Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory ...Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope.
The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.
A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members.
An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed.
The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
The aims of this study were to establish whether pulmonary rehabilitation (PR) improves domestic function and daily activity levels in COPD and whether individually targeted exercise is more ...effective than general exercise.
Prospective randomized, controlled trial.
Outpatient PR program in secondary care.
One-hundred eighty patients (mean ±SD age, 68.3 ± 8.6 years; FEV1, 0.95 ± 0.4 L; FEV1/FVC ratio, 0.51 ± 0.15; 111 male patients; 69 female patients) with stable COPD. One hundred twenty-one patients completed the study.
Patients were randomized to a conventional 7-week general exercise program (GEP n = 90) or an individually targeted exercise program (ITEP n = 90).
Daily activity was measured using ambulatory activity monitors (Z80 –32k V1 Int; Gaehwiler Electronics; Hombrechtikon, Switzerland). These were lightweight devices, which contained a uniaxial accelerometer. Domestic function was assessed by the Canadian Occupational Performance Measure (COPM). Exercise performance was assessed by the incremental shuttle walk test (ISWT) and the endurance shuttle walk test and health status by the chronic respiratory questionnaire–self-reported. Activity monitor counts increased by 29.18% (95% confidence interval CI, 3.19 to 55.17; p = 0.03) for the GEP and 40.63% (95% CI, 7.42 to 73.83; p = 0.02) for the ITEP. Mean COPM performance scores increased by 1.71 (95% CI, 1.37 to 2.05; p = 0.0001) for the GEP and 1.46 (95% CI, 1.05 to 1.87; p = 0.0001) for the ITEP. Mean COPM satisfaction scores increased by 2.27 (95% CI, 1.74 to 2.81; p = 0.0001) for the GEP and 2.04 (95% CI, 1.56 to 2.52; p = 0.0001) for the ITEP. ISWT scores increased by 81.72 m (range, 63.83 to 99.62) for the GEP and by 85.52 m (range, 67.62 to 103.42) for the ITEP. No statistically significant difference was found between the general exercise group and the individually targeted exercise group for any outcome measure.
Pulmonary rehabilitation improves domestic function and physical activity. This study also demonstrates that general exercise training is as effective as individually targeted training.
PURPOSE:The COPD Assessment Tool (CAT) has previously been shown to be a sensitive outcome measure for pulmonary rehabilitation (PR) in a stable population, but its utility in a postexacerbation PR ...population is unknown. The aim of this study was to investigate any differences in response to the CAT between stable and postexacerbation patients undertaking PR.
METHODS:Patients attending a 7-week outpatient PR program completed a CAT questionnaire pre- and postrehabilitation. Patients referred for elective outpatient PR were compared with those who had been referred to PR following a hospital admission for an exacerbation.
RESULTS:Two hundred consecutive patients completed the CAT questionnaire125 stable patients (74 male, mean age 71.1 ± 8.9 years, forced expiratory volume in 1 second FEV1 1.39 L ± 0.6, and body mass index BMI 28.5 ± 6.7 kg/m) and 75 postexacerbation patients (23 male, mean age 70.6 ± 8.6 years, FEV1 1.16 L ± 0.5, and BMI 25.8 ± 7.3 kg/m). A statistically significant difference between the stable and postexacerbation patient groups pre-PR CAT score (P = .05) was observed. There was no significant difference in post-PR CAT scores or change in CAT scores between the stable and postexacerbation groups. There was a significant difference in pre- and post-PR walking test results between the groups. The improvement in the Endurance Shuttle Walking Test (ESWT) in the stable group was greater (P < .05).
CONCLUSIONS:Postexacerbation PR patients had a worse CAT score prior to PR when compared with a stable PR population, but both groups made improvements in CAT following completion of PR.
Background:
Pulmonary rehabilitation (PR) is a highly effective intervention for individuals with chronic obstructive pulmonary disease (COPD). Physical activity (PA) has been shown to increase after ...a centre-based programme, yet it is not clear if a home-based programme can offer the same benefit. This study aimed to evaluate the effect of home-based PR compared with the centre-based PR on the PA levels post 7 weeks of PR and 6 months follow-up.
Method:
In this study, 51 participants with COPD, of them, 36 (71%) men completed physical activity monitoring with a SenseWear Armband, at three time points (baseline, 7 weeks, and 6 months). The participants were randomly assigned to either centre-based supervised PR (
n
= 25; 69 ± 6 years; FEV
1
55 ± 20% predicted) or home-based PR (
n
= 26; 68 ± 7 years; FEV
1
42 ± 19% predicted) programmes lasting 7 weeks. The home-based programme includes one hospital visit, a self-management manual, and two telephone calls. The PA was measured as step count, time in moderate PA (3–6 metabolic equivalent of tasks METs) in bouts of more than 10 min and sedentary time (<2 METs).
Results:
Home-based PR increased step count significantly more than the centre-based PR after 7 weeks (mean difference 1,463 steps: 95%
CI
280–2,645,
p
= 0.02). There was no difference in time spent in moderate PA was observed (mean difference 62 min: 95%
CI
−56 to 248,
p
= 0.24). Sedentary behaviour was also significantly different between the centre and home-based groups. The home group spent 52 min less time sedentary compared with the centre-based (
CI
−106 to 2,
p
= 0.039). However, after 6 months, the step count and time spent in moderate PA returned to baseline in both the groups.
Conclusion:
This study provides an important insight into the role of home-based PR which has the potential to be offered as an alternative to the centre-based PR. Understanding who may best respond from the centre or home-based PR warrants further exploration and how to maintain these initial benefits for the long-term.
Trial Registry:
ISRCTN: No.: ISRCTN81189044; URL:
isrctn.com
.
Seasonal differences may influence levels of physical activity and outcomes of a pulmonary rehabilitation (PR) program. This study examined the effect of seasonal variations upon baseline measures ...and outcomes of physical activity, exercise performance, and health status in PR. Stable patients (N = 95) with chronic obstructive pulmonary disease (COPD) were studied and placed into the seasonal group corresponding to when PR commenced: spring (n = 18), summer (n = 23), autumn (n = 34), winter (n = 20). Physical activity was measured by a uniaxial accelerometer, exercise performance by the Incremental Shuttle Walking Test (ISWT), and health status by the Chronic Respiratory Disease Questionnaire-Self Reported. Patients who commenced PR in the winter had lower levels of physical activity at baseline (P = .02) and attained the largest improvements when compared with any other seasonal group (P = .04). No seasonal variation was detected in ISWT scores or health status either prior to or upon completion of PR. The results of this study suggest that levels of daily activity may be vulnerable to seasonal variations and this should be considered when examining physical activity levels in patients with COPD.
► We developed a sensitive LCMS method for thalidomide with an LOQ of 3ng/mL in serum. ► The sample preparation, LLE, gives higher sample recovery than previous methods. ► In patient serum we ...detected thalidomide levels ranging from 25ng/mL to 1407ng/mL. ► We quantified thalidomide degradation in vitro with 50% remaining after 2h.
A simple, robust, sensitive and selective liquid chromatography tandem mass spectrometry (LC–MS/MS) method for the quantification of thalidomide was developed and validated. The method was applied to thalidomide quantification in three different types of biological samples. Thalidomide was extracted from human serum (100μL), cells (2.5×105), or cell culture media (100μL) by LLE and separated on a Prodigy C18 (150mm×4.0mm, 5μm i.d.) column with isocratic elution using water/acetonitrile (70/30, v/v) 0.1% formic acid, at a flow rate of 0.5mL/min, with umbelliferone (600ng/mL) as an internal standard. Thalidomide was quantified using a triple quadrupole mass spectrometer operated in multi-reaction-monitoring mode using positive electrospray ionisation. The method was validated in two separate thalidomide concentration ranges; human serum (0.05–20μg/mL) and in vitro cells (0.78–50ng) with an inter-day precision of 1.8% and 1.9% and average accuracy of 100% and 101% in serum and cells respectively. Despite the use of small sample volume, the limit of quantification for thalidomide in serum was determined to be 3ng/mL. The method was successfully employed to measure levels of thalidomide in cancer patient serum and cell culture model systems. Although cellular levels were quantifiable, thalidomide was shown to be unstable under in vitro conditions with a half life of approximately 2h. In patient samples, circulating serum levels showed a broad correlation with dose and uncovered some patient compliance issues.
Background Self-efficacy explores the emotional functioning and coping skills of an individual and is thought to be a strong predictor of health behaviors, which is particularly important for ...pulmonary rehabilitation (PR). However, to our knowledge, there is no measure of self-efficacy developed to explore behavior change in the context of PR. Methods We investigated the reproducibility and sensitivity of Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE): a tool adapted from the General Self-Efficacy Scale (GSES) to measure the dimension of self-efficacy at the time of a course of PR. Twenty-nine clinically stable patients with COPD completed PRAISE on their initial assessment to PR. The tool was then completed 7 days later. An additional 225 patients completed PRAISE prior to, and on completion of a 7-week course of PR. In addition, exercise capacity was measured by the incremental shuttle walk test (ISWT), with the Medical Research Council (MRC) dyspnea scale, Chronic Respiratory Questionnaire-Self Reported (CRQ-SR), and Hospital Anxiety and Depression Scale (HADS) also being collected. This process was repeated postrehabilitation. Data were then analyzed to investigate the possibility that PRAISE could be an indicator of PR response. Results In the reproducibility study, the mean change in score was 0.72 (95% CI, −2.27-0.82), examined with intraclass correlation coefficients, r = 0.99; indicating PRAISE test-retest reproducibility. The mean change of score in the sensitivity study pre- to post-PR was 3.59 (95% CI, 2.24-4.73; P = .015). Change in the ISWT was 83.44 m (95% CI, 54.0-112.8; P < .0001). There were several statistically significant differences between variables, particularly with the mastery and emotion elements of the CRQ-SR at baseline, but this was lost post-PR. This observation was also found with HADS. No significant differences were found between MRC dypsnea scale grades with the change in PRAISE score. PRAISE could not predict a successful outcome of PR. Conclusions The PRAISE tool is a reliable and sensitive measure of self-efficacy for patients with COPD attending PR.
Objective
Monitoring of physical activity and sedentary behaviours by mobile phone applications (apps) and wearable technology (wearables) may improve these health behaviours. This systematic review ...aims to synthesise the qualitative literature on the barriers and facilitators of using apps and wearables for monitoring physical activity and/or sedentary behaviour in adults.
Methods
This review protocol is registered in PROSPERO (CRD42017070194). Scientific databases including CINAHL Complete, MEDLINE, PsycINFO, SPORTDiscus, Cochrane Library and Scopus will be searched for relevant studies published from 1 January 2012 to the date the searches are conducted. Studies will be included if they incorporated adults who used an app or wearable for monitoring physical activity and/or sedentary behaviour; explored the barriers and/or facilitators of using an app and/or wearable; and were published in English. Following duplicate screening of titles and abstracts, full texts of potentially eligible papers will be screened to identify studies using qualitative approaches to explore barriers and facilitators of using apps and/or wearables for monitoring physical activity and/or sedentary behaviour. Discrepancies will be resolved through consensus or by consulting a third screener. Relevant excerpts (quotes and text) from the included papers will be extracted and analysed thematically. The Critical Appraisal Skills Programme Qualitative Research Checklist will be used to appraise included studies.
Conclusion
The results of this work will be useful for those intending to monitor physical activity and/or sedentary behaviour using these technologies.
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