8-week Pulmonary Rehabilitation Program Research Articles

Effectiveness of a home-based pulmonary rehabilitation maintenance programme: the Rehab2Life study protocol

Pulmonary rehabilitation (PR) is the bedrock of non-pharmacological treatment for people with COPD. Nonetheless, it is well described in the literature that unless the patient changes his behaviour, the benefits of PR programmes will decline in six to twelve months after finishing the programme. Therefore, maintenance programmes can address the problem of PR programmes’ effect loss over time.Community care units can provide multidisciplinary care in the current Portuguese primary health care context. These units have an interdisciplinary team that aims to develop competencies in COPD patients to self-manage the disease.This study aims to test the effectiveness of a 12-month home-based PR programme (Rehab2Life) compared to usual care through a single-blind randomised controlled trial with two parallel groups. The Rehab2Life programme includes two distinct phases. The first is an 8-week PR programme delivered to both groups, and the second is a PR maintenance programme delivered to the intervention group after the initial eight weeks. The control group receive the usual care and regular appointments. The primary outcome is functional capacity, and secondary outcomes are dyspnea, Health-Related Quality of Life (HRQoL), number of exacerbations, symptoms burden, anxiety and depression symptoms, and physical activity.We expect to observe that the home-based PR programme brings clinically relevant benefits to the participants at the end of the first eight weeks and that, at 12 months after the maintenance phase of the programme, benefits are less dissipated than in the control group. We expect to identify the characteristics of the patients who benefit the most from home-based programmes.The trial was registered on 7 April 2022 at ClinicalTrials.gov (NCT05315505).

Effects of Pulmonary Rehabilitation with Occupational Therapy on Occupational Performance

Aims 1) Explore occupational challenges of individuals participating in pulmonary rehabilitation (PR), and 2) examine impacts of occupational therapy, embedded within PR, on performance of, satisfaction with, dyspnea in and experience of challenging occupations. Methods A mixed methods cohort study recruited adults from a 8-week community-based PR program which incorporated targeted occupational therapy. Participant perspectives of the occupational therapy were explored using the Canadian Occupational Performance Measure (COPM) and Modified Borg Dyspnea Scale. Results Seventeen participants with either Chronic Obstructive Pulmonary Disease, Bronchiectasis, or Interstitial Lung Disease were recruited (age 71 ± 7(SD) identifying 269 problematic occupations. Nine participants completed the program obtaining clinically and statistically significant improvements in COPM performance, satisfaction scores and Modified Borg Dyspnea Scale, maintained at 12 wk, and validated through participants reporting they ‘now do things differently’. Conclusion People with chronic respiratory conditions are occupational beings. Occupational therapy embedded within PR can influence participants’ engagement in challenging occupations.

A pulmonary rehabilitation program is an effective strategy to improve forced vital capacity, muscle strength, and functional exercise capacity similarly in adults and older people with post-severe COVID-19 who required mechanical ventilation.

It is internationally known that our population is aging. At the same time, some patients with COVID-19, due to their symptoms, required mechanical ventilation (MV) and subsequent pulmonary rehabilitation (PR). This study aimed to compare the effects of a multimodal PR program "ADULT" versus "OLDER" people with COVID-19 who were on MV. The intervention consisted of an 8-week hybrid PR program (2x week). Forced vital capacity (FVC) was measured at the beginning and end of PR, upper and lower limb strength was obtained through hand grip strength (HGS) and the sit-to-stand test (STST), respectively, and functional exercise capacity was measured with the 6-minute walking test (6MWT). The main results were an increase in the FVC in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.27), an increase in HGS in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.52), in the same way, the number of repetitions on the STST increased in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.55). Finally, the distance covered on the 6MWT increased in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.65). The PR program is an effective strategy to improve FVC, muscle strength, and functional exercise capacity similarly in adults and older people with post severe COVID-19 who required MV.

Efficacy of Digital Therapeutics for Pulmonary Rehabilitation: A Multi-Center, Randomized Controlled Trial.

This study aimed to investigate the efficacy and safety of digital therapeutics (DTx), EASYBREATH, for pulmonary rehabilitation (PR) in patients with chronic respiratory diseases (CRDs). This prospective randomized controlled trial was conducted at multiple centers. Participants were randomly allocated 1:1 to the DTx group (DTxG), provided with DTx using EASYBREATH. The DTxG underwent an 8-week PR program with evaluations conducted at baseline, four weeks, and eight weeks. The control group (CG) underwent one PR session and was advised to exercise and undergo the same evaluation. The primary outcome was the change in six-minute walking distance (6MWD) over eight weeks, and secondary outcomes included changes in scores of Modified Medical Research Council (mMRC), chronic obstructive pulmonary disease assessment test (CAT), and St. George's respiratory questionnaire (SGRQ). The change in 6MWD after eight weeks demonstrated a significant difference between the DTxG and CG (57.68 m vs. 21.71 m, p = 0.0008). The change in mMRC scores (p = 0.0008), CAT scores (p < 0.0001), and total SGRQ scores (p = 0.0003) also showed a significant difference between the groups after eight weeks. EASYBREATH significantly improved exercise capacity, alleviated dyspnea, and enhanced the overall quality of life at eight weeks. EASYBREATH is a highly accessible, time-efficient, and effective treatment option for CRD with high compliance.

Clinical Utility of Diaphragmatic Ultrasound in Chronic Obstructive Pulmonary Disease Patients Undergoing Rehabilitation

ABSTRACT Background: Pulmonary rehabilitation (PR) is a well-recognized intervention in the management of individuals with chronic obstructive pulmonary disease (COPD) that is designed to improve patients’ physical and psychosocial conditions. The primary aim of the study was to determine the effect of PR on ultrasonography (USG) assessment of diaphragmatic excursion. Materials and Methods: The current study is a prospective, interventional study in COPD (Group D) patients. All subjects underwent 8 weeks of supervised PR. The baseline assessment with USG diaphragmatic excursion, quadriceps femoris (QF) thickness, biceps brachii (BB) thickness, mid-thigh circumference, mid-arm circumference, modified Medical Research Council score, 6-min walk distance, COPD assessment test score, and after 8 weeks of supervised rehabilitation same parameters observed. Results: About 25.71% of the study population was in the age group range of 45–55 years, 51.43% between 56 and 65 years and 22.86% within 66–75 years of the age group. Out of 35 patients, 15 (42.86%) were females and the rest 20 (57.14%) were males. A significant increase was found in the diaphragmatic excursion (cm) from (P &lt; 0.0001), mid-arm circumference (cm) (P &lt; 0.0001), BB thickness (cm) (P &lt; 0.0001) (upper limb strength and endurance training), and mid-thigh circumference (cm) (P &lt; 0.0001) along with QF thickness (cm) (P &lt; 0.0001) (lower limb strength and endurance training). Conclusion: An 8-week physical and PR program in COPD patients can lead to an improved USG diaphragmatic excursion.

Home-based pulmonary rehabilitation for adults with severe asthma exposed to psychosocial chronic stressors

ObjectiveTo evaluate the effects of a home-based pulmonary rehabilitation (PR) programme on hyperventilation symptoms, anxiety and depressive symptoms, general fatigue, health-related quality of life (HRQoL) and exercise capacity in adults with severe asthma who have been exposed to psychosocial chronic stressors. MethodsData on 111 non-selected consecutive adults with severe asthma who enrolled in an 8-week home-based PR programme (weekly supervised 90-min session) was retrospectively analysed. Chronic stressors included physical, sexual and psychological violence and/or a traumatic experience related to an intensive care unit stay. Hyperventilation symptoms (Nijmegen questionnaire), Hospital Anxiety and Depression Scale, Fatigue Assessment Scale, COPD Assessment Test, Six-Minute Stepper Test and Timed-Up and Go test were assessed at baseline and after PR. ResultsAt baseline, participants who have been exposed to chronic stressors (n = 48, 43.2%) were younger, more often female, more often treated for anxiety and depressive disorders, and had a higher score for anxiety symptoms, hyperventilation symptoms and a poorer HRQoL, compared to those who had not been exposed to chronic stressors (p < 0.05). All the study assessments were statistically improved after PR for both groups (p < 0.001). Anxiety and depressive symptoms, fatigue and health-related quality of life questionnaires were also clinically improved based on the minimal clinically important difference. ConclusionA large proportion of adults with severe asthma, mainly women, have been exposed to chronic stressors at the time of starting a PR programme, resulting in higher anxiety symptoms and hyperventilation symptoms. However, it did not prevent these individuals from benefiting from PR.

Peak Quadriceps Muscle Torque and Electromyographic Output in Patients With Chronic Respiratory Disorders: Effects of Pulmonary Rehabilitation

ObjectiveTo assess the change in relation of the peak quadriceps electromyographic signal to the peak torque produced during a train of 5 isokinetic knee extensions (from 90 degrees below horizontal at a constant speed of 60 degrees/s) at baseline, and at 4 and 8 weeks of pulmonary rehabilitation. DesignIn this prospective observational study, isokinetic contractions were recorded during the extensions from the knee bent at 90 degrees to the horizontal plane against graded resistance. Peak quadriceps torque signal (Tq) and peak electromyographic signal (Eq) were recorded by dynamometry and surface electrodes placed at designated locations over the muscle group, respectively. SettingPhysical therapy department in a tertiary care medical center. ParticipantsEighteen patients (9 restrictive lung disease, 6 chronic airflow limitation, 3 non-ILD restrictive; N=18) were compared with 11 healthy control subjects. InterventionsPatients underwent an 8-week pulmonary rehabilitation program. Main Outcome MeasuresComparisons of Tq, Eq, and Tq/Eq ratio among patients and controls were by analysis of variance. Associations between physiological variables were determined by multivariable Pearson's correlation. ResultsCompared with patients, controls exhibited a 22% higher baseline mean peak Eq (P<.05) and 76% higher mean peak Tq (P=.02) during knee extensions. Patients’ peak Eq/Tq was twice as high as in the controls (P=.02); at 4 weeks, Eq/Tq in patients decreased by 44% (P<.04) with no further decline at 8 weeks; changes in Eq/Tq of 5 of 6 patients paralleled changes in their respective St George's Respiratory Questionnaire scores. There was no change in Tq or Eq/Tq over time among the control cohort. ConclusionsEight weeks of pulmonary rehabilitation result in a decrease in Eq/Tq, indicating improvement in force generation of limb muscles, with the change occurring in the first 4 weeks.

Understanding the Impact of Pulmonary Rehabilitation on Airway Resistance in Patients with Severe COPD: A Single-Center Retrospective Study

We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation. This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) <50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) >120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT). Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant. We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.

Improving the wellbeing of caregivers of patients with COPD using a home-based pulmonary rehabilitation programme.

The aim of this study was to evaluate the effects of a home-based pulmonary rehabilitation (PR) programme on anxiety and depressive symptoms, general fatigue and burden in informal caregivers of patients with COPD. We also evaluated the baseline characteristics of both patients and caregivers that contributed to the change in caregiver's outcomes after PR. In this retrospective study, patients with COPD were referred to an 8-week home-based PR programme consisting of a weekly supervised 90-min session. Informal caregivers were invited to participate in PR according to the patient's preference and its availability. Caregivers received educational support, behavioural therapies and self-management strategies using the same methods as for patients. Burden, anxiety and depressive symptoms, and general fatigue of caregivers were assessed at baseline and at the end of PR. 241 patients with COPD and 138 (57.3%) caregivers were included. The majority of the caregivers were women (70.5%) and spouses (90.3%) and had at least three comorbidities (57.3%). A large proportion of caregivers showed baseline high burden, anxiety symptoms and abnormal fatigue (40%, 40% and 45%, respectively). Burden, anxiety and depressive symptoms, and general fatigue of informal caregivers were all improved after PR (p<0.05). Long-term oxygen therapy and/or noninvasive ventilation, coronaropathy and/or peripheral arterial disease and a higher baseline modified Medical Research Council Dyspnoea scale score in patients with COPD were associated with a decrease in caregiver's burden after PR. A large proportion of caregivers of patients with COPD showed anxiety symptoms, fatigue and a high burden. These outcomes were improved by integrating the caregiver into a home-based PR programme.

Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians: the breathe easy, walk easy, lungs for life (BE WELL) project (protocol)

BackgroundStrong evidence exists for the benefits of pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD), however the availability of culturally safe PR for Aboriginal and Torres Strait Islander (Indigenous) Peoples is limited. The study aims to determine whether PR can be implemented within Aboriginal Community Controlled Health Services (ACCHS) to improve outcomes for Indigenous people with COPD.MethodsMulti-centre cohort study using participatory action research guided by the Knowledge-to-Action Framework. ACCHS supportive of enhancing services for chronic lung disease will be recruited. Aboriginal Health Workers (AHW) and the exercise physiologist (EP) or physiotherapist (PT) within these ACCHS will attend a workshop aimed at increasing knowledge and skills related to management of COPD and the provision of PR. Indigenous people with COPD will be invited to attend an 8-week, twice weekly, supervised PR program. Outcomes: AHW, EP/PT knowledge, skills and confidence in the assessment and management of COPD will be measured before and immediately after the BE WELL workshop and at 3, 6 and 12 months using a survey. PR participant measures will be exercise capacity (6-minute walk test (6MWT), health-related quality of life and health status at commencement and completion of an 8-week PR program. Secondary outcomes will include: number, length and cost of hospitalisations for a COPD exacerbation in 12-months prior and 12-months post PR; local contextual factors influencing implementation of PR; specific respiratory services provided by ACCHS to manage COPD prior to project commencement and at project completion. Repeated measures ANOVA will be used to evaluate changes in knowledge and confidence over time of AHWs and EP/PTs. Paired t-tests will be used to evaluate change in patient outcomes from pre- to post-PR. Number of hospital admissions in the 12 months before and after the PR will be compared using unpaired t-tests.DiscussionPulmonary rehabilitation is an essential component of best-practice management of COPD and is recommended in COPD guidelines. Indigenous peoples have limited access to culturally safe PR programs. This study will evaluate whether PR can be implemented within ACCHS and improve outcomes for Indigenous people with COPD.Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001337369, Registered 2nd September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373585&isClinicalTrial=False

Predictors of premature discontinuation and prevalence of dropouts from a pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease

IntroductionTo date, very little is known about the risk factors that contribute to premature discontinuation (dropout) from pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). We examined prevalence and predictors of premature discontinuation in patients who participated in an eight week PR program. MethodsWe analyzed a prospectively maintained data-base of patients with COPD who attended a PR program from 2013 to 2019. We included patients 40 years or older with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio less than 0.7. Subjects were assigned completers or non-completers based on whether they completed the 8-week PR program. Quality of life was measured using the St-George's Respiratory Questionnaire (SGRQ), anxiety using the Anxiety Inventory for Respiratory disease (AIR), dyspnea using the modified Medical Research Council (mMRC) scale, and exercise capacity using the Incremental Shuttle Walk Test (ISWT). ResultsNine hundred nighty three COPD patients (mean age = 70.82 years, FEV1 = 59.21% predicted, 51% male) entered the PR program. Of these, 259 (26%) discontinued PR prematurely and 139 (53%) were male. Compared with completers, non-completers had elevated symptoms of dyspnea and anxiety, had reduced exercise tolerance, were younger, and had poorer quality of life at entry (all p < 0.05). On multivariate analysis, the following variables were independently associated with discontinuation from PR: younger age (p < 0.001), elevated symptoms of anxiety (p < 0.001), elevated symptoms of dyspnea (p < 0.01) and reduced exercise tolerance (p < 0.002). ConclusionOver a quarter of COPD patients discontinued the PR program prematurely. Discontinuation of PR was associated with younger age, elevated symptoms of dyspnea and anxiety, and reduced exercise capacity, but not with severity of airflow obstruction.

Analysis of retinal blood vessel diameters in patients with COPD undergoing a pulmonary rehabilitation program.

Regular exercise positively affects cardiovascular physiology, translating into the adequate capacity of microvascular blood vessels to dilate in response to acute bouts of exercise. However, this remains unstudied in patients with chronic obstructive pulmonary disease (COPD), who often suffer from cardiovascular comorbidity. Therefore, we studied acute changes in retinal blood vessel diameters in response to high-intensity exercise in patients with COPD. The effect of an exercise-based 8-week pulmonary rehabilitation (PR) program was evaluated. We consider changes in these retinal metrics as an indicator of microvascular reactivity. Demographics and clinical characteristics of 41 patients were collected at the start and end of the PR program. Patients performed a high-intensity exercise test on a cycle ergometer at the start and end of the PR program, during which we collected retinal images. Fundus images were taken immediately before and 0, 5, 10, 15, and 30min after the ergometer test. Widths of retinal blood vessels, represented as Central Retinal Arteriolar and Venular Equivalents (CRAE and CRVE), were calculated. Thirty patients with COPD completed the study protocol (57% males; mean age: 64±7years; mean FEV1: 45±17%pred). We did not observe a change in retinal vessel widths following the ergometer test at the start of the PR program. This null result remained at the end of the 8-week PR program. Our observations did not alter when considering responders and non-responders to PR. Retinal blood vessel diameters of patients with COPD did not change following an exercise test on an ergometer. The exercise-based PR program of eight weeks did not counteract the blunted retinal microvascular response.

Efficacy of pulmonary rehabilitation on patients with non-cystic bronchiectasis according to disease severity.

The European Respiratory Society guidelines support pulmonary rehabilitation (PR) in bronchiectasis through high-quality evidence. This study aimed to evaluate the efficacy of PR on bronchiectasis patients according to disease severity assessed by the Bronchiectasis Severity Index (BSI). This prospective study included patients with stable bronchiectasis. Demographic data of all patients were questioned. All patients underwent an 8-week PR program. The patients were grouped into three according to disease severity (mild, moderate and severe) based on their BSI scores. The following parameters were evaluated at baseline (pre-PR) and after PR (post-PR): pulmonary function test results, carbon monoxide diffusion capacity, body mass index, exercise capacity (6-minute walking test), quality of life (QoL; St. George's Respiratory Questionnaire), and Hospital Anxiety and Depression scores. The study included 69 patients (55 males; mean age, 62.6 ± 9 years). After PR, the patients were observed to have significantly improved QoL and exercise capacity (p< 0.05). According to BSI, 16 (23.2%), 29 (42.0%), and 24 (34.8%) patients had mild, moderate, and severe bronchiectasis, respectively. These patient groups significantly differed regarding age, exercise capacity, and QoL (p< 0.05). Comparing the change between post-PR and pre-PR values of the study parameters (∆ = post-PR value - pre-PR value), no significant differences were observed regarding the exercise capacity and QoL (p> 0.05) in the groups. PR increases exercise capacity and QoL in bronchiectasis patients, and its efficacy does not differ according to disease severity. Thus, appropriate bronchiectasis patients should be referred to PR program regardless of disease severity.

High intensity interval training versus moderate intensity continuous training for people with interstitial lung disease: protocol for a randomised controlled trial

BackgroundInterstitial lung disease is a debilitating condition associated with significant dyspnoea, fatigue, and poor exercise tolerance. Pulmonary rehabilitation is an effective and key intervention in people with interstitial lung disease. However, despite the best efforts of patients and clinicians, many of those who participate are not achieving clinically meaningful benefits. This assessor-blinded, multi-centre, randomised controlled trial aims to compare the clinical benefits of high intensity interval exercise training versus the standard pulmonary rehabilitation method of continuous training at moderate intensity in people with fibrotic interstitial lung disease.MethodsEligible participants will be randomised to either a standard pulmonary rehabilitation group using moderate intensity continuous exercise training or high intensity interval exercise training. Participants in both groups will undertake an 8-week pulmonary rehabilitation program of twice-weekly supervised exercise training including aerobic (cycling) and strengthening exercises. In addition, participants in both groups will be prescribed a home exercise program.Outcomes will be assessed at baseline, upon completion of the intervention and at six months following the intervention by a blinded assessor. The primary outcome is endurance time on a constant work rate test. Secondary outcomes are functional capacity (6-min walk distance), health-related quality of life (Chronic Respiratory Disease Questionnaire (CRQ), St George’s Respiratory Questionnaire idiopathic pulmonary fibrosis specific version (SGRQ-I), breathlessness (Dyspnoea 12, Modified Medical Research Council Dyspnoea Scale), fatigue (fatigue severity scale), anxiety (Hospital Anxiety and Depression Scale), physical activity level (GeneActiv), skeletal muscle changes (ultrasonography) and completion and adherence to pulmonary rehabilitation.DiscussionThe standard exercise training strategies used in pulmonary rehabilitation may not provide an optimal exercise training stimulus for people with interstitial lung disease. This study will determine whether high intensity interval training can produce equivalent or even superior changes in exercise performance and symptoms. If high intensity interval training proves effective, it will provide an exercise training strategy that can readily be implemented into clinical practice for people with interstitial lung disease.Trial registration ClinicalTrials.gov Registry (NCT03800914). Registered 11 January 2019, https://clinicaltrials.gov/ct2/show/NCT03800914Australian New Zealand Clinical Trials Registry ACTRN12619000019101. Registered 9 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376050&isReview=true

Feasibility, tolerance and effects of adding impact loading exercise to pulmonary rehabilitation in people with chronic obstructive pulmonary disease: study protocol for a pilot randomised controlled trial

BackgroundChronic obstructive pulmonary disease (COPD) is a disorder linked with a multitude of extra pulmonary manifestations (also known as treatable traits), including low bone mineral density (BMD). To date, no specific guidelines exist for the management of BMD in this population. Impact loading exercise has been identified as an intervention that improves or maintains BMD in other populations. However, the feasibility of and tolerance to impact loading exercise has not been tested in people with COPD. The aim of the proposed study will be to investigate the feasibility and tolerance of adding impact loading exercise to a standard pulmonary rehabilitation programme (PRP) in people with COPD and report its effects on bone health, balance and falls risk.MethodsThis is a protocol for a pilot feasibility and tolerance randomised controlled trial (RCT). Fifty-eight people with COPD will be randomly allocated, on a 1:1 ratio, to either the experimental or control group. Initially, participants in both groups will complete a standard 8-week (twice-weekly) PRP followed by a 32-week period of maintenance exercises. Over the initial 8-week period, participants allocated to the experimental group will also undertake targeted lower limb resistance exercises and commence a programme of impact loading exercises (e.g. bounding and drop jumps). On completion of the initial 8-week PRP, in addition to the standard maintenance exercises, participants in the experimental group will continue with home-based impact loading exercises, four times a week, for the extra 32 weeks. The primary outcome of this study is feasibility of and tolerance to impact loading exercises. Feasibility will be measured using data collected pertaining to recruitment, withdrawal and completion. Adherence to the exercises will be collected using exercise logs. Tolerance to the exercises will be determined using outcomes to assess pain, recording any adverse effects such as a fall and feedback from the participants in semi-structured interviews on completing of the trial. The effects of the 40-week experimental intervention on bone health, balance and falls risk will be reported.DiscussionThis pilot RCT will test the feasibility and tolerance of an intervention that has never been trialed in people with COPD. It will also provide initial information regarding the size of the effect this intervention has on outcomes such as BMD, balance and falls risk. These data will be critical when designing a definitive RCT to advance this area of research.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR): 12620001085965 (20/10/2020)

Effects of a Rehabilitation Programme Using a Nasal Inspiratory Restriction Device in COPD.

Chronic obstructive pulmonary disease (COPD) patients are characterised for presenting dyspnea, which reduces their physical capacity and tolerance to physical exercise. The aim of this study was to analyse the effects of adding a Feel-Breathe (FB) device for inspiratory muscle training (IMT) to an 8-week pulmonary rehabilitation programme. Twenty patients were randomised into three groups: breathing with FB (FBG), oronasal breathing without FB (ONBG) and control group (CG). FBG and ONBG carried out the same training programme with resistance, strength and respiratory exercises for 8 weeks. CG did not perform any pulmonary rehabilitation programme. Regarding intra group differences in the value obtained in the post-training test at the time when the maximum value in the pre-training test was obtained (PostPRE), FBG obtained lower values in oxygen consumption (VO2, mean = −435.6 mL/min, Bayes Factor (BF10) > 100), minute ventilation (VE, −8.5 L/min, BF10 = 25), respiratory rate (RR, −3.3 breaths/min, BF10 = 2), heart rate (HR, −13.7 beats/min, BF10 > 100) and carbon dioxide production (VCO2, −183.0 L/min, BF10 = 50), and a greater value in expiratory time (Tex, 0.22 s, BF10 = 12.5). At the maximum value recorded in the post-training test (PostFINAL), FBG showed higher values in the total time of the test (Tt, 4.3 min, BF10 = 50) and respiratory exchange rate (RER, 0.05, BF10 = 1.3). Regarding inter group differences at PrePOST, FBG obtained a greater negative increment than ONBG in the ventilatory equivalent of CO2 (EqCO2, −3.8 L/min, BF10 = 1.1) and compared to CG in VE (−8.3 L/min, BF10 = 3.6), VCO2 (−215.9 L/min, BF10 = 3.0), EqCO2 (−3.7 L/min, BF10 = 1.1) and HR (−12.9 beats/min, BF10 = 3.4). FBG also showed a greater PrePOST positive increment in Tex (0.21 s, BF10 = 1.4) with respect to CG. At PreFINAL, FBG presented a greater positive increment compared to CG in Tt (4.4 min, BF10 = 3.2) and negative in VE/VCO2 intercept (−4.7, BF10 = 1.1). The use of FB added to a pulmonary rehabilitation programme in COPD patients could improve tolerance in the incremental exercise test and energy efficiency. However, there is only a statically significant difference between FBG and ONBG in EqCO2. Therefore, more studies are necessary to reach a definitive conclusion about including FB in a pulmonary rehabilitation programme.

Pilot of a community-based interprofessional "student-infused" pulmonary rehabilitation program in Saint John, New Brunswick.

BackgroundWith the increasing prevalence of chronic pulmonary conditions in New Brunswick and Canada it is necessary to consider innovative interventions to improve access to rehabilitation and supportive care for affected clients. In Fall 2018 we piloted a pulmonary rehabilitation (PR) program for persons with moderate to severe chronic obstructive pulmonary disease (COPD) to demonstrate a novel approach of bridging interprofessional education of students in health care fields with provision of care in a community setting.MethodsAn 8-week PR program was implemented and evaluated using a quasi-experimental design with pre- and post-testing to measure the effects of the program’s exercise and educational interventions on persons with COPD. Participants were assessed using the 6-Minute Walk Test (6MWT), the St. George’s Respiratory Questionnaire (SGRQ), and a custom questionnaire that rated the participants’ activities of daily living and the PR program.ResultsSeven participants completed our PR program. Following the intervention, participants’ self-reported health demonstrated a statistically significant improvement. Even though changes on the 6MWT and SGRQ were not shown to be statistically significant, there was evidence of clinically meaningful improvements in those measures. On average, participants walked 25 m further postintervention and showed clinically meaningful improvements on the SGRQ.ConclusionsThis pilot project demonstrated that a community-based PR program with active involvement of students from multiple health care programs can have positive outcomes for clients with COPD. It also illustrated how educational programs can provide an innovative means for increasing access to rehabilitation and supportive care for clients in the community.

Does the benefit from pulmonary rehabilitation differ between phenotypes in chronic obstructive pulmonary disease?

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a disease caused by airway and/or parenchymal pathology. Therefore, some patients inevitably have chronic bronchitis and some patients have emphysema. The current thinking is that exercise affects these two major phenotypes differently. In this study, we investigated the benefits of pulmonary rehabilitation (PR) in chronic bronchitis- and emphysema-predominant COPD patients.METHODS: Retrospective data of chronic bronchitis- and emphysema-predominant COPD patients who completed an outpatient 8-week PR program between the years 2013 and 2017 in the PR unit of our hospital were examined. Demographic data (age, sex, body mass index, smoking history, long-term oxygen therapy, noninvasive ventilation, emergency admissions, and number of hospitalizations) were recorded. The patients were divided into two groups: chronic bronchitis predominant and emphysema predominant. Patients were assigned to the emphysema-predominant group based on radiology results. Patients were assigned to the chronic bronchitis-predominant group according to clinical description. The two groups were compared using the recorded data cited above.RESULTS: Of the 146 patients, 85 (58.2%) were assigned to the emphysema-predominant group and 61 (41.8%) were assigned to the chronic bronchitis-predominant group. There was no difference between the two groups in age and gender. Pulmonary function test (PFT) parameters (forced expiratory volume in 1 s and diffusing capacity of the lungs for carbon monoxide (DLCO)), arterial blood gas values (pO2, PCO2, and SpO2), 6 min of walking time, and quality of life scores were significantly improved after PR. However, there was no difference between the emphysema- and chronic bronchitis-predominant groups in terms of the improvements after PR.CONCLUSION: In this study, it was observed that the improvement due to PR seen in COPD patients was independent of phenotype. Therefore, all COPD patients should be encouraged to participate in PR programs regardless of their phenotypes.

Cambios en la tolerancia al ejercicio, disnea y calidad de vida a las 8 vs. 12 semanas de rehabilitación pulmonar en pacientes con EPOC

IntroductionIn patients with chronic obstructive pulmonary disease (COPD), pulmonary rehabilitation reports improvements in exercise tolerance, quality of life and decrease in symptoms; however, few studies compare shorter and longer pulmonary rehabilitation programmes. The objective was to describe the benefits of PR in terms of exercise tolerance, perception of dyspnoea and quality of life, in patients with COPD attending a pulmonary rehabilitation programme for 8 weeks compared to those attending for 12 weeks in a third level institution in the city of Cali, Colombia. MethodsQuasi-experimental study linking patients with COPD, 15 patients in the 8-week pulmonary rehabilitation programme and 15 patients in the 12-week pulmonary rehabilitation programme. Body mass index (BMI), distance covered in the 6-minute walk test (TC6M), quality of life CRQ-SAS questionnaire were assessed at the beginning and end of the programme. ResultsBMI did not show statistically significant changes in the groups, exercise tolerance showed statistically significant improvement in 12-week pulmonary rehabilitation programme (p<.05), the CRQ-SAS questionnaire evidences improvement in all domains, but there were no differences between both groups. ConclusionsCOPD patients, statistically significant improvement after the pulmonary rehabilitation programme in variables such as dyspnoea and quality of life; however, only the 12-week pulmonary rehabilitation programme group presented statistically significant improvements in the distance travelled of the TC6M compared to the 8-week pulmonary rehabilitation programme group.

Long-Term Benefits of Pulmonary Rehabilitation in Patients With COPD: A 2-Year Follow-Up Study

Pulmonary rehabilitation (PR) improves exercise capacity in patients with COPD in the short term. In patients with COPD, does 8weeks of PR confer long-term benefits on symptoms of dyspnea, anxiety, and depression, and on quality of life, 2 years after completion? One hundred and sixty-five patients with COPD completed an 8-week, community-based, comprehensive PR program, comprising 2-h sessions twice weekly. Sessions included aerobic exercise and an educational program. Patients were encouraged to perform daily walking exercise up to 30min at home. We evaluated a number of outcome measures at baseline, 8weeks, and 2 years, including the following: dyspnea measured with the modified Medical Research Council (mMRC) questionnaire, quality of life assessed with the St. George's Respiratory Questionnaire (SGRQ), and anxiety measured with the Anxiety Inventory for Respiratory Disease (AIR) and the Depression Anxiety Stress Scale (DASS). In addition, we measured exercise capacity, using the Incremental Shuttle Walk Test (ISWT), at baseline and 8weeks. Mean age (SD) was 72 (8.6) years; 55%were men. At 8weeks, improvements in mMRC, SGRQ, ISWT, DASS, and AIR were all statistically significant (P< .001). During the 2-year follow-up, changes observed at 8weeks were maintained for anxiety symptoms, and for symptoms, impact, and total SGRQ scores. In multivariate analysis, initial elevated levels of dyspnea, depression, anxiety, and decreased exercise capacity predicted greater quality of life improvement at 2 years (all P< .001). Over a 2-year period, an effective 8-week PR program provides sustained improvement in anxiety and quality of life. Short-term improvements in dyspnea, depression, and stress symptoms at 8weeks were not maintained at 2 years.