systemic inflammation, oxidative stress, respiratory muscle strength, exercise capacity, symptoms, daytime sleepiness, fatigue severity, and sleep quality in male patients with obstructive sleep apnea syndrome (OSAS).

METHODS

Thirty-one male patients diagnosed with moderate OSAS were included in this double-blind, randomized, parallel study. Patients were randomized into two groups: High-EMST and Low-EMST groups. EMST was used at home 7 days/week, once a day, for 25 breaths, 12 weeks. Respiratory muscle strength was measured using a mouth pressure device. Disease severity (Apnea-Hypopnea Index [AHI]) and, respiratory sleep events by polysomnography, total oxidant level(TOS), total antioxidant level(TAS), oxidative stress index (OSI), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels by blood serum were evaluated.

RESULTS

The percentage of AHI change in the high-EMST group(50.8%) was significantly higher than in the low-EMST group(6.3%; p = .002, d = 1.31). In general, as MEP increased by one unit, AHI decreased by 0.149 points (b = -0.149; CR = -3.065; p = .002), and as AHI increased by one unit, ODI increased by 0.746 points (b = 0.746; CR = 10.604; p < .001). TOS, OSI, TNF-α and IL-6 levels decreased at similar rates in both groups.

CONCLUSIONS

EMST significantly reduces systemic inflammation and oxidative stress while improving expiratory muscle strength in male patients with moderate OSAS. High-EMST is more effective in enhancing the severity of disease than low-EMST. EMST is a practical, effective, and promising treatment for pulmonary rehabilitation in patients with moderate OSAS.

CLINICAL TRIALS

Effect of EMST systemic inflammation and oxidative stress in patients with moderate OSAS, https://clinicaltrials.gov/study/NCT05242406, with the number NCT05242406.

Effect of Pilates exercises on pulmonary function, respiratory muscle strength, and functional capacity in patients with inhalation injury after flame thermal burn: A prospective randomized controlled trial

BACKGROUND

Inhalation injury is an acute respiratory tract injury that occurrs by inhalation of smoke, toxic gases, or steam. Early management is needed to reduce its mortality and morbidity. The purpose of this study was to ascertain whether Pilates training could help burn patients with inhalation injury after flame thermal burn in increasing pulmonary function, respiratory muscle strength, and functional ability.

METHODS

In this prospective, randomized, controlled trial, sixty participants (26 males and 34 females) with inhalation injury and deep partial-thickness flame burns of 30-40 % total body surface area (TBSA) were randomized in blocks of four, with a 1:1 allocation ratio into two groups: Group A (Pilates Group); received Pilates training plus conventional physical therapy program, and Group B (Control Group); received conventional physical therapy program only. This study was conducted at the Faculty of Physical Therapy's outpatient clinic, Cairo University, 3 sessions/week for 12 weeks. The primary outcome measure was the forced vital capacity (FVC) measured by a spirometer, while the secondary outcome measures were peak expiratory flow rate (PEFR), forced expiratory volume in 1 s (FEV1), FEV1/FVC% assessed by a spirometer, strength of respiratory muscles (maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) assessed by the digital manovacuometer, and the functional capacity evaluated by 6-Minute Walk Test (6-MWT).

RESULTS

A two-way mixed-design MANOVA was used to analyze the results within and between groups. There were no significant differences in demographic data between groups (P > 0.05). There were significant differences in all variables after treatment in group A compared with group B; FVC (95 % CI: 0.38, 1.13) (P = 0.001), FEV1 (95 % CI: 0.39, 0.97) (P = 0.001), FEV1/FVC % (95 % CI: 1.90, 17.19) (P = 0.02), PEFR (95 % CI: 0.47, 0.99) (P = 0.001), MIP (95 % CI: 5.12, 11.44) (P = 0.001), MEP (95 % CI: 2.57, 8.24) (P = 0.001), 6-MWT (95 % CI: 27.22, 54.96) (P = 0.001), FVC (% predicted) (95 % CI: 3.58, 12.58) (P = 0.001), FEV1 (% predicted) (95 % CI: 1.21, 11.11) (P = 0.02), PEFR (% predicted) (95 % CI: 1.33, 10.83) (P = 0.01), MIP (% predicted) (95 % CI: 2.26, 11.72) (P = 0.001) and MEP (% predicted) (95 % CI: 1.33, 10.37) (P = 0.01).

CONCLUSION

The current study demonstrated that a Pilates exercise program in addition to a traditional physical therapy program for 12 weeks significantly improved the pulmonary function (FVC, FEV1, PEFR and FEV1/FEV), strength of respiratory muscles (MIP and MEP), and functional capacity (6-MWT) in patients with inhalation injury after flame burns. These results underscore the importance of including Pilates exercises in the rehabilitation plan for burn patients with inhalation injury. Future studies are needed to evaluate the effect of Pilates exercises on other degrees and TBSA of burn, long-term follow up, and to measure cardiopulmonary parameters.

Percent Predicted vs. Absolute Six-Minute Walk Distance as Predictors of Lung Transplant-Free Survival in Fibrosing Interstitial Lung Diseases

INTRODUCTION

Fibrosing interstitial lung diseases (ILDs) often progress despite treatment and become life-threatening, with lung transplant (LTx) remaining the only curative option. Six-minute walk distance (6MWD) is increasingly recognized as reliable predictor of clinical course, especially when longitudinally considered. The use of reference equations to express 6MWD as percent predicted (6MWD%) has not been previously studied in fibrosing ILDs. We sought to investigate whether the prognostic power of 6MWD% is superior to that of 6MWD expressed in meters (6MWD-m).

METHODS

A retrospective, multicenter cohort analysis was conducted on both idiopathic pulmonary (IPF) and non-IPF fibrosing ILD patients. Patients were divided into a discovery (n = 211) and a validation (n = 260) cohort. Longitudinal changes of 6MWD% and lung function parameters were simultaneously considered. LTx-free survival at 3 years from baseline was the endpoint. Competing risks of death and LTx were considered.

RESULTS

Baseline 6MWD% and its longitudinal changes were significant predictors of LTx-free survival and independent from lung function variables. In both cohorts, on multivariate cox proportional hazard regression analysis, receiver operating characteristics analysis and Kaplan-Meier estimates, 6MWD% was consistently, but only slightly superior to 6MWD-m as a predictor of LTx-free survival.

CONCLUSION

6MWD% has only a slight, yet detectable advantage over 6MWD-m as a predictor of survival in fibrosing ILDs. Utilizing 6MWD% may aid in risk stratification, treatment monitoring, and LTx timing optimization. However, available reference equations do have predicting limitations. Refined predictive equations and standardizing reporting practices are therefore needed to further enhance the clinical utility of 6MWD% in fibrosing ILDs.

Assessment of novel cardiovascular biomarkers in chronic obstructive pulmonary disease

BACKGROUND

Cardiovascular disease is a common comorbidity in chronic obstructive pulmonary disease (COPD) and pre-COPD patients, contributing significantly to morbidity and mortality. We aimed to investigate whether Galectin-3 (Gal-3) levels correlate with cardiovascular biomarkers and cardiopulmonary function in COPD and pre-COPD patients to assess its potential role as a marker for cardiovascular comorbidity.

METHODS

Community-dwelling adults with and without COPD were recruited. Biomarkers including Gal-3, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured. Subjects underwent pulmonary function tests, chest CT, echocardiograms, and a 6-minute walking test. The relationships between biomarkers and cardiopulmonary function were examined.

RESULTS

Among 120 subjects (97 COPD, 23 pre-COPD), the mean age was 70.2 years, and the mean predicted forced expiratory volume in 1 s (FEV1%) was 68.5%. Gal-3 levels averaged 1733.7 pg/mL. Gal-3 significantly correlated with NT-proBNP (ρ = 0.229, p = 0.012) and negatively with maximal pulse rate during the 6-minute walking test (ρ=-0.185, p = 0.043). No significant correlation was found between Gal-3 and hs-cTnT levels. However, hs-cTnT levels showed significant negative correlations with age (ρ=-0.526, p < 0.001), FEV1% (ρ=-0.373, p < 0.001), E/A ratio (ρ=-0.390, p < 0.001), and walking distance (ρ=-0.444, p < 0.001), and positive correlations with deceleration time (ρ = 0.299, p = 0.001), right ventricular systolic pressure (ρ = 0.197, p = 0.037), and high-sensitivity C-reactive protein (ρ = 0.212, p = 0.020).

CONCLUSIONS

Gal-3 levels show correlations with NT-proBNP and maximal pulse rate, supporting its investigation as a potential marker for cardiovascular comorbidity in COPD and pre-COPD populations.

Relationship between high-resolution computed tomography quantitative imaging analysis and physiological and clinical features in antisynthetase syndrome-related interstitial lung disease

OBJECTIVES

To explore the association between the extent of CT abnormalities by quantitative imaging analysis (QIA) and clinical/physiological disease parameters in patients with antisynthetase syndrome associated interstitial lung disease (ARS-ILD).

METHODS

We analysed 20 patients with antisynthetase antibodies and active ILD enrolled in the Abatacept in Myositis-Associated Interstitial Lung Disease study. High-resolution chest CT was obtained at weeks 0, 24 and 48 and QIA scored the extent of ground glass (quantitative score for ground glass), fibrosis (quantitative score for lung fibrosis, QLF) and total ILD (quantitative ILD, QILD). Mixed-effects models estimated longitudinal QIA scores over time. Associations between QIA scores with clinical/physiological parameters were analysed longitudinally using repeated-measures mixed-effects models.

RESULTS

Patients were median age 57 years, 55% males and 85% white. Higher (worse) baseline QIA scores correlated with lower baseline forced vital capacity (FVC) and diffusing capacity adjusted for haemoglobin (DLCO). Longitudinal QIA trajectories trended towards improving scores during the trial, and patients on O2 at baseline had worsening QIA trajectories which were different from patients who were not on O2. Longitudinal QIA scores demonstrated strong associations with both FVC and DLCO over time. Higher QILD scores over time were also associated with worse dyspnoea scores, pulmonary visual analogue scale, physician and patient global disease activity, health status in 6/8 domains of the Short Form-36 and higher oxygen requirements. Patients with significant radiographic improvement at 48 weeks had higher baseline QLF, QILD and worse DLCO.

CONCLUSIONS

Longitudinal QIA scores associate with lung physiology, patient perception of respiratory status, overall disease activity and quality of life over time in ARS-ILD. QIA may allow reproducible monitoring of disease progression and response to therapy over time.

TRIAL REGISTRATION NUMBER

NCT03215927.

Functional exercise capacity in patients with ankylosing spondylitis

OBJECTIVE

This study aimed to measure the functional exercise capacity of patients with ankylosing spondylitis (AS) with the incremental shuttle walk test (ISWT), and to determine the factors associated with this test.

METHODS

This cross-sectional study included 54 patients with AS (29 males, 25 females). The ISWT was performed to determine functional exercise capacity. The number of completed shuttles was recorded, and the total incremental shuttle walk distance (ISWD) was calculated. Disease activity was assessed with the Bath AS Disease Activity Index (BASDAI), physical functioning was assessed with the Bath AS Functional Index (BASFI), and spinal mobility was assessed with the Bath AS Mobility Index (BASMI). Upper body and core endurance were assessed by sit-up and push-up tests. Tests were performed in a single session in the order listed.

RESULTS

The mean ISWD of the patients was 462.41 ± 97.96 m, and the subjects reached 50.48% of the predicted ISWD. The ISWD of male subjects was significantly higher than that of females (p < .05). At the end of the test, male subjects reached 60.87% of the age-predicted maximal heart rate, and female subjects reached 55.25%. There was a significant positive moderate correlation between ISWD and height (r = 0.535, p < .01), sit-up test (r = 0.617, p < .01), and push-up test (r = 0.495, p < .01), while there was a negative weak correlation between BASFI (r = -0.344, p = .011) and BASMI (r = -0.280, p = .040).

CONCLUSION

The study showed that functional exercise capacity as assessed by the ISWT decreased in patients with AS. ISWT performance was associated with sex, height, functionality, spinal mobility, and muscular endurance.

Unsupervised Exercise in Interstitial Lung Disease: A Delphi Study to Develop a Consensus Preparticipation Screening Tool for Lymphangioleiomyomatosis

BACKGROUND

Little research is available to provide practical guidance to health care providers for exercise preparticipation screening and referral of patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), to participate in remote, unsupervised exercise programs.

RESEARCH QUESTION

What exercise preparticipation screening steps are essential to determine whether a patient with LAM is medically appropriate to participate in a remote, unsupervised exercise program?

STUDY DESIGN AND METHODS

Sixteen experts in LAM and ILD participated in a two-round modified Delphi study, ranking their level of agreement for 10 statements related to unsupervised exercise training in LAM, with an a priori definition of consensus. Additionally, 60 patients with LAM completed a survey of the perceived risks and benefits of remote exercise training in LAM.

RESULTS

Seven of the 10 statements reached consensus among experts. Experts agreed that an in-person clinical exercise test is indicated to screen for exercise-induced hypoxemia and prescribe supplemental oxygen therapy as indicated prior to initiating a remote exercise program. Patients with recent pneumothorax should wait to start an exercise program for at least 4 weeks until after resolution of pneumothorax and clearance by a physician. Patients with high cardiovascular risk for event during exercise, severe resting pulmonary hypertension, or risk for falls may be more appropriate for referral to a rehabilitation center. A LAM-specific remote exercise preparticipation screening tool was developed from the consensus statements and agreed upon by the panelists.

INTERPRETATION

A modified Delphi study approach was useful to develop disease-specific recommendations for safety and preparticipation screening prior to unsupervised, remotely administered exercise in LAM. The primary product of this study is a clinical decision aid for providers to use when medically screening patients prior to participation in the newly launched LAMFit remote exercise program.

Evaluation of maximal exercise capacity through the incremental shuttle walking test in lymphangioleiomyomatosis

BACKGROUND

The cardiopulmonary exercise test (CPET) is the gold standard for assessing aerobic fitness; however, it is expensive, not widely available, and requires specialized equipment and staff. The incremental shuttle walking test (ISWT) is an exercise field test used to evaluate exercise capacity and may be an alternative to CPET in patients with lymphangioleiomyomatosis (LAM).

OBJECTIVE

To investigate whether the ISWT can be used to assess maximal aerobic capacity in patients with LAM.

METHODS

Forty-five women were evaluated on two days, and they randomly performed the CPET and ISWT. The maximum oxygen uptake (peak VO2) was evaluated using gas analyzers in both tests. The carbon dioxide production (VCO2), respiratory exchange ratio (RER), and heart rate (HR) were compared during peak exercise. Pearson's correlation and Bland-Altman assessed the association and agreement, respectively. The intraclass correlation coefficient (ICC) was used to assess the reliability of the data.

RESULTS

All patients (46.1 ± 10.2 years) presented similar peak VO2, RER, and peak HR during the CPET and ISWT (15.6 ± 4.6 vs. 15.7 ± 4.4 ml·kg-1·min-1; 1.15±0.09 vs. 1.17±0.12; and 142.2 ± 18.6 vs. 141.5 ± 22.2 bpm, respectively; p>0.05). A good linear correlation (r = 0.79; p<0.001) and ICC (0.86; 95%CI 0.74-0.93) were observed between the peak VO2 in both tests. Predictive peak VO2 equations based on the ISWT performance are also presented.

CONCLUSION

Our results suggest that the ISWT can be used to assess maximal exercise performance in patients with LAM, and it is a valuable option to be used as an alternative to the CPET and predict maximal exercise capacity.

Clinimetric Properties of the Steep Ramp Test to Assess Cardiorespiratory Fitness, Its Underlying Physiological Responses, and Its Current Applications: A Scoping Review

OBJECTIVE

Providing an overview of the clinimetric properties of the steep ramp test (SRT)-a short-term maximal exercise test-to assess cardiorespiratory fitness (CRF), describing its underlying physiological responses, and summarizing its applications in current clinical and research practice.

DATA SOURCES

MEDLINE (through PubMed), CINAHL Complete, Cochrane Library, EMBASE, and PsycINFO were searched for studies published up to July 2023, using keywords for SRT and CRF.

STUDY SELECTION

Eligible studies involved the SRT as research subject or measurement instrument and were available as full text articles in English or Dutch.

DATA EXTRACTION

Two independent assessors performed data extraction. Data addressing clinimetric properties, physiological responses, and applications of the SRT were tabulated.

DATA SYNTHESIS

In total, 370 studies were found, of which 39 were included in this study. In several healthy and patient populations, correlation coefficients between the work rate at peak exercise (WRpeak) attained at the SRT and oxygen uptake at peak exercise during cardiopulmonary exercise testing (CPET) ranged from .771-.958 (criterion validity). Repeated measurements showed intraclass correlation coefficients ranging from .908-.996 for WRpeak attained with the first and second SRT (test-retest reliability). Physiological parameters, like heart rate and minute ventilation at peak exercise, indicated that the SRT puts a lower burden on the cardiopulmonary system compared to CPET. The SRT is mostly used to assess CRF, among others as part of preoperative risk assessment, and to personalize interval training intensity.

CONCLUSIONS

The SRT is a practical short-term maximal exercise test that is valid for CRF assessment and to monitor changes in CRF over time in various healthy and patient populations. Its clinimetric properties and potential applications make the SRT of interest for a widespread implementation of CRF assessment in clinical and research practice and for personalizing training intensity and monitoring longitudinal changes in CRF.

Clinimetric properties of field exercise tests in cystic fibrosis: a systematic review

OBJECTIVES

Accurate measurement of exercise capacity is an important prognostic indicator for people with cystic fibrosis (pwCF); however, gold-standard, cardiopulmonary exercise tests are commonly unavailable. This review systematically describes the clinimetric properties of field exercise tests for pwCF.

METHODS

A systematic review was undertaken for studies reporting field exercise tests in pwCF. Four electronic databases were searched for studies published from 1990 to January 2024. Where available, clinimetric properties reported included reliability, validity, responsiveness and interpretability.

RESULTS

4041 studies were identified with 153 eligible for inclusion. 10 different field exercise tests were described, including six walk/run tests (incremental shuttle walk test (ISWT), modified shuttle test-15 levels (MST-15), MST-25 levels (MST-25), 20-m shuttle test, 6-min walk test (6MWT) and 12-min walk test (12MWT)), three step tests (3-min step test (3MST), incremental step test and Alfred step test (A-STEP)) and the 1-min sit-to-stand test (1STS). Reliability was found for the ISWT, MST-15, 6MWT, 1STS and 3MST (intraclass correlation coefficients >0.80). The ISWT, MST-15 and 6MWT were found to be valid (concurrent and discriminate). Responsiveness was supported for the 6MWT only. Four tests (MST-15, 6MWT, 3MST and 1STS) demonstrated ceiling effects.

CONCLUSION

This review supports the reliability, validity and responsiveness of the 6MWT in pwCF. The ISWT and MST-15 were found to be valid. The 1STS is reliable and feasible, but its utility is limited by ceiling effects. The 3MST, MST-25, 20-m shuttle test, incremental step test, A-STEP and 12MWT require further investigations of their clinimetric properties.

Does cognitive function affect functional capacity and perceived fatigue severity after exercise in patients with coronary artery disease?

BACKGROUND & OBJECTIVE

Successful execution of exercise-based cardiac rehabilitation programs, an important branch of physiotherapy in individuals with coronary artery disease (CAD), depends on adequate cognitive abilities. It has been identified that coronary microvascular dysfunction, marked by reduced coronary flow reserve, is associated with impaired cerebral blood flow, affecting haemodynamic and cognitive performance. This study aimed to investigate how cognitive function influences functional capacity and differences in fatigue perception in CAD patients.

METHODS

Fifty CAD patients, with an average age of 59.40 ± 6.58 years, were evaluated for comorbidities (Charlson comorbidity index), number of CAD risk factors (hypertension, diabetes mellitus, dyslipidaemia, smoking, and physical inactivity), cognitive performance (Montreal cognitive assessment scale [MoCA]), functional capacity (incremental shuttle walk test [ISWT]), exercise-induced fatigue (Modified Bourg Scale), and physical activity (PA) levels (international physical activity questionnaire-short form).

RESULTS

Analyses focused on the links between MoCA scores and CRF, ISWT outcomes, and differences in fatigue perception. Findings revealed a strong positive link between MoCA scores and ISWT performance (r = 0.83, p < 0.001), and a strong inverse relationship between CRF and MoCA scores (r = -0.95, p < 0.001). In addition, MoCA score was positively correlated with differences in fatigue perception (r = 0.88, p < 0.001).

CONCLUSION

These results highlight the critical role of cognitive function in determining functional capacity and managing fatigue in CAD patients. They also suggest that cognitive interventions may be a potential adjunctive approach in physiotherapy programmes.

Tele-rehabilitation in COVID-19 survivors (TERCOV): An investigator-initiated, prospective, multi-center, real-world study

INTRODUCTION

Center-based rehabilitation is limited by COVID-19 infectivity and social distancing policy. We hypothesized that discharged patients benefit from 8-week home-based tele-rehabilitation (tele-PR) using mobile phones and low-cost instruments.

METHODS

The TERCOV (Tele-rehabilitation in COVID-19 survivors) is an investigator-initiated, prospective, multi-center, real-world study. After proper assessment, 186 discharge patients received tele-PR by smartphone, including breathing exercise, respiratory muscle training, aerobic exercise, and resistance training. Physicians, physiotherapists, and nurses provided guidance through smartphone applications. The primary outcome was six-minute walk distance (6MWD). The secondary outcomes included hand grip, short physical performance battery, maximal inspiratory pressure, maximal expiratory pressure, self-rating anxiety/depression scale (SAS/SDS), 36-item short-form health survey (SF-36) and international physical activity questionnaire.

RESULTS

Dyspnea subgroups were more functionally impaired. After tele-PR, improvements were observed in exercise capacity(∆6MWD: 16.80 m, 95% CI 1.18-32.42, p < 0.0001), limb muscle function (∆SPPB 0.25 points, 95% CI 0.05-0.46), respiratory muscle strength (∆MIP 16.50 cm H2O, 95% CI 9.22-23.78, p < 0.0001; ∆MEP: 12.09 cm H2O, 95% CI 3.48-20.70, p = 0.0002), health-related quality of life (∆SF-36 49.85, 95% CI: 21.01-78.69, p < 0.0001), physical activity(∆HEPA 13.01%, p = 0.0029). Anxiety reduced in patients with mMRC ≥ 2 (∆SAS = -4.19 points, CI -8.16 to -0.22, p = 0.03). Greater change was seen in dyspnea patients.

IMPLICATIONS ON PHYSIOTHERAPY PRACTICE

Supervised/semi-supervised tele-PR is a promising option during the pandemic. Patients with Dyspnea benefit more.

Significance of Physical Exercise in Pregnancy: Comparison of Short and Long Exercise Programs

BACKGROUND

Several musculoskeletal changes occur in pregnancy, particularly in the abdominal region. The aim of this study was to search and compare the effects of long (LEP) and short exercise programs (SEP) in terms of the satisfaction of the needs of pregnant women.

METHODS

This study consisted of 2 groups: LEP (n=16) and SEP (n=16). Muscle thickness measurements determined by ultrasound, the 6 minute walk test, Pregnancy Physical Activity Questionnaire, Visual Analogue Scale, Oswestry Disability Index, and Short Form-36 Quality of Life Questionnaire were the study variables. Evaluations were done at the 16th (baseline), 24th, and 32nd gestational weeks. The LEP consisted of 20 and the SEP consisted of 9 exercises, which were applied for 16 weeks until the 32nd gestational week.

RESULTS

Emotional role limitation and pain scores of quality of life, 6 minute walk test, and occupational physical activity were found to be better in the LEP group at the 24th gestational week (p=0.043, p=0.049, p=0.049, p=0.026). At the 32nd gestational week, the 6 minute walk test and occupational physical activity were found to be higher in the LEP group (p=0.006, p=0.017). Additionally, rectus abdominis and bilateral diaphragm muscle thicknesses, "moderate intensity and sports physical activity" and "vitality and emotional well-being" were increased over time with the LEP (p+<+0.05 for all). On the other hand, unilateral diaphragm muscle thickness, sports physical activity level, and vitality were improved with the SEP (p+<+0.05 for all).

CONCLUSIONS

The SEP and LEP both have beneficial effects in pregnant women. However, the LEP increases physical activity level, functional capacity, and quality of life more than the SEP during the later stages of pregnancy.

Comparison of exercise capacity and physical activity in patients with hyperthyroidism and controls

BACKGROUND

Hyperthyroidism impairs muscle mitochondrial metabolism and destroys many body systems. However, information is limited on how much physical and physiological outcomes are impaired in patients with newly diagnosed hyperthyroidism (NDH) and euthyroid. The comparison of pulmonary function, functional exercise capacity, respiratory muscle strength and endurance, physical activity levels (PAL), dyspnea, and quality of life (QoL) in patients and healthy controls was aimed.

METHOD

Sixteen patients with hyperthyroidism (evaluated twice at new diagnosis and euthyroid state) and healthy controls were compared. Pulmonary function was evaluated with a spirometer, functional exercise capacity with a 6-min walking test (6-MWT), respiratory muscle strength with a mouth pressure device and endurance with threshold loading test, PAL with metabolic holter, dyspnea with Modified Medical Research Council (MMRC) scale, and QoL with Quality of Life in Thyroid Patients Scale (ThyPRO).

RESULTS

Six-MWT distance and respiratory muscle endurance significantly decreased, and MMRC dyspnea scale and ThyPRO scores were higher in patients with NDH and euthyroid compared to controls (p < 0.05). In addition, maximum inspiratory pressure and maximum expiratory pressure significantly decreased in patients with NDH compared to controls, and PAL was less active according to the number of steps in euthyroid patients (p < 0.05). The pulmonary function test was similar in both groups (p > 0.05).

CONCLUSION

Exercise capacity, respiratory muscle strength and endurance, PAL, dyspnea, and QoL were affected in patients. Patients with hyperthyroidism should be evaluated at the onset of diagnosis, followed up, and referred to cardiopulmonary rehabilitation programs at the earliest. ClinicalTrials number: NCT04825964.

Patient-managed interventions for adults with bronchiectasis: evidence, challenges and prospects

Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronic sputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused by various aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause. This review consolidates the existing evidence on patient-managed interventions for adults with bronchiectasis, while also outlining areas for future research. Airway clearance techniques and hyperosmolar agents are key components of the bronchiectasis management and consistently recommended for clinical implementation. Questions around their prescription, such as optimal sequence of delivery, are still to be answered. Pulmonary rehabilitation and exercise are also recommended for patients with bronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage of the disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear. Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack of consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence base. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Although managing cough in bronchiectasis may initially appear risky, further research is necessary to ascertain whether strategies employed in other respiratory conditions can be safely and effectively adapted to bronchiectasis, particularly through identifying patient responder populations and criteria where cough may not enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition of the importance of patient-managed interventions in the bronchiectasis management. Efforts to improve research methodologies and increase research funding are needed to further advance our understanding of these interventions, and their role in optimising patient care and outcomes.

Validation of the Late-Life Function and Disability Instrument in People Living with COPD

BACKGROUND

Disability and loss of function are acknowledged as important problems for people living with COPD, but there is a need for validated tools to assess them.

RESEARCH QUESTION

The Late-Life Function and Disability Instrument (LLFDI) was originally validated for community-dwelling older adults. The full instrument has not been validated to assess disability and loss of function in people with COPD.

METHODS

People with COPD from 6 European countries completed the LLFDI as part of an observational study. Its validity was assessed in terms of 1) levels and distribution of LLFDI domain and subdomain scores; 2) floor and ceiling effects; 3) instrument structure (3 domains, 7 subdomains) by confirmatory factor analysis; and 4) construct validity by (i) convergent validity, based on Spearman correlation with COPD-relevant and related constructs (functional exercise capacity, severity of dyspnea and COPD-related health status), and (ii) known-groups validity, based on the distribution of LLFDI scores according to COPD-meaningful groups (disease severity, age groups and use of a walking aid).

RESULTS

The study included 605 participants (aged 68±8 years, 37% female, FEV1 54±20%pred.). Most had impaired disability and function levels. We observed no floor effects and a ceiling effect in only two subdomains. Confirmatory factor analysis showed a moderate model fit for all LLFDI domains. Most of the correlations met our hypotheses (73%), with moderate to strong correlations for function domain (r min-max 0.25-0.70), followed by disability-limitation domain (r min-max 0.15-0.54), and weakest correlations in the disability-frequency domain (r min-max 0.04-0.41). The disability-limitation and function domains differed by disease severity, age group and use of a walking aid. The disability-frequency domain differed by disease severity and use of a walking aid, but not by age groups.

CONCLUSION

The LLFDI, a valid patient-reported outcome to investigate disability and function, has proven good construct validity in people with COPD.

A Pilot Study on the Effects of Exercise Training on Cardiorespiratory Performance, Quality of Life, and Immunologic Variables in Long COVID

Objectives: Fatigue is a prominent feature of long COVID (LC) and may be related to several pathophysiologic mechanisms, including immune hyperstimulation. Aerobic endurance exercise training may be a useful therapy, with appropriate attention to preventing post-exertional malaise. Methods: Fourteen participants completed a pilot study of aerobic exercise training (twenty 1.5 h sessions of over 10 weeks). Cardiorespiratory fitness, 6 min walk distance, quality of life, symptoms, 7-day physical activity, immunophenotype, and inflammatory biomarkers were measured before and after exercise training. Results: The participant characteristics at baseline were as follows: 53.5 ± 11.6 yrs, 53% f, BMI 32.5 ± 8.4, 42% ex-smokers, 15.1 ± 8.8 months since initial COVID-19 infection, low normal pulmonary function testing, V.O2peak 19.3 ± 5.1 mL/kg/min, 87 ± 17% predicted. After exercise training, participants significantly increased their peak work rate (+16 ± 20 W, p = 0.010) and V.O2peak (+1.55 ± 2.4 mL/kg/min, p = 0.030). Patients reported improvements in fatigue severity (-11%), depression (-42%), anxiety (-29%), and dyspnea level (-46%). There were no changes in 6MW distance or physical activity. The circulating number of CD3+, CD4+, CD19+, CD14++CD16, and CD16++CD14+ monocytes and CD56+ cells (assessed with flow cytometry) increased with acute exercise (rest to peak) and was not diminished or augmented by exercise training. Plasma concentrations of TNF-α, IL-6, IL-8, IL-10, INF-γ, and INF-λ were normal at study entry and not affected by training. Conclusions: Aerobic endurance exercise training in individuals with LC delivered beneficial effects on cardiorespiratory fitness, quality of life, anxiety, depression, and fatigue without detrimental effects on immunologic function.

The Importance of the Concentration of Selected Cytokines (IL-6, IL-10, IL-12, IL-15, TNF-α) and Inflammatory Markers (CRP, NLR, PLR, LMR, SII) in Predicting the Course of Rehabilitation for Patients after COVID-19 Infection

BACKGROUND/OBJECTIVES

In the course of COVID-19, there may be an excessive immune response of the body with the release of large amounts of pro-inflammatory cytokines, causing a "cytokine storm", also known as cytokine release syndrome (CRS). The COVID-19 pandemic has shown how important an integrated approach to health care is, with physiotherapy being one of its fundamental aspects. The aim of this study was to analyze the potential relationship between the level of selected cytokines (IL-6, IL-10, IL-12, IL-15, TNF-α) and inflammatory markers (CRP, NLR, PLR, LMR, SII) and the duration of rehabilitation in patients after COVID-19.

METHODS

The examined patients participated in a comprehensive rehabilitation program, which included breathing exercises, aerobic training, and strength and endurance training. Peripheral venous blood samples were also collected from each patient.

RESULTS

Factors such as gender, smoking status, IL-10, and the presence of pneumonia during infection were significantly associated with the length of rehabilitation after COVID-19.

CONCLUSIONS

The course of rehabilitation after COVID-19 may depend on many factors, including smoking, the presence of pneumonia due to infection, and some parameters of inflammation.

Diaphragm Muscle Atrophy Contributes to Low Physical Capacity in COVID-19 Survivors

Fatigue and dyspnea are the most commonly reported long-term complaints in individuals previously infected with SARS-CoV-2. This study aimed to comprehensively evaluate diaphragm muscle function in post-COVID-19 patients and investigate whether potential diaphragm dysfunction contributes to physical functioning impairment. A total of 46 patients who qualified for pulmonary rehabilitation were examined. Diaphragm muscle function parameters were evaluated using ultrasonography, while the severity of dyspnea, aerobic capacity, and the amount of energy used by the body during physical activity were assessed using the six-minute walk test, mMRC scale, and Metabolic Equivalent Task (MET), respectively. We identified that 69.5% of patients had diaphragm atrophy and 6.5% had diaphragm paralysis. The percentage of atrophy was not related to age, gender, BMI, oxygen therapy usage during the COVID-19 infection course, and disease severity. Patients who experienced cough, fever, and no loss of smell during the COVID-19 course had significantly greater diaphragm inspiratory thickness values, while patients with cough and no smell disorders had a significantly lower percentage of diaphragm atrophy. Diaphragm functional parameters were strongly associated with selected variables of exercise tolerance, such as distance in the six-minute walk test, oxygen saturation levels, fatigue, and exertion on the Borg scale. In conclusion, diaphragm muscle dysfunction is a serious long-term post-COVID-19 consequence and can be viewed as a major contributing factor to prolonged functional impairments.

Developing normative values and predictive models for the 6-minute walk test across diverse adolescent developmental stages

The six-minute walking test (6MWT) is commonly used to measure functional capacity in field settings, primarily through the distance covered. This study aims to establish reference curves for the six-minute walking distance (6MWD) and peak heart rate (PHR) and develop a predictive equation for cardiovascular capacity in Tunisian children and adolescents. A total of 1501 participants (706 boys and 795 girls), aged 10-18 years, were recruited from schools in Tunisia. The Lambda (L), Mu (M), and Sigma (S) methods (LMS method) were employed to develop smoothed percentile curves for 6MWD and PHR. Multivariate linear regression was utilized to formulate a prediction equation for 6MWD. Smoothed percentiles (3rd, 10th, 25th, 50th, 75th, 90th, and 97th) for 6MWD and PHR were presented with age. All variables showed a strong positive correlation (p < 0.001) with a six-minute walking distance (r ranged from 0.227 to 0.558 for girls and from 0.309 to 0.610 for boys), except resting heart rate, which showed a strong negative correlation (girls: r = -0.136; boys: r = -0.201; p < 0.001). Additionally, PHR showed a weak correlation (p > 0.05). The prediction equations, based on age as the primary variable, were established for both genders. For boys: 6MWD = 66.181 + 38.142 × Age (years) (R2 = 0.372; Standard Error of Estimate (SEE) = 122.13), and for girls: 6MWD = 105.535 + 28.390 × Age (years) (R2 = 0.312; SEE = 103.66). The study provides normative values and predictive equations for 6MWD and PHR in Tunisian children and adolescents. These findings offer essential tools for identifying, monitoring, and interpreting cardiovascular functional deficits in clinical and research settings.

Physical therapy management of an individual with post-COVID fatigue considering emotional health in an outpatient setting: A case report

PURPOSE

The purpose of this case report is to provide a plan of care with an emphasis on patient education and consideration of emotional health for a patient with post-COVID fatigue in an outpatient setting.

CASE DESCRIPTION

A 50-year-old woman, ten-weeks post-COVID syndrome, participated in an examination that revealed deficits in exercise capacity, strength, breathing pattern, mild depression, emotional breakdown, and mild anxiety accompanied by "brain fog" with activity. Her primary complaint was fatigue with ordinary activities around her home that impeded her from returning to work. On examination, scores included six-minute walk test distance (6MWD): 79.5 m, UCSD Shortness of Breath Questionnaire (SOBQ): 72/120, and Patient Health Questionnaire (PHQ-9): 6/27. The patient participated in 20 biweekly sessions with a focus on patient education, supporting emotional health, aerobic training, strengthening exercises, breathing exercises, and home exercise program.

OUTCOMES

At discharge, the patient's exercise capacity, muscle strength, dyspnea, and depression improved, beyond the MCID/MID values, 6MWD: 335 m, SOBQ: 34/120; and PHQ-9 :1/27. The patient had no anxiety with activity and reported confidence to resume activities, allowing her to return to work safely.

CONCLUSION

Following an intervention that addressed emotional needs with physical symptoms, our patient with post-COVID fatigue showed substantial improvements in exercise capacity, muscle strength, dyspnea, and depression. This highlights the consideration of psychosocial well-being in our plan of care for this population.

Muscle function, exercise capacity, physical activity level and cardiovascular disease risk factor knowledge in patients with prolactinoma

OBJECTIVE

Prolactinoma can increase the risk of cardiovascular diseases (CVDs), such as arterial stiffness, atherosclerosis, dysrhythmia and heart failure. This study aimed to evaluate and compare muscle function, exercise capacity, physical activity (PA) level, CVD risk factor knowledge level, sleep quality, fatigue and quality of life between prolactinoma patients and healthy controls.

METHODS

Nineteen female patients with prolactinomas and 19 healthy women were included in this study. Quadriceps muscle strength (QMS) was measured using a hand dynamometer, and muscular endurance was evaluated via the squat test. The 6-minute walking test (6MWT) distance was also measured. CVD risk factor knowledge levels were evaluated with the Cardiovascular Diseases Risk Factors Knowledge Level Scale (CARRF-KL), PA levels were assessed with the International Physical Activity Questionnaire-short form (IPAQ), sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), fatigue was assessed with the Multidimensional Fatigue Rating Scale (MAF), and quality of life was assessed with the Short Form-36 questionnaire (SF-36).

RESULTS

Patients with prolactinomas had significantly lower 6MWT distances; CARRF-KL total scores; SF-36 general health and physical limitation scores; and higher IPAQ-sitting scores than did healthy controls (p < 0.05). Moreover, there were no significant differences between the groups in terms of QMS score; number of squats; severity of IPAQ score; severity, moderate, or total walking score; total PSQI score; or total MAF score (p > 0.05).

CONCLUSIONS

Exercise capacity and quality of life are adversely affected, and sedentary behavior is observed in prolactinomas. Patients with prolactinomas have less knowledge about CVD risk factors than healthy individuals. CVD incidence and knowledge and functional capacity should be improved in patients with prolactinomas by the use of a multidisciplinary team for cardiac rehabilitation.

CLINICAL TRIAL REGISTRATION

This study is part of a larger clinical trial registered on ClinicalTrials.gov prior to participant enrollment (NCT05236829).

Reference values for the 1-minute sit-to-stand and 5 times sit-to-stand tests to assess functional capacity: a cross-sectional study

OBJECTIVES

To establish age-specific and sex-specific reference values and equations for the 1-minute sit-to-stand (1MSTS) and 5 times sit-to-stand (5TSTS) tests for Portuguese adults.

DESIGN

Cross-sectional study. Descriptive statistics were explored to compute reference values and reference equations were established with a forward stepwise multiple regression.

SETTING

Community.

PARTICIPANTS

546 adult volunteers without disabilities [age range 18 to 95 years; 58% female] were recruited.

MAIN OUTCOME MEASURES

Data on age, sex, height, weight, body mass index (BMI), smoking status and physical activity were collected using a structured questionnaire developed specifically for this study.

PROCEDURE

Participants performed three repetitions of the 1MSTS and 5TSTS and the best repetition was used for analysis.

RESULTS

Normative values were provided by sex for each age decade. Reference equations were: 1MSTS= 61.53 - (0.34 x age) - (3.57 x sex) - (0.33 x BMI), r2 = 26%; and 5TSTS= 3.89 + (0.10 x age) - (0.96 x physical activity), r2 = 27%.

CONCLUSIONS

The proposed reference values and equations will help to interpret the results of functional capacity obtained from healthy or diseased adult populations. CONTRIBUTION OF THE PAPER.

[Effects of gender on pulmonary rehabilitation outcomes in patients with COPD]

INTRODUCTION

COPD has become more prevalent among women, revealing a specific feminine phenotype. Women experience greater dyspnea and a more impaired quality of life. The main objective of this study was to assess the effect of gender on dyspnea during a pulmonary rehabilitation program (PRP).

METHODS

Retrospective study including COPD patients having participated in PRPs. The following data were analyzed according to gender before and after a PRP: dyspnea, quality of life, anxiety and depression, exercise capacity, muscle function (quadriceps and inspiratory muscles).

RESULTS

More than 500 patients (252 men and 252 women) were included. We did not find a significant effect of gender on the evolution of dyspnea, anxiety or depressive disorders, exercise capacity, inspiratory muscle strength, or overall quality of life score. That said, we found a possible effect on the sub-scores of the quality of life questionnaire, and regarding quadriceps strength. All criteria improved during the program in both groups.

CONCLUSIONS

During a PRP, gender does not impact the evolution of dyspnea. While women may nonetheless benefit to a greater extent in terms of quality of life sub-scores (impact, activities, symptoms) and quadriceps strength, these results still require confirmation.

Association between the 6MWT and other measurements of physical functioning in patients with cancer awaiting major surgery

BACKGROUND

The Six Minute Walk Test (6MWT) is a widely used measure of functional capacity in (p)rehabilitation of cancer patients, but it is time-consuming and requires specific space conditions. In this study we explore the association between the 6MWT with other measurements of physical functioning and their predictive value in classifying patients according to their estimated functional capacity.

DESIGN

This prospective study included cancer patients referred to a prehabilitation programme prior to major surgery. For each patient, data on different measurements of physical functioning including the Duke Activity Status Index (DASI), the handgrip strength, the 30" Sit-to-Stand Test and self-reported physical activity levels were collected. Bivariate associations were performed to determine the association between the 6MWT and other variables. Multivariate analyses were performed to identify potential predictive factors of 6MWT in this population. A subsequent algorithm was developed to classify patients based on their functional capacity (good performance - 6MWT>400 m or poor performance 6MWT<400 m) RESULTS: Between mid-2018 to mid 2022, 692 patients were assessed of whom the 6MWT was performed in 524 (75.7 %) (mean age 72.5 ± 11.8 years; 57.1 % men). Moderate-to-strong correlations were found between 6MWT and 30" Sit-To-Stand Test (r = 0.54, p < 0.001), DASI (r = 0.68; p < 0.001) and handgrip strength (r = 0.5; p < 0.001). Multivariate analyses confirmed that a combination of six variables were able to classify 80 % of patients in good (>400 m) or poor (<400 m) performance in the 6MWT.

CONCLUSION

The 6MWT was moderately associated with several variables of physical functioning, a combination of which can be used to predict performance in the 6MWT.

Efficacy of a student-led interprofessional health clinic in regional Australia for preventing and managing chronic disease

Increasing chronic disease rates in regional Australian communities necessitates innovative models of healthcare. We evaluated the efficacy of an interprofessional chronic disease program, delivered within a regional student-led nursing and allied health clinic in Southern Queensland, Australia. Changes to anthropometric, aerobic fitness and strength, and quality of life outcomes were examined at four time points spanning 16 months: intake, program transition (4 months), 6 and 12 months (post-transition). Our primary aim was to investigate whether the health improvements achieved during the program were sustained at 12 months in a subset of participants who provided complete data. Significant improvements were found in 6 of 11 measures, including the 6-minute walk test, grip strength, and self-reported quality of life across physical and psychosocial dimensions, with these improvements maintained to final review. No significant changes were found in body mass index (BMI), waist circumference, fat mass, or muscle mass. This is the first health clinic in regional Australia to deliver a student-led model of interprofessional and collaborative service to tackle the increasing burden of chronic disease in the community. The cost-effectiveness of this service and other potential clinical and social benefits remain to be investigated.

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Assessment and monitoring of lung disease in patients with severe alpha 1 antitrypsin deficiency: a european delphi consensus of the EARCO group

BACKGROUND

Currently, there is conflicting information and guidance on the effective management of Alpha 1 Antitrypsin Deficiency (AATD). Establishing a consensus of assessment and disease management specific to AATD is important for achieving a standardized treatment pathway and for improving patient outcomes. Here, we aim to utilize the Delphi method to establish a European consensus for the assessment and management of patients with severe AATD.

METHODS

Two rounds of a Delphi survey were completed online by members of the European Alpha-1 Research Collaboration (EARCO). Respondents were asked to indicate their agreement with proposed statements for patients with no respiratory symptoms, stable respiratory disease, and worsening respiratory disease using a Likert scale of 1-7. Levels of agreement between respondents were calculated using a weighted average.

RESULTS

Round 1 of the Delphi survey was sent to 103 members of EARCO and 38/103 (36.9%) pulmonologists from across 15 countries completed all 109 questions. Round 2 was sent to all who completed Round 1 and 36/38 (94.7%) completed all 79 questions. Responses regarding spirometry, body plethysmography, high-resolution computed tomography, and the initiation of augmentation therapy showed little variability among physicians, but there was discordance among other aspects, such as the use of low-dose computed tomography in both a research setting and routine clinical care.

CONCLUSIONS

These results provide expert opinions for the assessment and monitoring of patients with severe AATD, which could be used to provide updated recommendations and standardized treatment pathways for patients across Europe.

Changes in COPD-related anxiety symptoms during pulmonary rehabilitation: a prospective quantitative and qualitative study

Background

Fear-avoidance in COPD can have detrimental effects on pulmonary rehabilitation (PR) outcomes and is therefore important to address. This prospective study examined changes in and management of COPD-related anxiety symptoms over the course of a PR program.

Methods

Patients with COPD referred to 9-weeks of PR in the municipality of Vejle, Denmark from January to December 2022 completed a six-minute walk test (6MWT) and the following questionnaires, both before and after PR: COPD Anxiety Questionnaire 20-item version (CAF-R), measuring COPD-related anxiety; COPD Assessment Test (CAT), measuring COPD-related disability; 12-Item Short-Form Health Survey (SF-12), measuring health-related quality of life (HR-QoL); sociodemographic and disease-related information. After PR, a subsample of the patients took part in semi-structured interviews exploring their understanding of how they managed COPD-related anxiety during PR. Pre- and post-assessment of COPD-related anxiety and other PR outcomes were analysed with t-tests and correlation analyses. Qualitative interviews were analysed using a thematic analysis approach.

Results

A total of 72 patients with COPD (mean ± SD age 71 ± 8, 53% female) were included in the study, and 13 took part in qualitative interviews. A significant decrease in COPD-related anxiety was observed from before to after PR, corresponding to a small effect size (Cohen's d = 0.32; p = 0.018). Reductions in COPD-related anxiety were not associated with improvements in COPD-related disability, HR-QOL, or functional exercise capacity. The qualitative findings identified four anxiety management strategies, i.e., "planning", "problem-solving", "accepting", and "confronting", which were influenced by interactions with healthcare professionals and co-patients as well as patients' own perception.

Conclusions

COPD-related anxiety symptoms was reduced after PR, potentially through the use of various management strategies. The strategies appeared to be influenced by interactional factors during the PR program.

Effect of Pulmonary Rehabilitation on Exercise Capacity, Dyspnea, Fatigue, and Peripheral Muscle Strength in Patients With Post-COVID-19 Syndrome: A Systematic Review and Meta-analysis

OBJECTIVE

To establish the effects of pulmonary rehabilitation (PR) in patients with persistent symptoms after COVID-19 infection. In addition, to compare the modalities of PR services (face-to-face and telerehabilitation) and the duration of PR in weeks (4-8 weeks and >8 weeks).

DATA SOURCES

PubMed/MEDLINE, Embase (Elsevier), Central/Cochrane Library, SciELO Citation Index (Web of Science), and CINAHL.

STUDY SELECTION

Studies determining the effects of PR in patients with post-COVID-19 syndrome were included and grouped according to PR delivery modality.

DATA EXTRACTION

Data extraction and quality assessment were independently performed by 2 reviewers. The methodological quality was assessed using the Cochrane Risk of Bias Tool 1 (RoB-1).

DATA SYNTHESIS

The literature search retrieved 1406 articles, of which 7 studies explored the effects of PR on patients with post-COVID-19 syndrome, with 188 patients randomized to PR. The mean age of participants was 50 years and 49% were women. Meta-analysis showed an increase in exercise capacity with PR compared with control (6-minute walking test: mean difference: 60.56 m, 95% confidence interval: 40.75-80.36), a reduction in fatigue (Fatigue Severity Scale: -0.90, -1.49 to -0.31) but no change in dyspnea (-0.57, -1.32 to 0.17) and muscle strength (3.03, -1.89 to 7.96). There were no differences between telerehabilitation and face-to-face PR regarding effects on peripheral muscle strength (P=.42), dyspnea (P=.83), and fatigue (P=.34). There were no differences between programs 4-8 weeks and >8 weeks regarding exercise capacity (P=.83), peripheral muscle strength (P=.42), and dyspnea (P=.76).

CONCLUSIONS

PR improves exercise capacity and reduces fatigue in patients with post-COVID-19 syndrome. Duration of PR (4-8 weeks vs > 8 weeks) or PR modality (telerehabilitation vs face-to-face) did not affect outcomes but data were limited and based on subgroup analysis. Further evidence is required to determine the optimal delivery mode and duration of PR for post-COVID-19 syndrome.

Exercise capacity prior to major cancer surgery: A cross-sectional observational study of the validity of the 6-minute walk and 30-second sit-to-stand tests

INTRODUCTION

Cardiopulmonary exercise testing (CPET) is the gold standard for measuring exercise capacity, however, it is resource intensive and has limited availability. This study aimed to determine: 1) the association between the 6-min walk test (6MWT) and the 30-s sit-to-stand test (30STS) with CPET peak oxygen uptake (VO2peak) and anaerobic threshold (AT) and 2) 6MWT and 30STS cut points associated with a higher risk of postoperative complications.

METHODS

A cross-sectional study, retrospectively analyzing data collected from a tertiary cancer center over a 23-month period. Measures included CPET VO2peak and AT, 6MWT and 30STS test. Correlations were used to characterize relationships between variables. Receiver operating characteristic curve analyses determined 6MWT and 30STS cut points that aligned with CPET variable cut points.

RESULTS

Note that, 156 participants were included. The 6MWT and 30STS displayed moderate correlations with VO2peak, rho = 0.65, p = 0.01 and rho = 0.52, p < 0.005 respectively. Fair correlations were observed between AT and 6MWT (rho = 0.36, p = 0.01) and 30STS (rho = 0.41, p < 0.005). The optimal cut points to identify VO2peak < 15 mL/kg/min were 493.5 m on the 6MWT and 12.5 stands on the 30STS test and for AT < 11 mL/kg/min were 506.5 m on the 6MWT and 12.5 stands on the 30STS test.

CONCLUSION

Both the 6MWT and 30STS test could be used as alternative tools for measuring exercise capacity preoperatively in the cancer setting where CPET is not available. A range of 6MWT and 30STS cut points, according to sensitivity and specificity levels, may be used to evaluate risk of postoperative outcomes.

Cardiopulmonary Complications after Pulmonary Embolism in COVID-19

Although pulmonary embolism (PE) is a frequent complication in COVID-19, its consequences remain unknown. We performed pulmonary function tests, echocardiography and computed tomography pulmonary angiography and identified blood biomarkers in a cohort of consecutive hospitalized COVID-19 patients with pneumonia to describe and compare medium-term outcomes according to the presence of PE, as well as to explore their potential predictors. A total of 141 patients (56 with PE) were followed up during a median of 6 months. Post-COVID-19 radiological lung abnormalities (PCRLA) and impaired diffusing capacity for carbon monoxide (DLCOc) were found in 55.2% and 67.6% cases, respectively. A total of 7.3% had PE, and 6.7% presented an intermediate-high probability of pulmonary hypertension. No significant difference was found between PE and non-PE patients. Univariate analysis showed that age > 65, some clinical severity factors, surfactant protein-D, baseline C-reactive protein, and both peak red cell distribution width and Interleukin (IL)-10 were associated with DLCOc < 80%. A score for PCRLA prediction including age > 65, minimum lymphocyte count, and IL-1β concentration on admission was constructed with excellent overall performance. In conclusion, reduced DLCOc and PCRLA were common in COVID-19 patients after hospital discharge, but PE did not increase the risk. A PCRLA predictive score was developed, which needs further validation.

Effectiveness of smartphone-assisted cardiac rehabilitation: a systematic review and meta-analysis

PURPOSE

To explore the effectiveness of smartphone-assisted home cardiac rehabilitation and whether it can be used as a remote detection method to promote home cardiac rehabilitation.

METHODS

Four databases were searched to collect randomized controlled trials (RCTs) about smartphone-assisted cardiac rehabilitation. The Cochrane risk-of-bias tool was used to assess the methodological quality of the included studies. Two independent investigators performed the literature screening, information extraction, and risk of bias assessment. Any disagreements were resolved by a third investigator. Meta-analysis and systematic review were performed. Sensitivity analysis and subgroup analysis were carried out to explore the sources of heterogeneity.

RESULTS

A total of 14 RCTs involving 1962 patients were included. Meta-analysis showed that compared with conventional cardiac rehabilitation/usual care, smartphone-assisted cardiac rehabilitation significantly improved VO2peak in patients with cardiovascular disease (WMD= 1.32, 95%CI:0.82 to 1.81, p > 0.05) and enhanced their treatment compliance (RR = 1.62, 95%CI:1.21 to 2.17, p > 0.05). There were no significant differences in six-minute walk distance (WMD = 12.88, 95%CI:-0.82 to 26.57, p > 0.05), body mass index (BMI) (WMD=-0.14, 95%CI:-0.34 to 0.06, p > 0.05), life quality, psychological status, and other cardiovascular risks.

CONCLUSION

Smartphone-assisted cardiac rehabilitation showed significant improvement in exercise capacity and treatment compliance in patients with cardiac rehabilitation but did not improve BMI, quality of life, psychological status, or reduce other cardiovascular risks. Smartphone-based cardiac rehabilitation is increasingly used as a remote detection method for cardiac rehabilitation in middle-income countries, which provides new insights into home cardiac rehabilitation.