Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not ...available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p < 0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p < 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 < r < 0.64, p < 0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.
Purpose
To evaluate aerobic exercise capacity in 5-year intensive care unit (ICU) survivors and to assess the association between severity of organ failure in ICU and exercise capacity up to 5-year ...follow-up.
Methods
Secondary analysis of the EPaNIC follow-up cohort (NCT00512122) including 433 patients screened with cardiopulmonary exercise testing (CPET) between 1 and 5 years following ICU admission. Exercise capacity in 5-year ICU survivors (
N
= 361) was referenced to a historic sedentary population and further compared to demographically matched controls (
N
= 49). In 5-year ICU survivors performing a maximal CPET (respiratory exchange ratio > 1.05,
N
= 313), abnormal exercise capacity was defined as peak oxygen consumption (VO
2
peak) < 85% of predicted peak oxygen consumption (%predVO
2
peak), based on the historic sedentary population. Exercise liming factors were identified. To study the association between severity of organ failure, quantified as the maximal Sequential Organ Failure Assessment score during ICU-stay (SOFA-max), and exercise capacity as assessed with VO
2
peak, a linear mixed model was built, adjusting for predefined confounders and including all follow-up CPET studies.
Results
Exercise capacity was abnormal in 118/313 (37.7%) 5-year survivors versus 1/48 (2.1%) controls with a maximal CPET,
p
< 0.001. Aerobic exercise capacity was lower in 5-year survivors than in controls (VO
2
peak: 24.0 ± 9.7 ml/min/kg versus 31.7 ± 8.4 ml/min/kg,
p
< 0.001; %predVO
2
peak: 94% ± 31% versus 123% ± 25%,
p
< 0.001). Muscular limitation frequently contributed to impaired exercise capacity at 5-year 71/118 (60.2%). SOFA-max independently associated with VO
2
peak throughout follow-up.
Conclusions
Critical illness survivors often display abnormal aerobic exercise capacity, frequently involving muscular limitation. Severity of organ failure throughout the ICU stay independently associates with these impairments.
Inspiratory muscle training (IMT) improves respiratory muscle function and might enhance weaning outcomes in patients with weaning difficulties. An electronic inspiratory loading device provides ...valid, automatically processed information on breathing characteristics during IMT sessions. Adherence to and quality of IMT, as reflected by work of breathing and power generated by inspiratory muscles, are related to improvements in inspiratory muscle function in patients with chronic obstructive pulmonary disease. The aim of this study was to investigate the validity of an electronic training device to assess and provide real-time feedback on breathing characteristics during inspiratory muscle training (IMT) in patient with weaning difficulties. Patients with weaning difficulties performed daily IMT sessions against a tapered flow-resistive load of approximately 30 to 50% of the patient’s maximal inspiratory pressure. Airflow and airway pressure measurements were simultaneously collected with the training device (POWERbreatheKH2, POWERbreathe International Ltd, UK) and a portable spirometer (reference device, Pocket-Spiro USB/BT100, M.E.C, Belgium). Breath by breath analysis of 1002 breaths of 27 training sessions (n = 13) against a mean load of 46±16% of the patient’s maximal inspiratory pressure were performed. Good to excellent agreement (Intraclass correlation coefficients: 0.73–0.97) was observed for all breathing characteristics. When individual differences were plotted against mean values of breaths recorded by both devices, small average biases were observed for all breathing characteristics. To conclude, the training device provides valid assessments of breathing characteristics to quantify inspiratory muscle effort (e.g. work of breathing and peak power) during IMT in patients with weaning difficulties. Availability of valid real-time data of breathing responses provided to both the physical therapist and the patient, can be clinically usefull to optimize the training stimulus. By adapting the external load based on the visual feedback of the training device, respiratory muscle work and power generation during IMT can be maximized during the training.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Fatigue is a common and distressing symptom in cancer patients, especially in lymphoma patients. One hypothesized mechanism in the etiology of fatigue is a vicious circle between fatigue, physical ...inactivity, and deconditioning. However, the natural evolution of physical activity and physical fitness over the course of treatment is unknown. Therefore, the aim of this longitudinal study was to assess fatigue, physical activity, and physical fitness in lymphoma patients before, during, and after treatment. Fatigue was measured with the EORTC-QLQ-C30, physical activity with an accelerometer, and physical fitness with a maximal incremental cycle ergometer test, 6-min walking distance test, and muscle strength measurements. Differences between the three measurement moments and baseline differences between Hodgkin lymphoma and non-Hodgkin lymphoma, early and advanced disease, were analyzed. Twenty-nine patients were included. Functional exercise capacity and quadriceps force were impaired before the start of treatment (86 ± 15 and 82 ± 16 % of predicted value, respectively). Over the course of treatment, significant declines were found in hemoglobin, quadriceps force, handgrip force, and maximal oxygen uptake, while patients reported more fatigue (
p
values < 0.016). Fatigue was significantly correlated with hemoglobin (
r
= −0.49), physical activity (
r
= 0.81), and physical functioning (
r
= −0.44). Large interindividual variations were found. The present study partially confirmed the hypothesized vicious circle between fatigue, physical inactivity, and deconditioning. Further research with larger samples and longer follow-up is needed to identify factors associated with individual variation in the evolution of fatigue, physical activity, and physical fitness.
Background: Despite a variety of benefits brought by pulmonary rehabilitation to patients with COPD, it is unclear whether these patients
are more active during daily life after the program.
Methods: ...Physical activities in daily life (activity monitoring), pulmonary function (spirometry), exercise capacity (incremental
cycle-ergometer testing and 6-min walk distance testing), muscle force (quadriceps and handgrip force, and inspiratory and
expiratory maximal pressures), quality of life (chronic respiratory disease questionnaire), and functional status (pulmonary
functional status and dyspnea questionnaire-modified version) were assessed at baseline, after 3 months of a multidisciplinary
rehabilitation program, and at the end of a 6-month multidisciplinary rehabilitation program in 29 patients (mean ± SD age,
67 ± 8 years; FEV 1 , 46 ± 16% predicted).
Results: Exercise capacity, muscle force, quality of life, and functional status improved significantly after 3 months of pulmonary
rehabilitation (all p < 0.05), with further improvements in muscle force, functional status, and quality of life at 6 months.
Movement intensity during walking improved significantly after 3 months (p = 0.046) with further improvements after 6 months
(p = 0.0002). Walking time in daily life did not improve significantly at 3 months (mean improvement, 7 ± 35%; p = 0.21),
but only after 6 months (mean improvement, 20 ± 36%; p = 0.008). No significant changes occurred in other activities or in
the pattern of the time spent walking in daily life. Changes in dyspnea after the program were significantly related to changes
in walking time in daily life ( r = 0.43; p = 0.02).
Conclusion: If one aims at changing physical activity habits in the daily life of COPD patients, the contribution of long-lasting programs
might be important.
COPD
exercise
physical activity
pulmonary rehabilitation
Acute exacerbations (AEs) have a negative impact on various aspects of the progression of COPD, but objective and detailed data on the impact of hospitalizations for an AE on physical activity are ...not available.
We aimed to investigate physical activity using an activity monitor (DynaPort; McRoberts; the Hague, the Netherlands), pulmonary function, muscle force, 6-min walking distance, and arterial blood gas levels in 17 patients (mean age, 69 ± 9 years ± SD; body mass index, 24 ± 5 kg/m2) at the beginning and end of a hospitalization period for an AE and 1 month after discharge.
Time spent on weight-bearing activities (walking and standing) was markedly low both at day 2 and day 7 of hospitalization (median, 7%; interquartile range IQR, 3 to 18% of the time during the day; and median, 9%; IQR, 7 to 21%, respectively) and 1 month after discharge (median, 19% IQR, 10 to 34%; Friedman test, p = 0.13). Time spent on weight-bearing activities was positively correlated to quadriceps force at the end of the hospitalization period (r = 0.47; p = 0.048). Patients with hospitalization for an AE in the previous year had an even lower activity level when compared to those without a recent hospitalization. In addition, patients with a lower activity level at 1 month after discharge were more likely to be readmitted in the following year.
Patients with COPD are markedly inactive during and after hospitalization for an AE. Efforts to enhance physical activity should be among the aims of the disease management during and following the AE periods.
Pulmonary rehabilitation programs only modestly enhance daily physical activity levels in patients with chronic obstructive pulmonary disease (COPD). This randomised controlled trial investigates the ...additional effect of an individual activity counselling program during pulmonary rehabilitation on physical activity levels in patients with moderate to very severe COPD.
Eighty patients (66 ± 7 years, 81% male, forced expiratory volume in 1 second 45 ± 16% of predicted) referred for a six-month multidisciplinary pulmonary rehabilitation program were randomised. The intervention group was offered an additional eight-session activity counselling program. The primary outcomes were daily walking time and time spent in at least moderate intense activities.
Baseline daily walking time was similar in the intervention and control group (median 33 interquartile range 16-47 vs 29 17-44) whereas daily time spent in at least moderate intensity was somewhat higher in the intervention group (174-50 vs 122-26 min). No significant intervention*time interaction effects were observed in daily physical activity levels. In the whole group, daily walking time and time spent in at least moderate intense activities did not significantly change over time.
The present study identified no additional effect of eight individual activity counselling sessions during pulmonary rehabilitation to enhance physical activity levels in patients with COPD.
clinicaltrials.gov NCT00948623.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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