Background The success of pulmonary rehabilitation (PR) is established, but how to sustain benefits over the long term is less clear. The aim of this systematic review was to determine the effect of ...supervised exercise programs after primary PR on exercise capacity and health-related quality of life (HRQL) in individuals with COPD. Methods Randomized controlled trials of postrehabilitation supervised exercise programs vs usual care for individuals with COPD were identified after searches of six databases and reference lists of appropriate studies. Two reviewers independently assessed study quality. Standardized mean differences (SMDs) with 95% CIs were calculated using a fixed-effect model for measures of exercise capacity and HRQL. Results Seven randomized controlled trials, with a total of 619 individuals with moderate to severe COPD, met the inclusion criteria. At 6-month follow-up there was a significant difference in exercise capacity in favor of the postrehabilitation interventions (SMD, −0.20; 95% CI, −0.39 to −0.01), which was not sustained at 12 months (SMD, −0.09; 95% CI, −0.29 to 0.11). There was no difference between postrehabilitation interventions and usual care with respect to HRQL at any time point. Conclusions Supervised exercise programs after primary PR appear to be more effective than usual care for preserving exercise capacity in the medium term but not in the long term. In this review, there was no effect on HRQL. The small number of studies precludes a definitive conclusion as to the impact of postrehabilitation exercise maintenance on longer-term benefits in individuals with COPD.
Background Although balance deficits are increasingly recognized in COPD, little is known regarding the disordered subcomponents underlying the control of balance. We aimed to determine the specific ...components of balance that are impaired in COPD and to investigate the association among balance, peripheral muscle strength, and physical activity. Methods Balance, physical activity, and lower extremity muscle strength were assessed in 37 patients with COPD and 20 age-matched healthy control subjects using the Balance Evaluation Systems Test (BESTest), the Physical Activity Scale for the Elderly, and an isokinetic dynamometer, respectively. A subset of subjects (20 patients with COPD and 20 control subjects) underwent a second testing session in which postural perturbations were delivered using a lean-and-release system. Results Subjects with COPD (age, 71 ± 7 years; FEV1 , 39% ± 16% predicted) exhibited significantly lower scores than did control subjects (age, 67 ± 9 years) on all of the BESTest subscales (all P < .001). In response to anterior perturbations, subjects with COPD showed a longer time to foot-off ( P = .027) and foot contact ( P = .018), and a longer duration anticipatory phase ( P = .008) compared with control subjects. Muscle strength ( P = .008) and self-reported physical activity ( P = .033) explained 35% of the variance in balance in subjects with COPD. Conclusions Individuals with COPD exhibit impairments in all balance subcomponents and demonstrate slower reaction times in response to perturbations. Deficits in balance are associated with reduced physical activity levels and skeletal muscle weakness.
Background Deficits in balance are increasingly recognized among the important secondary impairments in COPD. The purpose of this study was to investigate the effect of a balance-training program on ...measures of balance and physical function in patients with COPD enrolled in pulmonary rehabilitation (PR). Methods Patients were assigned randomly to an intervention or control group. The intervention group underwent balance training three times a week for 6 weeks concurrently with PR. The control group received only the 6-week PR program. Clinical balance measures included the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BESTest), and the Activities-Specific Balance Confidence (ABC) scale. The physical function subscale of the 36-Item Short Form Health Survey (PF-10) and the 30-s chair-stand test were used to measure self-reported physical function and lower-extremity muscle strength, respectively. Results Thirty-nine patients with COPD (mean FEV1 , 37.5% ± 15.6% predicted) were enrolled in the study. Mean compliance with the balance-training program was 82.5%, and no adverse events were reported. Compared with control subjects, scores on the BBS ( P < .01), BESTest ( P < .01), PF-10 ( P = .01), and 30-s chair-stand ( P = .02) were significantly improved in the intervention group. No significant between-group differences were found in change scores on the ABC scale ( P = .2). Conclusions Our results support the feasibility and effectiveness of balance training as part of PR for improving balance performance, muscle strength, and self-reported physical function in patients with moderate to severe COPD. Trial registry ClinicalTrials.gov ; No.: NCT01424098; URL: www.clinicaltrials.gov
Background The objectives of this systematic review were to synthesize the literature on measures of activities of daily living (ADLs) that have been used in individuals with COPD and to provide an ...overview of the psychometric properties of the identified measures and describe the relationship of the disease-specific instruments with other relevant outcome measures for individuals with COPD and health-care use. Methods Studies that included a measure of ADLs in individuals with COPD were identified using electronic and hand searches. Two investigators performed the literature search. One investigator reviewed the study title, abstract, and full text of the articles to determine study eligibility and performed the data extraction and tabulation. In cases of uncertainty, a second reviewer was consulted. Results A total of 679 articles were identified. Of those, 116 met the inclusion criteria. Twenty-seven ADLs instruments were identified, of which 11 instruments were respiratory disease-specific, whereas 16 were generic. Most instruments combined instrumental ADLs (IADLs) with basic ADLs (BADLs). The majority of the instruments were self-reported; only three instruments were performance based. Twenty-one studies assessed psychometric properties of 16 ADLs instruments in patients with COPD. Conclusions Although several ADLs instruments were identified, psychometric properties have only been reported in a few. Selection of the most appropriate measure should focus on the target construct (BADLs or IADLs or both), type of test (disease-specific vs generic and self-reported vs performance-based), depth of information obtained, and psychometric properties of the instruments. Given the relevance of ADLs to the lives of patients with COPD, its assessment should be more frequently incorporated as a clinical outcome in their management.
Abstract Objectives To determine whether adults with diabetes and with transtibial amputations (TTAs) are meeting the recommended guidelines for physical activity intensity and daily step counts. The ...secondary objectives were to 1) to explore whether physical activity levels are maintained following discharge from prosthetic rehabilitation and 2) to determine whether clinical measures of physical function are associated with physical activity. Methods Adults ≥40 years of age with TTAs secondary to diabetes were recruited following discharge from prosthetic rehabilitation. Outcomes included accelerometer-measured physical activity (worn on the ankle of the intact limb), the 2-minute walk test, gait speed, the L-test and balance confidence. Assessments were conducted at 3 months (baseline) and at 9 months following discharge from rehabilitation. Analyses included paired sample t tests and Pearson correlation coefficients. Results The mean age for all participants (n=22) was 63±12 years. Participants took 3809±2189 steps per day at follow up, markedly lower than the 6500 steps per day recommended for older adults with chronic illness. Participants accumulated 24±41 minutes per week of moderate to vigorous physical activity, falling well below the recommended total of 150 minutes per week. An improvement was observed for performance on the L-test of functional mobility at follow up (−8.7 s±11.4; p=0.008). All other outcomes remained stable over time. Physical activity exhibited a good to excellent correlation with the 2-minute walk test distance (r=0.753; p<0.001) and gait speed (r=0.752; p<0.001) at discharge from rehabilitation. Conclusions Physical activity levels for adults with diabetes and TTAs remain stable following discharge from prosthetic rehabilitation but fall well below recommended guidelines of 6500 steps per day and 150 minutes of moderate to vigorous physical activity per week.
Abstract Background Despite well-established improvements following rehabilitation, functional gains often diminish following discharge. Objective To explore the attitudes of older adults with HF and ...COPD, who have completed rehabilitation, toward community-based exercise maintenance. Methods Semi-structured interviews were conducted with 11 individuals with HF or COPD. Results Deductive thematic analysis uncovered three themes: 1) transitioning to community exercise is challenging, highlighting participants' struggle with unstructured maintenance and a lack of appropriate programs; 2) a structured, group-based program tailored to functional ability facilitates adherence, describing participants views on the importance of routine, and accountability; and 3) “We are all there for the same purpose” – participant support for integrated exercise, including the benefit of multiple perspectives and sustainability. Conclusions A motivating program leader and access to appropriate facilities are key features to support adherence to prescribed activity. Tailored programs can be delivered consecutively to older adults with HF and COPD.
BACKGROUND Music has been used as a distractive auditory stimulus (DAS) in patients with COPD, but its effects are unclear. This systematic review aimed to establish the effect of DAS on exercise ...capacity, symptoms, and health-related quality of life (HRQOL) under three conditions: (1) during exercise training, (2) during exercise testing, and (3) for symptom management at rest. METHODS Randomized controlled or crossover trials as well as cohort studies of DAS during exercise training, during formal exercise testing, and for symptom management among individuals with COPD were identified from a search of seven databases. Two reviewers independently assessed study quality. Weighted mean differences (WMDs) with 95% CIs were calculated using a random-effects model. RESULTS Thirteen studies (12 of which were randomized controlled or crossover trials) in 415 participants were included. DAS increased exercise capacity when applied over at least 2 months of exercise training (WMD, 98 m; 95% CI, 47-150 m). HRQOL improved only after a training duration of 3 months. Less dyspnea was noted with DAS during exercise training, but this was not consistently observed in short-term exercise testing or as a symptom management strategy at rest. CONCLUSIONS DAS appears to reduce symptoms of dyspnea and fatigue when used during exercise training, with benefits observed in exercise capacity and HRQOL. When applied during exercise testing, the effects on exercise capacity and symptoms and as a strategy for symptom management at rest are inconsistent.
BACKGROUND Cardiorespiratory fitness, assessed during cardiopulmonary exercise tests by peak oxygen uptake ( V ˙ o2 pk), is an independent predictor of mortality in obesity. We investigated whether V ...˙ o2 pk and systemic responses measured during field walking tests were similar to those measured during an incremental treadmill test (ITMT) in obese individuals with treated OSA. METHODS Individuals with treated OSA and a BMI > 30 kg/m2 were recruited. Participants completed an ITMT, two 6-min walk tests (6MWTs), and two incremental shuttle walk tests (ISWTs) on three separate days in a randomized order. Expired gas analysis was performed during all tests. RESULTS The study was completed by 16 patients (nine men) (mean SD age, 58 12 y; BMI, 36.1 7.6 kg/m2 ). There was no difference ( P = .27) in V ˙ o2 pk assessed by the ITMT and the ISWT (2,266 478 and 2,017 561 mL/min, respectively). The V ˙ o2 pk measured by the 6MWT (1,778 360 mL/min) was lower than that measured by the ITMT ( P < .01). The limits of agreement for V ˙ o2 pk between the ISWT and the ITM were ± 730 mL/min. Cardiorespiratory responses during the ISWT and the ITMT reflected a graded response to a peak, whereas the 6MWT demonstrated a rapid rise to a plateau. CONCLUSIONS The ISWT can be used instead of an ITMT and in preference to the 6MWT to assess cardiorespiratory fitness for a cohort of obese people with treated OSA. However, the imprecision of the agreement in V ˙ o2 pk between the ITMT and ISWT means they cannot be used interchangeably in an individual. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01930513; www.clinicaltrials.gov
Abstract Beauchamp MK, O'Hoski S, Goldstein RS, Brooks D. Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease. Objectives To describe within-subject ...effects of pulmonary rehabilitation (PR) on balance in persons with chronic obstructive pulmonary disease (COPD) and to determine whether any observed changes in balance were associated with change in exercise tolerance or health-related quality of life. Design Single-arm longitudinal study. Setting Inpatient PR center. Participants Subjects with COPD (N=29; mean ± SD age, 69.8±10.3y; forced expiratory volume in 1 second, 46.3%±22.3% predicted; 59% men n=17). Interventions A standardized 6-week multidisciplinary PR program (exercise training, breathing exercises, education, and psychologic support). Main Outcome Measures Balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Activities-Specific Balance Confidence (ABC) scale. Exercise tolerance was determined from the 6-minute walk test (6MWT), and health-related quality of life from the Chronic Respiratory Questionnaire (CRQ). Results Subjects showed small improvements in BBS (2.8±2.8 points; P <.001) and TUG (−1.5±2.4s; P =.003) scores, but not in ABC scores (4.8±15.4 points; P >.05). There was a weak relationship between change in BBS and change in CRQ scores ( r =.40; P =.045) and no relationship with change in 6MWT. Conclusions PR contributed to minor improvements in balance and had no effect on balance confidence in subjects with COPD. Further work is warranted to determine the optimal intervention for improving balance in this population.
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