Exercise, ageing and the lung

Associations between physical activity and the incidence of restrictive spirometry patterns: A cohort study

BACKGROUNDS

Restrictive spirometry patterns (RSP) are associated with adverse health outcomes, but the association between physical activity (PA) levels and RSP risk, as well as the influence of factors like age, sex, and smoking status, is not well understood.

METHODS

This study included 212,023 participants (mean age: 38 years, 40.7 % women). PA levels were classified into four groups, and RSP incidence was assessed. RSP was defined using Global Lung Initiative criteria as FEV1/FVC z-score ≥ -1.64 and FVC z-score < -1.64. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs) for RSP incidence. Subgroup analyses were conducted to evaluate the potential influence of age, sex, and smoking status on the association between PA and RSP risk.

RESULTS

Engaging in any level of PA was associated with a reduced risk of RSP compared with complete inactivity. Subgroup analyses revealed that older adults (≥45 years) exhibited a significantly lower risk of RSP (HR: 0.81, 95 % CI: 0.73-0.90) compared to younger adults. Men had a lower risk than women (HR: 0.87, 95 % CI: 0.83-0.92), and current smokers showed a reduced risk compared to non-smokers (HR: 0.86, 95 % CI: 0.80-0.93). These findings indicate that the protective effect of PA on RSP may vary across population subgroups.

CONCLUSIONS

Even minimal PA is associated with a lower RSP risk. Subgroup differences highlight the need for tailored PA interventions in diverse populations.

Assessing the Italian version of the respiratory symptom experience scale (IT-RSES) in smokers and former smokers: a validation study

BACKGROUND

Smoking causes respiratory symptoms, and research suggests these improve with cessation or switching to less harmful nicotine products. The Respiratory Symptom Experience Scale (RSES) was developed and validated for the purpose of assessing these such symptoms online in an English-speaking American sample. This study aimed to develop and validate an Italian version, the IT-RSES, administered via telephone interview, and, further, to use it to assess symptoms in smokers who had switched to e-cigarettes or to heated tobacco products (HTPs).

METHODS

After translation into Italian, the IT-RSES was administered by phone interview to 750 Italian participants in 5 tobacco use groups (150 each never-smokers, former smokers not using alternative products, HTP users, e-cigarette users, and continuing smokers) who also reported any history of diagnoses with relevant medical conditions. Psychometric analyses examined scale factor structure, reliability, and convergent validity. Analyses controlling for age and for years smoking compared symptoms across tobacco use groups.

RESULTS

Factor analyses confirmed the IT-RSES' unidimensionality (factor one accounting for 74.2% of the variance; all factor loadings > 0.80). Internal-consistency reliability was high ( Cronbach's alpha = 0.91). IT-RSES scores correlated significantly with years of smoking (r = 0.51, p < 0.0001), and were higher in individuals with respiratory conditions (2.02 vs. 1.36, SE = 0.05, significant by THSD). Discriminant validity was demonstrated by higher scores in smokers compared to never-smokers, even among those without respiratory conditions. After adjustment for years of smoking, former smokers, HTP users and e-cigarette users had lower scores than smokers (m = 2.17 vs. 1.49, SE = 0.06, p < 0.05, THSD; 1.63 vs. 2.16, SE = 0.06, THSD) and did not significantly differ from each other.

CONCLUSIONS

The results support the reliability and validity of the IT-RSES, suggesting its utility for assessing respiratory symptoms in smokers, and former smoker who stopped smoking and were using e-cigarettes or HTPs. The scores of former smokers are similar to those not using these products, and lower than smokers', suggests that HTPs and e-cigarettes do not add materially to respiratory symptoms when smokers stop smoking.

Pulmonary V̇O2 on-kinetics and walking net V̇O2 associate with fatigue and mood disturbance in postmenopausal women

Postmenopausal women often experience fatigue and mood disturbance both of which interfere with quality-of-life. Since greater physical function aids psychosocial well-being, we hypothesized the acute cardiopulmonary responses during walking may reveal important factors linked to fatigue and mood disturbance. In this cross-sectional study, women of similar body mass index (BMI) aged 55-75 y were dichotomized to mid-life (55-65 y; 83.4 ± 8.4 kg/m2; n = 14) or older (≥65 y; 81.8 ± 10.4 kg/m2; n = 11) groups. A 6-minute walk test was used to estimate peak aerobic capacity (V̇O2peak). A treadmill task coupled with indirect calorimetry measured mean response time (MRT) - representing the duration to reach 63 % of steady-state net oxygen uptake (V̇O2). Average daily fatigue and fatigue interference were measured with the Fatigue Symptom Inventory. General mood disturbance was measured with the Profile of Mood States (POMS) questionnaire. Age-group differences were not detected in fatigue ratings, MRT, or walking net V̇O2. However, older women had lower aerobic capacity (p = 0.002, ES = 1.39) and greater disturbance in the POMS Depression-Dejection subscale (p = 0.042, ES = 0.41). Among all participants, and independent of V̇O2peak, MRT correlated with average daily fatigue (r = 0.500, p = 0.015), fatigue interference (r = 0.421, p = 0.046), and POMS total mood disturbance (rs = 0.437, p = 0.037). Regression modeling revealed MRT and walking net V̇O2 jointly explained 55 % (R = 0.744, p < 0.001) of the variance in average daily fatigue. In conclusion, MRT and walking net V̇O2 may serve as important points of intervention to alleviate fatigue and mood disturbance in postmenopausal women.

Development and Validation of a Risk Predictive Model for Adverse Postoperative Health Status of Elderly Patients Undergoing Major Abdominal Surgery Using Lasso-Logistic Regression

Background

The postoperative health status of elderly patients has a substantial impact on both the individuals themselves and their families, and this impact became more pronounced with advancing age. The aim of this study was to identify risk factors that can predict the health status of patients aged 80 and over after major abdominal surgery and to establish a nomogram model.

Methods

We conducted a retrospective study of elderly patients (aged 80+) who underwent major abdominal surgery at the First Affiliated Hospital of Soochow University from January 2017 to June 2023. Least absolute shrinkage and selection operator (lasso) regression analysis was employed to identify potential perioperative factors associated with the patients' health status one year post-surgery. Subsequently, logistic regression was then used to refine these factors for the model. The nomogram's performance was assessed through discriminative ability, calibration, and clinical utility in both training and validation datasets.

Results

In total, 576 and 145 individuals were allocated to the training and validation sets, respectively. Lasso regression first identified 10 variables as candidate risk factors. After further screening through univariate and multivariate logistic regression, it was confirmed that seven variables, including tumor, operative duration, left ventricular ejection fraction (LVEF), blood transfusion, direct bilirubin, erythrocyte, and self-care, were included in the final nomogram model. The Hosmer-Lemeshow test, with a P-value of 0.835, indicates that the model was well-fitted. The area under the Receiver Operating Characteristic curve (ROC-AUC) for the model on the training set was 0.81 (95% CI 0.764-0.855), and for the validation set, it was 0.83 (95% CI 0.751-0.91). Additionally, the calibration curves and decision curve analyses in both the training and validation sets demonstrated the accuracy and clinical applicability of the predictive model.

Conclusion

The nomogram has a good predictive ability for the health status of older patients aged 80 years and above after abdominal surgery for one year, which can help clinical doctors develop better treatment plans.

How cardiac output is controlled in a Fontan circulation: an update

After creating a Fontan circuit, control of the circulation is shifted upstream from the ventricle to the newly created Fontan portal system. The goal of this review was to illustrate that the customary laws of biventricular cardiac output no longer apply and explain why standardized cardiac failure treatment regimens have little or no effect on a failing Fontan patient. A Fontan circulation is, in effect, a circulation in series regulated by the basic rules of any hydrodynamic circuit. We developed a formula that elucidates how flow through the critical bottleneck, and therefore through the whole circuit, is controlled. The critical bottleneck in a hydrodynamic model is the prime determinant of overall flow; other (less critical) bottlenecks may control local upstream congestion, but not overall flow. Once relieved, control of flow shifts to the next most significant bottleneck. The available options for improving flow in a hydrodynamic model are identical to those applicable to any dam: tackle the obstruction (the most impactful approach), push harder upstream (the easiest action) or pull/suck further downstream of the bottleneck (the least efficient strategy). In the early stages, the Fontan neo-portal circulation plays a pivotal role in the pathophysiology. The ventricle has little effect and has an impact only at a late stage. The Fontan formula in the present article stands as a valuable tool, aiding physicians in comprehending the pathophysiological and hydrodynamic intricacies of the Fontan circuit within the context of everyday clinical practice.

Perioperative Pulmonary Complications in the Older Adults: The Forgotten System

With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.

Age and estrogen-associated reductions in hypoxic ventilatory response and chemosensitivity in female rats

Respiratory function is modulated by circulating steroid hormones. In female rats, steroid hormones fluctuate across the normal estrous cycle and decline with age, similar to human menopause. To determine the influence of steroid hormones, and mimic aspects of age-related reductions in hormones, the ovariectomy model is often employed. Ovariectomy (OVX) induces an immediate and persistent decrease in steroid hormones. The current study aimed to interrogate whether the OVX model of hormone reduction impacted specific aspects of respiratory function [chemosensitivity and the hypoxic ventilatory response (HVR)] in a manner consistent with natural age-related declines in hormones. Using barometric plethysmography, three experimental groups of female rats were assessed for HVR, chemosensitivity, and respiratory neural drive during progressive hypoxic challenges (FIO2: 0.15, 0.12, and 0.09): young (3-5 mos. old; in proestrus; n = 10), young OVX (3-5 mos. old; n = 10), and aged (>20 mos. old; n = 10). Our findings indicted that sex hormone loss did not appear to impact chemosensitivity or neural drive. Natural aging, but not OVX, resulted in decreased HVR as well as reduced magnitude in ventilatory output during stepwise hypoxia. Differences in metabolism were important to the interpretation of these results. Collectively, these data support the concept that aging impacts female respiratory function in complex and unique ways that differ from OVX.

Associations of Cardiorespiratory Fitness and Muscular Endurance Fitness With Pulmonary Function in Physically Active Young Adults

RATIONALE

While the beneficial effects of physical fitness on general health are well-documented, the specific relationship between different types of physical fitness, particularly cardiorespiratory fitness (CRF) and muscular endurance fitness (MEF), and lung function in physically active young adults remains less explored.

OBJECTIVE

This study investigated the relationship between CRF and MEF, and their correlation with lung function in physically active young adults.

METHODS

This cross-sectional study involved a cohort of 1227 physically active young adults without lung diseases. Lung function was assessed using FEV1, FVC, and FEV1/FVC measurements. The 3000-m run was used to assess CRF, and the 2-min push-up and sit-up tests were used to assess MEF. Multivariable linear regression analysis was used to evaluate the relationships between these fitness measures and lung function, adjusting for potential covariates.

RESULTS

Enhanced CRF was associated with superior FEV1 and FVC after adjusting for covariates (β=-.078, p=.015 for FEV1; β=-.086, p=.009 for FVC). Push-ups were positively associated with FEV1 (β=.102, p=.014), but not with FVC. In contrast, sit-ups showed no significant correlation with lung function in the fully adjusted model.

CONCLUSION

The study demonstrated a clear association between improved physical fitness and better lung function in physically active young adults, with various exercises showing distinct associations with lung metrics. Notably, push-ups were particularly associated with higher FEV1. A future prospective study is necessary to determine whether routine exercises, such as push-ups, might lead to greater lung function.

Advancements and challenges in the management of pneumonia in elderly patients with COPD

INTRODUCTION

Chronic Obstructive Pulmonary Disease (COPD) significantly predisposes the elderly to pneumonia, presenting a complex interplay of pulmonary dysfunction and infection risk.

AREAS COVERED

This article reviews the substantial epidemiologic impact, elucidates the interlinked pathophysiology of COPD and pneumonia, and examines the microbial landscape shaping infection in these patients. It also evaluates management protocols and the multifaceted clinical challenges encountered during treatment.

EXPERT OPINION

Delving into the latest research, we underscore the criticality of preventive measures such as vaccination and present an integrated approach to managing Community-Acquired Pneumonia (CAP) in the COPD demographic. The review also proposes strategic directions for future investigations aimed at enhancing patient outcomes through a deeper understanding of the COPD-pneumonia nexus.

Association of obstructive sleep apnea with bone metabolism in older adults: a hospital-based study

PURPOSE

Obstructive sleep apnea (OSA) significantly affects patients' quality of life; however, the mechanisms, such as its effects on bone mineral density (BMD) and bone turnover marker (BTM) expression, remain unclear. In this study, we investigated the relationships among OSA, BMD, and (BTMs) in older adults.

METHODS

This retrospective study enrolled 260 participants (114 women; 44.5%). Data of an established system (Alice NightOne) were used to diagnose OSA and analyze nocturnal hypoxia. Participants were divided into four groups according to respiratory event index (REI) (control, < 5 times/hour; mild OSA, 5-15 times/hour; moderate OSA 15-30 times/hour; severe OSA ≥ 30 times/hour). BMD were mesured by dual-energy x-ray absorptiometry. BTMs including bone specific alkaline phosphatase (BALP), tartrate-resistant acid phosphatase 5b (TRAP-5b) were collected.

RESULTS

Patients with OSA had higher BMD at first lumbar vertebra, left and right femur than those without (all p < 0.05). REI was positively correlated with BMD at the first lumbar vertebra (r = 0.181, p = 0.006), left femur (r = 0.160, p = 0.014), and right femur (r = 0.243, p < 0.001). In participants with body mass index (BMI) of 18-24 kg/m2 (N = 96), the correlation between REI and BMD at the left femur(r = 0.251, p = 0.019) and right femur (r = 0.258, p = 0.018) remained. Multiple regression analysis showed that OSA was significantly associated with osteoporosis (p = 0.034, 95% confidence interval, 0.092-0.100, odds ratio, 0.092). MSaO2 was positively correlated with TRAP5b (r = 0.560, p = 0.007). In participants with a BMI of ≥ 24 kg/m2(N = 164), MSaO2 was negatively correlated with BALP (r = -0.331, p = 0.034). No significant association between REI and BMD was observed.

CONCLUSIONS

OSA and hypoxia were associated with higher BMD in older adults in BMI of 18-24 kg/m2 but not in participants with a BMI of ≥ 24 kg/m2. This study suggests a negative association between OSA and osteoporosis in non-overweight and obese population. BMI played an important role. The study's findings could help exploration mechanisms of osteoporosis and promoting its treatment.

Is breathing frequency a potential means for monitoring exercise intensity in people with atrial fibrillation and coronary heart disease when heart rate is mitigated?

PURPOSE

Moderate-intensity aerobic exercise is safe and beneficial in atrial fibrillation (AF) and coronary heart disease (CHD). Irregular or rapid heart rates (HR) in AF and other heart conditions create a challenge to using HR to monitor exercise intensity. The purpose of this study was to assess the potential of breathing frequency (BF) to monitor exercise intensity in people with AF and CHD without AF.

METHODS

This observational study included 30 AF participants (19 Male, 70.7 ± 8.7 yrs) and 67 non-AF CHD participants (38 Male, 56.9 ± 11.4 yrs). All performed an incremental maximal exercise test with pulmonary gas exchange.

RESULTS

Peak aerobic power in AF ( V ˙ O2peak; 17.8 ± 5.0 ml.kg-1.min-1) was lower than in CHD (26.7 ml.kg-1.min-1) (p < .001). BF responses in AF and CHD were similar (BF peak: AF 34.6 ± 5.4 and CHD 36.5 ± 5.0 breaths.min-1; p = .106); at the 1st ventilatory threshold (BF@VT-1: AF 23.2 ± 4.6; CHD 22.4 ± 4.6 breaths.min-1; p = .240). % V ˙ O2peak at VT-1 were similar in AF and CHD (AF: 59%; CHD: 57%; p = .656).

CONCLUSION

With the use of wearable technologies on the rise, that now include BF, this first study provides an encouraging potential for BF to be used in AF and CHD. As the supporting data are based on incremental ramp protocol results, further research is required to assess BF validity to manage exercise intensity during longer bouts of exercise.

Can we "prehabilitate" pancreatic cancer patients prior to surgery? A critical appraisal of the literature

BACKGROUND

Enhancing a patient's functional capacity to withstand the surgical stress by means of multimodal (combined exercise, nutrition and psychological interventions) prehabilitation may potentially lead to improved outcomes in pancreatic cancer surgery.

METHODOLOGY

A systematic review was undertaken searching PubMed, Google Scholar and Cochrane Library databases, exploring the impact of prehabilitation in pancreatic surgery. Outcomes of interest were adherence to the prehabilitation, functional capacity, overall complications and post-operative length of stay. Pooled analysis was performed using a random-effects model.

RESULTS

Twelve studies comprising of 1497 patients were included in the review. Most of the studies seem to lack a multimodal approach. Less than 50 % of the studies reported adherence, which ranged between 27 and 100 %. Functional capacity, in terms of 6-min walk test, showed improvement with prehabilitation. Among the post-operative outcomes, prehabilitation was associated with significant improvement in pulmonary complications (2.4 % versus 6.7 %, RR 0.36, CI 0.17-0.74, p = 0.01, I2 = 28%). Prehabilitation was not effective in terms of length of stay or readmission rates.

CONCLUSIONS

Larger studies with multimodal prehabilitation approaches may demonstrate more consistent and clinically meaningful benefits, which would lead to a firm appreciation of its role the management of pancreatic cancer patients undergoing surgery.

Respiratory and physical health consequences in older adults in a high-risk volcanic area: Comparison of two rural villages

INTRODUCTION

Volcanism is an important natural producer of pollution that impacts health and the quality of the environment. Lung changes caused by exposure to volcanoes have been previously studied. However, limited information exists regarding the effects of prolonged exposure to volcanic compounds. So, this study aimed to analyze the pulmonary effects and stress tolerance in older adults for chronic exposure to the volcanic ashes of the Galeras volcano.

METHODS

A descriptive cross-sectional study of association included rural inhabitants aged over 60 years from Genoy, a village located in a high volcanic hazard zone of Galeras volcano, 2603 meters above sea level. Those in this group, called exposed, were contrasted with a sample of El Encano inhabitants with similar socioeconomic and cultural characteristics. Both villages belong to the rural area of San Juan de Pasto in Colombia.

RESULTS

It was found that of 31 exposed participants, 18 had obstructive alteration, and in the control group, it was found that of 31 subjects, 6 presented this alteration. The difference between the two groups was significant (p<0.001). A similar situation occurred with distal airway obstruction assessed with the forced expiratory flow of 25-75%. No significant differences were found in restrictive alteration between the exposed and unexposed groups.

CONCLUSION

Chronic exposure to volcanic compounds has generated obstructive changes in the population, and these changes were greater in number and severity than those in the control group of unexposed people.

The metabolic cost of breathing for exercise ventilations: effects of age and sex

Given that there are both sex-based structural differences in the respiratory system and age-associated declines in pulmonary function, the purpose of this study was to assess the effects of age and sex on the metabolic cost of breathing (V̇o2RM) for exercise ventilations in healthy younger and older males and females. Forty healthy participants (10 young males 24 ± 3 yr; 10 young females 24 ± 3 yr; 10 older males 63 ± 3 yr, 10 older females 63 ± 6 yr) mimicked their exercise breathing patterns (voluntary hyperpnea) in the absence of exercise across a range of exercise intensities. At peak exercise, V̇o2RM represented a significantly greater fraction of peak oxygen consumption (V̇o2peak) in young females, 12.7 ± 4.0%, compared with young males, 10.7 ± 3.0% (P = 0.027), whereas V̇o2RM represented 13.5 ± 2.3% of V̇o2peak in older females and 13.2 ± 3.3% in older males. At relative ventilations, there was a main effect of age, with older males consuming a significantly greater fraction of V̇o2RM (6.6 ± 1.9%) than the younger males (4.4 ± 1.3%; P = 0.012), and older females consuming a significantly greater fraction of V̇o2RM (6.9 ± 2.5%) than the younger females (5.1 ± 1.4%; P = 0.004) at 65% V̇emax. Furthermore, both younger and older males had significantly better respiratory muscle efficiency than their female counterparts at peak exercise (P = 0.011; P = 0.015). Similarly, younger participants were significantly more efficient than older participants (6.5 ± 1.5% vs. 5.5 ± 2.0%; P = 0.001). Normal age-related changes in respiratory function, in addition to sex-based differences in airway anatomy, appear to influence the ventilatory responses and the cost incurred to breathe during exercise.NEW & NOTEWORTHY Here we show that at moderate and high-intensity exercise, older individuals incur a higher cost to breathe than their younger counterparts. However, as individuals age, the sex difference in the cost of breathing narrows. Collectively, our findings suggest that the normative age-related changes in respiratory structure and function, and sex differences in airway anatomy, appear to influence the ventilatory responses to exercise and the oxygen cost to breathe.

Assessing the quality of forced vital capacity measurement in patients with systemic sclerosis

INTRODUCTION

Forced vital capacity (FVC) is an important tool for monitoring lung functions in patients with systemic sclerosis (SSc). However, several disease manifestations may influence the quality of FVC test in SSc. We aimed to assess the quality of FVC measurements according to current guidelines in patients with SSc and determine the factors that may affect results.

METHOD

In this cross-sectional study, SSc patients and age/sex matched controls underwent spirometry. Quality of FVC measurements were graded according to updated American Thoracic Society (ATS) and European Respiratory Society (ERS) guidelines. Demographics, clinical features and parameters that may affect FVC test quality were compared between SSc patients with high and low quality FVC test.

RESULTS

98 SSc patients (90 female) and 100 controls were included. The rate of high quality FVC measurement in SSc patients was significantly lower in SSc patients compared to controls. (80 % vs 60.2 % p = 0.002). Among SSc patients; diffuse disease, ILD, anti-topoisomerase 1 antibody positivity, immunosuppressive use, flexion contractures of hands, reduced mouth opening and decreased chest expansion were more frequent in patients with low quality FVC (p < 0.05 for all). Patients with muscle weakness and medium/high risk of malnutrition were also numerically higher in low quality FVC group. Presence of more than one condition that may affect FVC quality was significantly higher among patients with low quality FVC.

CONCLUSION

A significant percent of SSc patients had low quality FVC measurement. Physicians should be aware of this point while interpreting FVC test results especially in SSc patients with more than one condition that may affect the quality of the test.

Physically Active Lifestyle Attenuates Impairments on Lung Function and Mechanics in Hypertensive Older Adults

AIM

Physical activity attenuates hypertension in older adults, but its impact on pulmonary function and mechanics in hypertensive older adults is unknown. The study seeks to understand whether a physically active lifestyle can improve respiratory capacity, the mechanical efficiency of the lungs, and, consequently, the quality of life of these individuals, comparing data between groups of active and sedentary hypertensive older adults.

METHODS

This is a cross-sectional study. We evaluated 731 older adults, stratified into two initial groups: hypertensive older adults (HE; n = 445) and non-hypertensive older adults (NHE; n = 286). For a secondary analysis, we used the International Physical Activity Questionnaire to sub-stratify HE and NHE into four groups: physically inactive hypertensive (PIH; n = 182), active hypertensive (AH; n = 110), physically inactive non-hypertensive (PINH; n = 104), and active non-hypertensive (ANH; n = 65). Lung function was measured by spirometry, and lung mechanics were assessed by impulse oscillometry.

RESULTS

Hypertensive older adults presented reduced lung function compared to non-hypertensive older adults, and physical inactivity accentuated this decline. Regarding pulmonary mechanics, hypertensive older adults had higher resistance of the entire respiratory system (R5 Hz), the central airways (R20 Hz), and peripheral airways (R5-20 Hz), which may trigger bronchoconstriction.

CONCLUSIONS

Hypertension is associated with impaired lung function and mechanics in older adults, and a physically active lifestyle attenuates these dysfunctions.

The pulmonary physiology of exercise

The pulmonary system is the first and last "line of defense" in terms of maintaining blood gas homeostasis during exercise. Our review provides the reader with an overview of how the pulmonary system responds to acute exercise. We undertook this endeavor to provide a companion article to "Cardiovascular Response to Exercise," which was published in Advances in Physiological Education. Together, these articles provide the readers with a solid foundation of the cardiopulmonary response to acute exercise in healthy individuals. The intended audience of this review is level undergraduate or graduate students and/or instructors for such classes. By intention, we intend this to be used as an educational resource and seek to provide illustrative examples to reinforce topics as well as highlight uncertainty to encourage the reader to think "beyond the textbook." Our treatment of the topic presents "classic" concepts along with new information on the pulmonary physiology of healthy aging.NEW & NOTEWORTHY Our narrative review is written with the student of the pulmonary physiology of exercise in mind, be it a senior undergraduate or graduate student or those simply refreshing their knowledge. We also aim to provide examples where the reader can incorporate real scenarios.

Cognition as mediator of pulmonary function and risk of sarcopenia among older adults

BACKGROUND

The relationship between lung function and sarcopenia remains ambiguous. The primary aim of this study was to investigate the potential association between lung function and sarcopenia in the older adults, as well as to examine the mediating role of cognitive function in this relationship.

METHODS

The participants were selected from a nationally representative population-based cohort in China. The peak expiratory flow (PEF) measurement was used to evaluate the lung function in older persons. The sarcopenia was diagnosed using the guidelines of the Asian Working Group for Sarcopenia (AWGS) in 2019. The Cox proportional hazard model was utilized to perform primary analyses of the relationship between PEF and sarcopenia. The mediating effect of cognitive function was evaluated using the counterfactual mediation method.

RESULTS

This cohort study included 4,011 older adults (average age, 66.6 years; 53.3% males). During a follow-up period of 3.86 years, 349 individuals were diagnosed with sarcopenia. After adjusting for potential confounders, each one-standard-deviation increase in PEF was associated with a 28% reduction in the risk of sarcopenia (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.63, 0.80). There was a significant mediation of cognition for the association between PEF and incident sarcopenia, and the proportion mediated was 12.2% (95% CI: 4.5%, 23.1%).

CONCLUSIONS

Older adults with impaired lung function are more likely to develop sarcopenia. Nevertheless, cognition can explain only a small portion of this association. Thus, other potential pathways between lung function and sarcopenia must be elucidated.

The Role of the Redox Enzyme p66Shc in Biological Aging of the Lung

The mitochondrial adaptor protein p66Shc has been suggested to control life span in mice via the release of hydrogen peroxide. However, the role of p66Shc in lung aging remains unsolved. Thus, we investigated the effects of p66Shc-/- on the aging of the lung and pulmonary circulation. In vivo lung and cardiac characteristics were investigated in p66Shc-/- and wild type (WT) mice at 3, 12, and 24 months of age by lung function measurements, micro-computed tomography (µCT), and echocardiography. Alveolar number and muscularization of small pulmonary arteries were measured by stereology and vascular morphometry, respectively. Protein and mRNA levels of senescent markers were measured by western blot and PCR, respectively. Lung function declined similarly in WT and p66Shc-/- mice during aging. However, µCT analyses and stereology showed slightly enhanced signs of aging-related parameters in p66Shc-/- mice, such as a decline of alveolar density. Accordingly, p66Shc-/- mice showed higher protein expression of the senescence marker p21 in lung homogenate compared to WT mice of the corresponding age. Pulmonary vascular remodeling was increased during aging, but aged p66Shc-/- mice showed similar muscularization of pulmonary vessels and hemodynamics like WT mice. In the heart, p66Shc-/- prevented the deterioration of right ventricular (RV) function but promoted the decline of left ventricular (LV) function during aging. p66Shc-/- affects the aging process of the lung and the heart differently. While p66Shc-/- slightly accelerates lung aging and deteriorates LV function in aged mice, it seems to exert protective effects on RV function during aging.

Respiratory Muscle Strength Is Related to Handgrip Performance in Community-Dwelling Persons Aged 80+ from the BUTTERFLY Study

INTRODUCTION

This study aimed to evaluate the association of respiratory muscle strength with sarcopenia and its indicators in the oldest old.

METHODS

Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and sarcopenia-related factors (handgrip strength and appendicular lean mass) were evaluated in a cohort of n = 286 (45.5% female) non-frail, community-dwelling persons aged 83.6 ± 3.0 years (age range 80-97 years).

RESULTS

The sample presented a sarcopenia prevalence of 32.2%. Sarcopenic subjects showed comparable MIP and MEP as non-sarcopenic ones (female: MIP 43.9 ± 18.9 vs. 50.3 ± 19.5, p = 0.053; MEP 63.0 ± 23.0 vs. 69.2 ± 19.1, p = 0.067; male: MIP, 65.1 ± 24.4 vs. 64.4 ± 23.9, p = 0.433; MEP 87.7 ± 33.3 vs. 93.8 ± 30.9, p = 0.124). Statistically significant but very low associations were found between grip strength and MIP (r = 0.193 for male, p < 0.05 and r = 0.257 for female participants, p < 0.01) and MEP (r = 0.200 for male, p < 0.01 and r = 0.191 for female participants, p < 0.05). Lean mass was significantly correlated to MIP and MEP in female (r = 0.253, p < 0.01 and r = 0.343, p < 0.01, respectively), whereas this association was not found in male participants. Grip strength was the only statistically significant predictor of MEP (r2 = 0.212, p < 0.001), while MIP was independently predicted by age, male sex, and grip strength (r2 = 0.177, p < 0.001).

CONCLUSIONS

Peripheral muscle strength is a statistically significant, albeit weak predictor for respiratory muscle strength in well-functioning, community-dwelling persons aged 80+. When confronted to a low grip strength, one should be aware of concomitant respiratory muscle weakness, as this is a known risk factor for atelectasis and pneumonia. Given the relatively low association with handgrip strength, respiratory muscle strength testing might be indicated.

Chinese Herbal Medicine Combined With Liuzijue Exercise in Physiological Rehabilitation After Video-assisted Lung Lobectomy for Cancer: A Prospective Propensity Score Matching Study

OBJECTIVE

To observe the clinical efficacy of Chinese herbal medicine combined with Liuzijue exercise on the physiological symptoms and quality of life (QoL) in postoperative patients with early-stage lung cancer.

METHODS

One hundred and eighty-three lung cancer patients who underwent video-assisted thoracoscopic surgery (VATS) were categorize into either a traditional Chinese medicine treatment group (CM) or a control group (non-traditional Chinese medicine treatment, NC), among whom 73 underwent Chinese herbal medicine and Liuzijue therapy, while 110 underwent no comprehensive treatment with traditional Chinese medicine. The propensity score matching (PSM) method with a 1:2 ratio was used to balance the baseline characteristics and evaluate the efficacy of CM in improving postoperative symptoms and QoL.

RESULTS

Cough, dyspnea, chest pain, and fatigue were the most common clinical symptoms after VATS. Except for chest pain, they were all correlated with the scope of operation (P < .05). After PSM, 165 patients were identified in the matched cohort, and the covariates of gender, age, operative site, and scope of operation were balanced between the 2 groups (P > .05). In the domain of global health status, the improvement in QoL in CM was greater than that in NC (6.06 ± 15.83 vs -1.06 ± 14.68, P = .005). In terms of symptoms, improvements in cough (1.69 ± 3.15 vs 0.38 ± 2.63, P = .006), dyspnea during climbing stairs (-10.30 ± 16.82 vs -1.82 ± 17.97, P = .004), and pain (-0.76 ± 1.32 vs -0.08 ± 1.31, P = .002) in CM were better than in NC.

CONCLUSION

Comprehensive treatment with traditional Chinese medicine (TCM) can provide therapeutic benefits in physiological rehabilitation after VATS for cancer.

Impact of lifestyle and psychological resilience on survival among the oldest-old in China: a cohort study

Introduction

Healthy lifestyles and psychological resilience are important factors influencing the life expectancy of the oldest-old (≥80 years). Stratified by urban and rural groups, this study used a 10-year cohort to examine the mechanism of lifestyle and psychological resilience on the survival of the oldest-old in China.

Methods

This study used the China Longitudinal Healthy Longevity Survey datasets spanning from 2008 to 2018, and 9,250 eligible participants were included. The primary outcome variable was all-cause mortality, and independent variables included healthy lifestyle index and psychological resilience. Six covariates were included in the survival analysis and moderation-mediation model, such as gender and annual household income.

Results

This study found that the oldest-old with five healthy lifestyles had the longest survival time, averaging 59.40 months for urban individuals and 50.08 months for rural individuals. As the lifestyle index increased, the survival rate significantly increased. The Cox regression showed that for the urban oldest-old, the lifestyle index served as a protective factor for survival outcomes. However, this effect lost statistical significance among rural oldest-old individuals. For urban oldest-old individuals, psychological resilience significantly mediated and moderated the effect of the lifestyle index on survival status, but the moderating effect was not statistically significant for the rural ones.

Discussion

Overall, healthy lifestyles and psychological resilience can be effective in enhancing the survival of the oldest-old, and there are differences between urban and rural population, so different interventions should be adopted for urban and rural areas to achieve longer life in China.

Association of biological age with health outcomes and its modifiable factors

Identifying the clinical implications and modifiable and unmodifiable factors of aging requires the measurement of biological age (BA) and age gap. Leveraging the biomedical traits involved with physical measures, biochemical assays, genomic data, and cognitive functions from the healthy participants in the UK Biobank, we establish an integrative BA model consisting of multi-dimensional indicators. Accelerated aging (age gap >3.2 years) at baseline is associated incident circulatory diseases, related chronic disorders, all-cause, and cause-specific mortality. We identify 35 modifiable factors for age gap (p < 4.81 × 10-4 ), where pulmonary functions, body mass, hand grip strength, basal metabolic rate, estimated glomerular filtration rate, and C-reactive protein show the most significant associations. Genetic analyses replicate the possible associations between age gap and health-related outcomes and further identify CST3 as an essential gene for biological aging, which is highly expressed in the brain and is associated with immune and metabolic traits. Our study profiles the landscape of biological aging and provides insights into the preventive strategies and therapeutic targets for aging.

Proportional Internal Work-a New Parameter of Exercise Testing in Study of Health in Pomerania (SHIP)

PURPOSE

Cardiopulmonary exercise testing usually requires a maximal exhaustive effort by the patient and is time consuming. The purpose of this study was to assess whether the cost to initiate exercise termed "proportional internal work" (PIW) was related to cardiovascular disease (CVD) risk factors, ventilatory parameters, and mortality.

METHODS

We used data from population-based Study of Health in Pomerania. A total of 2829 (49.5% female) study participants with a median age of 52 (42-62) yr were included. Standardized questionnaires were used to assess CV risk factors. The cardiopulmonary exercise testing was performed using a modified Jones protocol. Regression models adjusted for sex and age were used to relate PIW with CVD risk factors and ventilatory parameters. The PIW was calculated by the following formula: (Oxygen uptake at rest - Oxygen uptake without load)/V˙ o2peak ) × 100. Cox regression analysis was used to relate PIW and all-cause mortality.

RESULTS

We identified a nonlinear association between PIW and percent predicted V˙ o2peak . Women had a 2.96 (95% CI, 2.61-3.32) greater PIW than men. With each year of age and every point in body mass index, the PWI increased by 0.04 (95% CI, 0.03-0.05) and 0.16 (95% CI, 0.12-0.20), respectively. After adjustment for age, sex, smoking, and body mass index, a 1-point greater PIW was associated with a 5% higher risk to die (HR = 1.05; 95% CI, 1.01-1.07).

CONCLUSIONS

The PIW is a new cardiopulmonary exercise testing parameter related to CVD risk and all-cause mortality. Future studies should assess the prognostic relevance of PIW for CVD prevention.

Self-reported walking pace and 10-year cause-specific mortality: A UK biobank investigation

OBJECTIVE

To investigate associations of self-reported walking pace (SRWP) with relative and absolute risks of cause-specific mortality.

PATIENTS AND METHODS

In 391,652 UK Biobank participants recruited in 2006-2010, we estimated sex- and cause-specific (cardiovascular disease [CVD], cancer, other causes) mortality hazard ratios (HRs) and 10-year mortality risks across categories of SRWP (slow, average, brisk), accounting for confounders and competing risk. Censoring occurred in September 30, 2021 (England, Wales) and October 31, 2021 (Scotland).

RESULTS

Over a median follow-up of 12.6 years, 22,413 deaths occurred. In women, the HRs comparing brisk to slow SRWP were 0.74 (95% CI: 0.67, 0.82), 0.40 (0.33, 0.49), and 0.29 (0.26, 0.32) for cancer, CVD, and other causes of death, respectively, and 0.71 (0.64, 0.78), 0.38 (0.33, 0.44), and 0.29 (0.26, 0.32) in men. Compared to CVD, HRs were greater for other causes (women: 39.6% [6.2, 72.9]; men: 31.6% [9.8, 53.5]) and smaller for cancer (-45.8% [-58.3, -33.2] and - 45.9% [-54.8, -36.9], respectively). For all causes in both sexes, the 10-year mortality risk was higher in slow walkers, but varied across sex, age, and cause, resulting in different risk reductions comparing brisk to slow: the largest were for other causes of death at age 75 years [women: -6.8% (-7.7, -5.8); men: -9.5% (-10.6, -8.4)].

CONCLUSION

Compared to slow walkers, brisk SRWP was associated with reduced cancer (smallest reduction), CVD, and other (largest) causes of death and may therefore be a useful clinical predictive marker. As absolute risk reductions varied across age, cause, and SRWP, certain groups may particularly benefit from interventions to increase SRWP.

Factors affecting the willingness of patients with type 2 diabetes to use digital disease management applications: a cross-sectional study

Background

The global burden of type 2 diabetes has significantly increased, leading to a considerable impact on healthcare systems worldwide. While the advent of mobile healthcare has provided some relief by addressing the shortage of certain medical resources, its adoption among the Chinese population remains relatively low. To extend the benefits of mHealth to a greater number of Chinese diabetic patients, it is essential to investigate the factors that influence their willingness to utilize it and implement targeted interventions based on these influencing factors. The Technology Acceptance Model (TAM) is widely employed to examine users' ultimate usage behaviors, and previous studies have indicated the potential relevance of the Perceived Risk (PR) theory and the eHealth Literacy Theory to users' usage behaviors.

Objective

Our objective was to investigate the determinants that affect the willingness of Chinese patients diagnosed with type 2 diabetes patients to utilize digital disease management applications (DDMAs).

Methods

We conducted a cross-sectional study of patients with type 2 diabetes in three tertiary general hospitals in Chengdu using questionnaires designed by the investigators. Participants were sampled using a convenience sampling method. The questionnaire comprised three sections: socio-demographic profile and medical history; current awareness and willingness to use digital disease management applications; and the current level of e-health literacy. Structural equation modeling was employed to assess the impact of patient awareness of DDMAs and e-health literacy on the willingness to use such DDMAs.

Results

(1) Patients' attitudes toward using DDMAs were significantly influenced by perceived ease of use (β = 0.380, P < 0.001) and perceived usefulness (β = 0.546, P < 0.001); (2) Electronic health literacy exerted a significant impact on patients' perceived usefulness (β = 0.115, P = 0.018) and perceived ease of use (β = 0.659, P < 0.001); (3) Patients' willingness to use was significantly influenced by perceived usefulness (β = 0.137, P < 0.001) and use attitude (β = 0.825, P < 0.001).

Conclusions

The present research findings hold both theoretical and practical significance, and can serve as a guide for healthcare practitioners and researchers to gain a deeper comprehension of the acceptance of digital disease management applications (DDMAs) among type 2 diabetes patients.

Estimated standard values of aerobic capacity according to sex and age in a Japanese population: A scoping review

Aerobic capacity is a fitness measure reflecting the ability to sustain whole-body physical activity as fast and long as possible. Identifying the distribution of aerobic capacity in a population may help estimate their health status. This study aimed to estimate standard values of aerobic capacity (peak oxygen uptake [Formula: see text] and anaerobic threshold [AT]/kg) for the Japanese population stratified by sex and age using a meta-analysis. Moreover, the comparison of the estimated standard values of the Japanese with those of other populations was performed as a supplementary analysis. We systematically searched original articles on aerobic capacity in the Japanese population using PubMed, Ichushi-Web, and Google Scholar. We meta-analysed [Formula: see text] (total: 78,714, men: 54,614, women: 24,100) and AT (total: 4,042, men: 1,961, women: 2,081) data of healthy Japanese from 21 articles by sex and age. We also searched, collected and meta-analysed data from other populations. Means and 95% confidence intervals were calculated. The estimated standard values of [Formula: see text] (mL/kg/min) for Japanese men and women aged 4-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years were 47.6, 51.2, 43.2, 37.2, 34.5, 31.7, 28.6, and 26.3, and 42.0, 43.2, 33.6, 30.6, 27.4, 25.6, 23.4, and 23.1, respectively. The AT/kg (mL/kg/min) for Japanese men and women aged 20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years were 21.1, 18.3, 16.8, 15.9, 15.8, and 15.2, and 17.4, 17.0, 15.7, 15.0, 14.5, and 14.2, respectively. Herein, we presented the estimated standard values of aerobic capacity according to sex and age in a Japanese population. In conclusion, aerobic capacity declines with ageing after 20-29 years of age. Additionally, aerobic capacity is lower in the Japanese population than in other populations across a wide range of age groups. Standard value estimation by meta-analysis can be conducted in any country or region and for public health purposes.

Perioperative Pulmonary Complications in the Elderly: The Forgotten System

With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.

Physical exercise and persistent organic pollutants

Exposure to the legacy and emerging persistent organic pollutants (POPs) incessantly has become an important threat to individual health, which is closely related to neurodevelopment, endocrine and cardiovascular homeostasis. Exercise, on the other hand, has been consistently shown to improve physical fitness. Whereas associations between traditional air pollutants, exercise and lung function have been thoroughly reviewed, reviews on associations between persistent organic pollutants and exercise are scarce. Hence, a literature review focused on exercise, exposure to POPs, and health risk assessment was performed for studies published from 2004 to 2022. The purpose of this review is to provide an overview of exposure pathways and levels of POPs during exercise, as well as the impact of exercise on health concerns attributable to the redistribution, metabolism, and excretion of POPs in vivo. Therein lies a broader array of exercise benefits, including insulin sensitizing, mitochondrial DNA repair, lipid metabolism and intestinal microecological balance. Physical exercise is conducive to reduce POPs body burden and resistant to health hazards of POPs generally. Besides, individual lipid metabolism condition is a critical factor in evaluating potential link in exercise, POPs and health effects.

The effects of age on dyspnea and respiratory mechanical and neural responses to exercise in healthy men

The respiratory muscle pressure generation and inspiratory and expiratory neuromuscular recruitment patterns in younger and older men were compared during exercise, alongside descriptors of dyspnea. Healthy younger (n = 8, 28 ± 5 years) and older (n = 8, 68 ± 4 years) men completed a maximal incremental cycling test. Esophageal, gastric (Pga ) and transdiaphragmatic pressures, and electromyography (EMG) of the crural diaphragm were measured using a micro-transducer and EMG catheter. EMG of the parasternal intercostals, sternocleidomastoids, and rectus abdominis were measured using skin surface electrodes. After the exercise test, participants completed a questionnaire to evaluate descriptors of dyspnea. Pga at end-expiration, Pga expiratory tidal swings, and the gastric pressure-time product (PTPga ) at absolute and relative minute ventilation were higher (p < 0.05) for older compared to younger men. There were no differences in EMG responses between older and younger men. Younger men were more likely to report shallow breathing (p = 0.005) than older men. Our findings showed younger and older men had similar respiratory neuromuscular activation patterns and reported different dyspnea descriptors, and that older men had greater expiratory muscle pressure generation during exercise. Greater expiratory muscle pressures in older men may be due to compensatory mechanisms designed to offset increasing airway resistance due to aging. These results may have implications for exercise-induced expiratory muscle fatigue in older men.

Handgrip strength as a diagnostic tool for frailty risk in elderly patients with moderate to severe asthma

OBJECTIVE

To evaluate handgrip strength (HGS) as a diagnostic tool for frailty risk in elderly patients with asthma, as well as to investigate the prevalence of frailty in this population.

METHODS

This was a cross-sectional study including 96 patients ≥ 60 years of age diagnosed with moderate to severe asthma and treated at a tertiary referral center in Brazil. We measured HGS using a calibrated hydraulic hand dynamometer. We used a frailty scale and the AUC to assess the diagnostic accuracy of the HGS test.

RESULTS

The median age of participants was 67 years. Most (78%) were women and non-White (91%) of low socioeconomic status. HGS identified those at risk for frailty, with an AUC of 71.6% (61.5-80.4%; p < 0.002), as well as a sensitivity of 73.58% and a specificity of 67.53%, on the basis of a cutoff of ≤ 19 kgf.

CONCLUSIONS

HGS appears to be a simple, reliable tool for clinicians to determine frailty risk in older asthma patients in a point-of-care setting.

Enhancing bioavailability of natural extracts for nutritional applications through dry powder inhalers (DPI) spray drying: technological advancements and future directions

Natural ingredients have many applications in modern medicine and pharmaceutical projects. However, they often have low solubility, poor chemical stability, and low bioavailability in vivo. Spray drying technology can overcome these challenges by enhancing the properties of natural ingredients. Moreover, drug delivery systems can be flexibly designed to optimize the performance of natural ingredients. Among the various drug delivery systems, dry powder inhalation (DPI) has attracted much attention in pharmaceutical research. Therefore, this review will focus on the spray drying of natural ingredients for DPI and discuss their synthesis and application.

Changes in pulmonary function following thoracic spine manipulation in a healthy inactive older adult population-a pilot study

[Purpose] Pulmonary function pathology is primarily treated pharmacologically, with a range of medication side effects. Few studies have systematically examined non-pharmacologic approaches such as joint manipulation effects on pulmonary function. This study examined the immediate and short-term effects of thoracic manipulation on pulmonary function. [Participants and Methods] Twenty-one physically inactive otherwise healthy participants aged 50 years or older were randomly assigned to either receive three sessions of thoracic manipulation (n=10) or three sessions of "sham intercostal training" (n=11). Outcome measures included forced vital capacity, maximal voluntary ventilation and thoracic excursion during maximal inhalation and exhalation. [Results] There was a statistically significant difference in maximal voluntary ventilation in the manipulation group, when measured within a week of the third intervention session and immediate effects in thoracic excursion during exhalation in the sham group following a single intervention session. There were no significant changes in other measures. [Conclusion] Spinal manipulation had no immediate effect on pulmonary function, however, affected an improvement in maximal voluntary ventilation within 7 days following a third session. The sham intervention showed a change in thoracic excursion during exhalation after the first session. Future research is necessary to further explore the relationship between thoracic manipulation and pulmonary function.

Biomarkers of aging

Aging biomarkers are a combination of biological parameters to (i) assess age-related changes, (ii) track the physiological aging process, and (iii) predict the transition into a pathological status. Although a broad spectrum of aging biomarkers has been developed, their potential uses and limitations remain poorly characterized. An immediate goal of biomarkers is to help us answer the following three fundamental questions in aging research: How old are we? Why do we get old? And how can we age slower? This review aims to address this need. Here, we summarize our current knowledge of biomarkers developed for cellular, organ, and organismal levels of aging, comprising six pillars: physiological characteristics, medical imaging, histological features, cellular alterations, molecular changes, and secretory factors. To fulfill all these requisites, we propose that aging biomarkers should qualify for being specific, systemic, and clinically relevant.

Pulmonary function in a cohort of heart-healthy individuals from Northern Sweden-a comparison with discordant reference values

BACKGROUND

Dynamic spirometry is an important investigation to differentiate between impaired and normal lung function. This study aimed to evaluate the results of lung function testing in a cohort of subjects from Northern Sweden without any known heart or pulmonary disease. Our focus was to compare with two reference materials that have showed differences in the age-dependency of lung function in Swedish subjects.

METHODS

The study population consisted of 285 healthy adults (148 males, 52%) between 20-90 years of age. The subjects had been randomly selected from the population register for inclusion in a study investigating cardiac function in heart-healthy subjects, but were also assessed with dynamic spirometry. At least seven percent reported smoking. Sixteen subjects presented with pulmonary functional impairments and were excluded from the current study. The sex-specific age-dependency in lung volumes was estimated using the LMS model, where non-linear equations were derived for the mean value (M), the location (L) or skewness, and the scatter (S) or coefficient of variation. This model of the observed lung function data was compared with reference values given by the original LMS model published by the Global Lung Initiative (GLI), and with the model from the recent Obstructive Lung Disease In Norrbotten (OLIN) study, where higher reference values were presented for Swedish subjects than those given by the GLI model.

RESULTS

No differences were found in the age-dependency of pulmonary function between the LMS model developed in the study and the OLIN model. Although the study group included smokers, the original GLI reference values suggested significantly lower normal values of FEV₁ (forced expiratory volume) and FVC (forced vital capacity), and consequently fewer subjects below the lower limit of normality, than both the rederived LMS and OLIN models.

CONCLUSIONS

Our results are in line with previous reports and support that the original GLI reference values underestimate pulmonary function in the adult Swedish population. This underestimation could be reduced by updating the coefficients in the underlying LMS model based on a larger cohort of Swedish citizens than was available in this study.

Longitudinal association of lung function with frailty among older adults: the English Longitudinal Study of Ageing

PURPOSE

To investigate the effect of baseline lung function on the trajectory of frailty over time.

METHODS

This longitudinal study included 3,658 adults aged 60 and over (average age 70.4 years old and 46.4% males) at baseline from the English Longitudinal Study of Ageing. Lung function indicators included forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), both measured at baseline examination. Frailty was defined based on Fried's frailty phenotype criteria, the measurement was repeated for four times. Linear mixed-effect regression model was applied to estimate the association of baseline lung function with the trajectory of frailty over time.

RESULTS

Frailty score increased significantly over time (β = 0.030, P < 0.001). Linear mixed-effect regression model identified significant interactions between FVC (β =- 0.018, P < 0.001) or FEV1 (β =- 0.022, P < 0.001) and time on frailty.

CONCLUSION

Poor baseline lung function might accelerate the speed of frailty. Lung function might be an important predictor of the development and progression of frailty among older adults.

Functional assessment of respiratory muscles and lung capacity of CrossFit athletes

CrossFit is a high-intensity training related to physical fitness and respiratory capacity that can promote changes in lung function. This cross-sectional study was aimed at evaluating respiratory muscle strength, electromyographic (EMG) activity, and lung capacity in CrossFit athletes. Thirty subjects aged between 25 and 35 years were divided into groups: CrossFit athletes (n=15) and sedentary individuals without comorbidities (n=15). Respiratory muscle strength was evaluated using maximal inspiratory and expiratory pressures, lung capacity, and EMG of the sternocleidomastoid, serratus anterior, external intercostal, and diaphragm muscles at respiratory rest, maximal inspiration and expiration, and respiratory cycle. Data were tabulated and subjected to statistical analyses (t-test and Spearman test, P<0.05). Respiratory muscle strength on EMG of the sternocleidomastoid, serratus, external intercostal, and diaphragm muscles at the respiratory cycle and maximal forced inspiration and expiration were higher in the CrossFit athletes group than in the sedentary group without comorbidities. CrossFit athlete group showed significantly strong positive correlation between maximal inspiratory and expiratory muscle strengths (Spearman rho= 0.903, P=0.000), with increasing muscle strength during inspiration favoring an increase in strength during expiration. The forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV₁) also showed a significantly high positive correlation (Spearman rho=0.912, P=0.000) in the CrossFit athletes group, showing that higher FVC favors higher FEV₁. The results of this study suggest that improved fitness is based on increased respiratory muscle strength on EMG in CrossFit athletes.

Respiratory muscle endurance training improves exercise performance but does not affect resting blood pressure and sleep in healthy active elderly

PURPOSE

Ageing is associated with increased blood pressure (BP), reduced sleep, decreased pulmonary function and exercise capacity. The main purpose of this study was to test whether respiratory muscle endurance training (RMET) improves these parameters.

METHODS

Twenty-four active normotensive and prehypertensive participants (age: 65.8 years) were randomized and balanced to receive either RMET (N = 12) or placebo (PLA, N = 12). RMET consisted of 30 min of volitional normocapnic hyperpnea at 60% of maximal voluntary ventilation while PLA consisted of 1 inhalation day-1 of a lactose powder. Both interventions were performed on 4-5 days week-1 for 4-5 weeks. Before and after the intervention, resting BP, pulmonary function, time to exhaustion in an incremental respiratory muscle test (incRMET), an incremental treadmill test (IT) and in a constant-load treadmill test (CLT) at 80% of peak oxygen consumption, balance, sleep at home, and body composition were assessed. Data was analyzed with 2 × 2 mixed ANOVAs.

RESULTS

Compared to PLA, there was no change in resting BP (independent of initial resting BP), pulmonary function, IT performance, sleep, body composition or balance (all p > 0.05). Performance significantly increased in the incRMET (+ 6.3 min) and the CLT (+ 3.2 min), resulting in significant interaction effects (p < 0.05).

CONCLUSION

In the elderly population, RMET might be used to improve respiratory and whole body endurance performance either as an adjunct to physical exercise training or as a replacement thereof for people not being able to intensively exercise even if no change in BP or sleep may be expected.

Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry

Background

It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic.

Methods

Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic.

Results

Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60–63] years vs 64 [62–66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6–9.0] vs 5.8 [5.3–6.4], p < 0.001) and increased, while more female patients (26 [23–29]% vs 41 [35–48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2–7.2| days vs 9.7 [8.9–10.5] days, p < 0.001). The PaO₂/FiO₂ at admission was lower (132 [123–141] mmHg vs 101 [91–113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20–48] mmHg vs 70 [41–100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4–7]% vs 20 [14–29], p < 0.001) and non-invasive mechanical ventilation (14 [11–18]% vs 24 [17–33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76–86]% vs 74 [64–82]%, p < 0.001). The ICU mortality (23 [19–26]% vs 17 [12–25]%, p < 0.001) and length of stay (14 [13–16] days vs 11 [10–13] days, p < 0.001) decreased over 19 months of the pandemic.

Conclusion

Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-022-04065-2.

The effects of respiratory exercises on partial pressures of gases and anxiety in the acute phase of COVID-19 infection

INTRODUCTION

Respiratory exercise in post-COVID-19 significantly improves pulmonary function, exercise capacity and quality of life. Our study aimed to investigate the effect of respiratory exercise on partial pressures of oxygen, carbon dioxide and oxygen saturation in arterial blood and anxiety assessed by the GAD-7 scale in the acute phase of COVID-19 infection.

METHODS

The study was conducted at the Clinical Center, Kragujevac, from June to July 2020. The study was a prospective clinical trial and included 62 patients with the acute-phase of COVID-19 infection (61.3% males, mean age 60.82 ± 11.72). The duration of the comprehensive pulmonary rehabilitation program was 14 days ± 2.28 days. Oxygen saturation and heart rate were determined by using the pulse oximeter, oxygen flow, and arterial blood gas analysis values by using the gas analyzer. The anxiety assessment was measured using the Generalized Anxiety Disorder (GAD-7).

RESULTS

The values of oxygen saturation significantly differed before and after the respiratory exercise sessions (95.77 vs 98.02, respectively; p < .001). After the respiratory exercise program, significantly lower values of the GAD-7 scale were observed compared to the values before the respiratory exercise program (p = .049). A significant negative correlation was observed between oxygen saturation after respiratory exercise and age and presence of chronic obstructive pulmonary disease (ρ = -0.329; p = .013; ρ = -0.334; p = .009, respectively). GAD-7 score after respiratory exercise negatively correlated with chronic obstructive pulmonary disease and malignancy (ρ = -0.285; p = .025; ρ = -0.350; p = .005, respectively).

CONCLUSION

The respiratory exercise program significantly improves oxygen saturation and anxiety levels in COVID-19 patients.

Transcutaneous electrical nerve stimulation over acupoint for chronic obstructive pulmonary disease: A systematic review and meta-analysis

Background

Transcutaneous electrical nerve stimulation over an acupoint (acu-TENS), a new technique applied in pulmonary rehabilitation programs, has been gradually used in the management of chronic obstructive pulmonary disease (COPD). However, the effects of acu-TENS have not been fully evaluated. Therefore, this review was conducted to assess the effects of acu-TENS on COPD.

Methods

A total of seven electronic databases were searched from their inception to September 2021 for randomized controlled trials of acu-TENS for COPD. Two investigators independently performed data extraction and methodological quality assessment. Heterogeneity was examined by Cochrane χ2 and I 2 tests. The source of heterogeneity was investigated by subgroup analysis or sensitivity analysis.

Results

In our review, ten studies between 2008 and 2021 were included. The aggregated results indicated that acu-TENS showed positive effects in forced expiratory volume in 1 s (FEV1) [MD = 0.13 L, 95% CI (0.11-0.16), P < 0.00001], FEV1% predicted [MD = 5.92%, 95% CI (3.43-8.41), P < 0.00001], 6-min walk distance (6MWD) [MD = 14.68m, 95% CI (6.92-22.44), P = 0.0002], dyspnea visual analog scale (DVAS) [MD = -7.58, 95%CI (-14.33 to -0.84), P = 0.03], modified Borg scale (MBS) [MD = -0.46, 95% CI (-0.86 to -0.06), P = 0.03], and COPD assessment test (CAT) [MD = -4.25, 95% CI (-5.24 to -3.27), P < 0.00001]. Although six studies reported adverse effects, only one patient had shoulder pain after acu-TENS.

Conclusion

Acu-TENS seems to be effective in improving pulmonary function and health status in patients with COPD, with little effect on exercise capacity and dyspnea. However, this result should be interpreted with caution, and high-quality RCTs were needed for further verification.

Dynamic Balance and Chest Mobility of Older Adults after Speleotherapy Combined with Pulmonary Rehabilitation, Endurance and Strength Training-A Prospective Study in Chronic Respiratory Diseases

BACKGROUNDS

As people age, they are more likely to experience balance disturbances. Pulmonary rehabilitation is recognized as a core component in the management of older adults with chronic respiratory diseases. The aim of the study was to assess the dynamic balance and chest mobility of older adults participating in speleotherapy combined with pulmonary rehabilitation, endurance and strength training.

METHODS

The study group consisted of 51 older adults with chronic respiratory disorders who participated in a 3-week pulmonary rehabilitation programme in underground salt chambers in the 'Wieliczka' Salt Mine Health Resort. These individuals underwent the Four Square Step Test (FSST) and circumferential chest mobility measurement before and after the outpatient rehabilitation programme conducted 135 m underground.

RESULTS

Before rehabilitation in the underground salt chambers, half of the results (50%, 22 patients) were below the norm in the assessment of chest mobility between maximal inhale and exhale. The average time needed to perform FSST decreased significantly (p ≤ 0.05) from 10.2 ± 1.9 s before the stay to 9.1 ± 1.7 s after the stay and the average increase in chest mobility increased significantly (p ≤ 0.05) from 4.5 ± 5.5 cm to 5.4 ± 2.8 cm.

CONCLUSIONS

Speleotherapy combined with pulmonary rehabilitation, endurance and strength training increased the dynamic balance and chest mobility of older adults with chronic respiratory diseases, as measured by the FSST and circumferential chest expansion assessment.

Fitness tracking reveals task-specific associations between memory, mental health, and physical activity

Physical activity can benefit both physical and mental well-being. Different forms of exercise (e.g., aerobic versus anaerobic; running versus walking, swimming, or yoga; high-intensity interval training versus endurance workouts; etc.) impact physical fitness in different ways. For example, running may substantially impact leg and heart strength but only moderately impact arm strength. We hypothesized that the mental benefits of physical activity might be similarly differentiated. We focused specifically on how different intensities of physical activity might relate to different aspects of memory and mental health. To test our hypothesis, we collected (in aggregate) roughly a century’s worth of fitness data. We then asked participants to fill out surveys asking them to self-report on different aspects of their mental health. We also asked participants to engage in a battery of memory tasks that tested their short and long term episodic, semantic, and spatial memory performance. We found that participants with similar physical activity habits and fitness profiles tended to also exhibit similar mental health and task performance profiles. These effects were task-specific in that different physical activity patterns or fitness characteristics varied with different aspects of memory, on different tasks. Taken together, these findings provide foundational work for designing physical activity interventions that target specific components of cognitive performance and mental health by leveraging low-cost fitness tracking devices.

Mediator Effect of Cardiorespiratory Fitness on the Association between Physical Activity and Lung Function in Adults: Cross-Sectional Results from the Epimov Study

We investigated whether cardiorespiratory fitness (CRF) mediates the association between moderate-to-vigorous physical activity (MVPA) and lung function in asymptomatic adults. We examined the cross-sectional results of 1362 adults aged 18-80 years from the Epidemiology and Human Movement Study. Participants were submitted to spirometry to obtain forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1). Additionally, we used cardiopulmonary exercise testing to obtain peak oxygen uptake (V˙O2) as a measure of CRF. Participants used a triaxial accelerometer for 4-7 days to obtain MVPA. Mediation analyses were performed considering the CRF as a mediator, MVPA as an independent variable, and FVC and FEV1 as dependent variables with adjustment for age, sex, and cardiovascular risk score. We aimed to investigate the total (path c) and direct (paths a, b, c') effects through the regression coefficients. We also examined the indirect effect, which was obtained from the product of the coefficients (path ab). Our sample was composed mainly of overweight and middle-aged women. MVPA was positively related to CRF (path a), as well as CRF and lung function (path b). MVPA also presented a significant positive total effect (path c) in the lung function. However, this relationship became non-significant when CRF was included in the model for both FVC and FEV1 (path c'). We did not observe a direct effect of MVPA on the lung function. In contrast, the indirect effect was significant (path ab). Lastly, CRF mediated 60% of the total effect of MVPA on FVC and 61.9% on FEV1. CRF mediates the relationship between lung function and MVPA in asymptomatic adults. Therefore, our results reinforce the need to include CRF assessment in practice clinical routine and suggest that strategies focusing on CRF might be more promising to prevent respiratory diseases in adults.

Cardiorespiratory fitness as a mediator in the relationship between lung function and blood pressure in adults

It is unclear whether physical activity and cardiorespiratory fitness (CRF) are pathways that link low pulmonary function (LPF) to increased blood pressure (BP). Therefore, we investigated the extent to which CRF and moderate-to-vigorous physical activity (MVPA) mediate the relationship between LPF and high BP in adults. We conducted a cross-sectional study with 1,362 participants that underwent cardiopulmonary exercise testing (CPET), spirometry, and wore an accelerometer to determine physical activity patterns. We performed mediation analyses using structural equations considering peak oxygen uptake (V̇O₂) and MVPA as mediators, forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) as independent variables, and systolic and diastolic blood pressure (SBP, DBP) as dependent variables. The probability of alpha error was set at 5%. We found a significant total effect of FVC on SBP and DBP considering V̇O₂ as mediator (P<0.01). Indirect effects were also significant, with 42.6% of the total effect of FVC on SBP and 77% on DBP mediated by V̇O₂ (P<0.01). We did not observe a direct effect of FVC on SBP and DBP. Considering FEV1 as an independent variable, the total effect on SBP was also significant, as were the indirect effects, mediated by V̇O₂ at 14.8% for SBP and 7.6% for DBP (P<0.01). We did not find an indirect effect of FVC or FEV1 considering the MVPA as a mediator. CRF mediates the pathway that links LPF and elevated BP. Therefore, CRF is more sensitive to variations in FVC and FEV1 than MVPA.

Impact of frailty in elderly patients with moderate to severe asthma

Frailty assessment has been identified as critical approach in chronic respiratory diseases with substantial impact in the health status and functionality in later life. Aging modifies the immune response leading to a chronic pro-inflammatory state and increased susceptibility to airway infections. Since epigenetic changes, airway epithelium dysfunction and inflammatory cytokine activity seem to be more pronounced in the immunosenescence, elderly asthmatics are at higher risk of poor clinical outcomes. Therefore, we hypothesize that frailty would be associated with the degree of asthma control in elderly patients with moderate to severe asthma. The aims of this study are to investigate association between frailty and asthma control in patients over 60 years old to estimate the prevalence of frailty in this study population. We plan to conduct a cross-sectional study with at least 120 patients above 60 years old with diagnostic of moderate to severe asthma according to Global Initiative for Asthma (GINA) guidelines, treated at a referral outpatient clinic. We defined asthma control by the six-domain Asthma Control Questionnaire (ACQ-6) and frailty phenotype in accordance with Fried scale and visual scale of frailty (VS-Frailty). We hope to analyze the multidimensional relationships between frailty and asthma and contribute to innovative therapeutic plans in geriatric asthma.