Improvements In Functional Exercise Capacity Research Articles

A hospital and home-based exercise program to address functional decline in people following allogeneic stem cell transplantation.

The aims of this study are to investigate the feasibility of an exercise program commencing 60days following allogeneic stem cell transplantation (alloSCT), to investigate changes in physical function and health-related quality of life (HRQoL) in patients from pre- to post-alloSCT and to explore changes in patient outcomes before and after the program. This study is a single site, prospective case series including 43 adults undergoing alloSCT. The intervention was an 8-week outpatient and home-based exercise and education program. Outcomes included feasibility (consent, attendance, compliance and completion rates), functional exercise capacity (incremental shuttle walk test), muscle strength (hand-held dynamometry), self-efficacy for physical activity (Physical Activity Assessment Inventory) and HRQoL (Functional Assessment of Cancer Therapy-Bone Marrow Transplant). Outcomes were measured pre-alloSCT, 60days post-alloSCT (pre-intervention) and 100days post-alloSCT (post-intervention). The consent rate was 93%. From baseline to 60days post-alloSCT, there was significant decline in functional exercise capacity (mean difference 224m, 95% CI 153-295, p < 0.0005), self-efficacy for physical activity (294 points, 95% CI 136-452, p = 0.001) and HRQoL (15 points, 95% CI 8-21, p < 0.0005). Ten participants did not commence the exercise program due to death (n = 5), illness (n = 1) or cancellation of alloSCT (n = 4). The intervention was feasible in those not affected by major medical complications or death. No adverse events occurred. From pre- to post-intervention, there was significant improvement in functional exercise capacity (p = 0.001) and HRQoL (p = 0.001). AlloSCT results in significant decline in functional exercise capacity, self-efficacy for physical activity and HRQoL, which may be improved through an exercise program. This pilot demonstrated safety, feasibility and high patient interest. Further randomised research is required.

Improvement In Functional Exercise Capacity Differs By Attendance Duration But Not Intake Diagnosis In A Hospital-based Phase Ii Outpatient Cardiac Rehabilitation Program.

PURPOSE: Investigate differences and interactions between intake diagnosis and time-to-completion on functional exercise capacity (FEC) improvement in a hospital-based outpatient cardiac rehabilitation (CR) program in New Mexico. METHODS: During a 12-month span, 10 women and 39 men eligible for participation in a CR program completed all authorized 36-sessions in the Phase II CR program. Eligible diagnoses were: heart failure (HF), acute coronary syndrome (ACS), and cardiothoracic surgery (CT). A modified Atterbom protocol (2-min stages of increasing treadmill speed and incline) was used to assess differences between FEC at intake and immediately following completion of the 36-session program. Handrail support was allowed during the exercise tests as needed. FEC was determined by the attainment of an RPE of 15 (Borg 6-20 scale) and reported in METs. As part of a chart review, all data were deidentified prior to collection and analyses. Patients were separated into groups based on time-to-completion (≤4mo and >4mo) and diagnosis. Separate, group-specific independent t-tests were initially applied to examine changes in FEC by diagnosis and time-to-completion. All groups significantly improved FEC (p<.05). Consequently, ΔFEC ((post- pre/pre)*100) was calculated and analyzed. A 2 (time) by 3 (diagnosis) analysis of variance (ANOVA) was applied to assess group differences and interactions for ΔFEC. RESULTS: Forty-nine patients (61.6 ± 11.0 yr, 171.5 ± 8.9 cm, 79.7 ± 16.0 kg) completed the 36-session CR program during the 12-mo period. Group means ± SD for improvement in METs at ≤4mo (n=33) and >4mo (n=16) were 3.30 ± 1.92 METs, and 1.97 ± 1.27 METs, respectively. Group means ± SD for ΔFEC among HF (n=12), ACS (n=25), and CT (n=12) were 108.0 ± 95.5%, 60.4 ± 41.8%, and 54.1 ± 40.2%, respectively. Group means ± SD for ΔFEC at ≤4mo (n=33) and >4mo (n=16) were 82.2 ± 68.7%, and 46.5 ± 34.8%, respectively. Results indicate a significant (F (1,43)= 6.344, p = .016, partial η2 = .129) effect between ΔFEC and the time to complete the 36 sessions. CONCLUSIONS: These results highlight the effectiveness of a completed hospital-based outpatient CR program to elicit positive health outcomes across intake diagnoses. Completing the 36 sessions in 4mo or less produced the greatest improvement in FEC regardless of intake diagnosis.

Physical function and body composition in kidney transplant recipients over time with physiotherapy intervention

Introduction: The long-term usage of immunosuppressants post-kidney transplantation often results in adverse effects such as weight gain, osteoporosis and an increased risk of cardiovascular diseases. Physical activity has been shown to have a protective effect against these adverse effects. This paper aims to investigate the changes over time in physical function and body composition in kidney transplant recipients with a home exercise regimen prescribed by a physiotherapist. Methods: Forty-two kidney transplant recipients aged 45 ± 12 years were recruited before transplant and reviewed at fixed time points after transplant. Body composition, hand grip strength and functional exercise capacity were measured at every session. A home exercise regimen was prescribed and modified when appropriate. Results: There was an observed trend towards an improvement in functional exercise capacity in terms of six-minute walk distance. There was no change in body weight, fat mass and skeletal muscle mass. Conclusion: There may be a need to provide supervised exercise training programmes for kidney transplant recipients in bringing about positive changes in body composition as well as ensure compliance to exercise training after transplant. Further research is needed for more conclusive results.

Effects of whole body vibration on pulmonary function, functional exercise capacity and quality of life in people with chronic obstructive pulmonary disease: a systematic review

Objective: To examine the effect of whole-body vibration in enhancing pulmonary function, functional exercise capacity and quality of life in people with chronic obstructive pulmonary disease and examine its safety. Method: Randomized controlled trials examining the effects of whole body vibration among people with chronic obstructive pulmonary disease were identified by two independent researchers. Articles were excluded if they were studies on people with other primary diagnosis, abstracts published in the conferences or books. PEDro scale was used to assess the methodological quality of the selected studies. We evaluated the level of evidence by using the GRADE approach. The results were extracted by two researchers and confirmed by the third researcher if disagreement existed. Data source: Sources included Cochrane Central Register of Controlled Trials, PubMed, CINAHL, EMBASE, PEDro, AMED, PsycINFO, ClinicalTrials.gov, Current Controlled Trials and reference lists of all relevant articles. Result: Four studies involving 206 participants were included in this systematic review. Methodological quality was rated as good for two studies. No great benefits on pulmonary function were found in whole body vibration treatment group. Two studies showed that quality of life was improved in people with chronic obstructive pulmonary disease. Whole body vibration led to significant improvements in functional exercise capacity measured with six minutes walking test. Nearly no adverse events were observed. Conclusion: Whole body vibration may improve functional exercise capacity and quality of life in people with chronic obstructive pulmonary disease. There was insufficient evidence to prove the effects of whole body vibration on pulmonary function.

Iron Deficiency (ID) in patients with Ventricular Assist Devices (VADs) and improvement in functional exercise capacity with intravenous iron supplementation

Iron Deficiency (ID) in patients with Ventricular Assist Devices (VADs) and improvement in functional exercise capacity with intravenous iron supplementation

Pulmonary rehabilitation for interstitial lung disease.

Interstitial lung disease (ILD) is characterised by reduced functional capacity, dyspnoea and exercise-induced hypoxia. Pulmonary rehabilitation, an intervention that includes exercise training, is beneficial for people with other chronic lung conditions; however its effects in ILD have not been well characterised. • To determine whether pulmonary rehabilitation in patients with ILD has beneficial effects on exercise capacity, symptoms, quality of life and survival compared with no pulmonary rehabilitation in patients with ILD.• To assess the safety of pulmonary rehabilitation in patients with ILD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 6), MEDLINE (Ovid), EMBASE (Ovid), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO) and the Physiotherapy Evidence Database (PEDro) (all searched from inception to June 2014). We also searched the reference lists of relevant studies, international clinical trial registries and respiratory conference abstracts to look for qualifying studies. Randomised and quasi-randomised controlled trials in which pulmonary rehabilitation was compared with no pulmonary rehabilitation or with other therapy in people with ILD of any origin were included. Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias. Study authors were contacted to provide missing data and information regarding adverse effects. A priori subgroup analyses were specified for participants with idiopathic pulmonary fibrosis (IPF) and participants with severe lung disease (low diffusing capacity or desaturation during exercise). We planned to subgroup according to training modality applied, but there were insufficient data. Nine studies were included, six of which were published as abstracts. Five studies were included in the meta-analysis (86 participants who undertook pulmonary rehabilitation and 82 control participants). One study used a blinded assessor and intention-to-treat analysis. No adverse effects of pulmonary rehabilitation were reported. Pulmonary rehabilitation improved the six-minute walk distance with weighted mean difference (WMD) of 44.34 metres (95% confidence interval (CI) 26.04 to 62.64 metres) and improved oxygen consumption (VO2) peak with WMD of 1.24 mL/kg/min(-1) (95% CI 0.46 to 2.03 mL/kg/min(-1)). Improvements in six-minute walk distance and VO2 peak were also seen in the subgroup of participants with idiopathic pulmonary fibrosis (IPF) (WMD 35.63 metres, 95% CI 16.02 to 55.23 metres; WMD 1.46 mL/kg/min(-1), 95% CI 0.54 to 2.39 mL/kg/min(-1), respectively). Reduced dyspnoea (standardised mean difference (SMD) -0.66, 95% CI -1.05 to -0.28) following pulmonary rehabilitation was also seen in the IPF subgroup (SMD -0.68, 95% CI -1.12 to -0.25). Quality of life improved following pulmonary rehabilitation for all participants on a variety of measures (SMD 0.59, 95% CI 0.20 to 0.98) and for the subgroup of people with IPF (SMD 0.59, 95% CI 0.14 to 1.03). Two studies reported longer-term outcomes, with no significant effects of pulmonary rehabilitation on clinical variables or survival at three or six months. Available data were insufficient to allow examination of the impact of disease severity or exercise training modality. Pulmonary rehabilitation seems to be safe for people with ILD. Improvements in functional exercise capacity, dyspnoea and quality of life are seen immediately following pulmonary rehabilitation, with benefits also evident in IPF. Because of inadequate reporting of methods and small numbers of included participants, the quality of evidence was low to moderate. Little evidence was available regarding longer-term effects of pulmonary rehabilitation.

Reporting of exercise attendance rates for people with chronic obstructive pulmonary disease: A systematic review

While recommendations for the duration, frequency, mode and intensity of exercise programmes for people with chronic obstructive pulmonary disease (COPD) are specified in consensus statements, criteria for exercise session attendance are less clear. The review questions were: (i) how commonly are a priori criteria and attendance rates reported for people with COPD participating in exercise programmes and (ii) what is the strength of association between attendance and improvements in functional exercise capacity. Database searches identified primary studies of people with COPD participating in exercise or pulmonary rehabilitation programmes of at least 2 weeks duration. Primary outcomes were a priori criteria for attendance, reports of attendance at supervised exercise sessions and mean improvements in functional exercise assessments. Data extraction processes were confirmed prospectively (>80% agreement). Variants of exercise attendance data were described. Linear associations between attendance and improvements in exercise outcomes were explored (Pearson r, P < 0.05). Of the 234 included studies, 86 (37%) reported attendance and 29 (12%) provided a priori criteria for attendance. In the small sample of studies which reported attendance and functional exercise data before and after the intervention, there was little to no relationship between improvements in functional exercise capacity and training volume (prescribed r = -0.03, P = 0.88; attended r = -0.24, P = 0.18). Reporting of exercise programme attendance rates is low and of variable quality for people with COPD. Consistent and explicit reporting of exercise attendance in people with COPD will enable calculation of dose-response relationships and determine the value of a priori exercise attendance criteria.

The influence of comorbidities on outcomes of pulmonary rehabilitation programs in patients with COPD: a systematic review.

Introduction. Chronic obstructive pulmonary disease (COPD) is associated with comorbidities such as cardiovascular disease, metabolic disease, osteoporosis, and anxiety and/or depression. Although pulmonary rehabilitation programs are proven to be beneficial in patients with COPD, it is unclear whether comorbidities influence pulmonary rehabilitation outcomes. The aim of the present review was to investigate to what extent the presence of comorbidities can affect pulmonary rehabilitation outcomes. Methods. The systematic literature search (Pubmed, EMBASE, and PEDro) resulted in 4 articles meeting the inclusion criteria. The odds ratios (95% confidence intervals) of the logistic regression analyses, with comorbidities as independent variables and pulmonary rehabilitation outcomes (dyspnea, functional exercise capacity, and quality of life) as dependent variables, were used for data extraction. Results. Patients with anxiety and/or depression less likely improve in dyspnea. Osteoporosis is associated with less improvements in functional exercise capacity, while cardiovascular disease does not seem to negatively impact on this outcome. Patients with cardiovascular comorbidity will experience less positive changes in quality of life. Conclusion. Evidence from literature suggests that comorbidities can have a negative influence on pulmonary rehabilitation outcomes. Screening for comorbidities in pulmonary rehabilitation settings seems useful to readdress the right patients for individually tailored pulmonary rehabilitation.

Abstract P132: Effectiveness of a Worksite Wellness Program on Dietary Intake, Adiposity, Exercise Performance, Insulin Sensitivity, and Lipids in Overweight Women

Introduction The prevalence of obesity is increasing, especially among black women. Wellness programs have been proposed to prevent obesity-associated disease. Success of worksite programs in achieving weight loss and improving obesity-associated metabolic complications for women is widely variable. Hypothesis A program emphasizing reduced fat and energy intake in addition to exercise at the worksite can improve health measures in overweight female NIH employees, especially when provided with regular nutritional counseling. Methods One hundred overweight (BMI 25 to 57 kg/m2) women (59% black) were provided web-based nutritional information, then randomized to regular meetings and weigh-ins with a dietitian (intervention) or control; all were instructed to increase pedometer counts by 5000 over baseline and given access to a private fitness room. Three day food records, body composition (DXA), lipids, glucose, insulin, and treadmill exercise capacity were measured at baseline and 6 month visits. Results At 6 months, subjects reported decreased daily energy intake (-21%), total fat intake (-24%), and percent calories from fat (-6%), all p&lt; 0.001. Significant reduction in weight, fat mass, and percent truncal fat was determined for all subjects, in addition to improvement in functional exercise capacity (Table). Subjects improved insulin sensitivity (HOMA), and showed reduction in cholesterol and triglyceride levels (Table). There were no significant differences between interventions vs. controls in outcome measures. Intervention subjects who attended &gt; 80% of nutrition classes (n= 17) tended to lose more weight (-3.8 ± 4.4 vs. -1.3 ± 3.0 kg, p=0.06) and fat mass (-2.7 ± 3.9 vs. -1 ± 2.8 kg, p= 0.07), than women who attended less regularly (n=38). Conclusion Overweight female employees provided with web-based nutritional information and worksite exercise resources significantly improved health measures. Consistent attendance at nutrition counseling sessions may facilitate achievement of weight and fat loss.

Impact of a pulmonary rehabilitation programme on respiratory parameters and health care utilization in patients with chronic lung diseases other than COPD

Pulmonary rehabilitation is a tool that is receiving more acceptance in chronic lung diseases. A retrospective study was made in Riyadh, Saudi Arabia, on the impact of pulmonary rehabilitation on respiratory parameters and health care utilization in a group of outpatients with chronic lung diseases other than chronic obstructive pulmonary disease. A group of 51 patients diagnosed with interstitial lung diseases, bronchiectasis, asthma and scoliosis were studied. Initial number of emergency department visits and hospital admissions and use of prednisone and antibiotics were significantly associated with adherence to the pulmonary rehabilitation programme. There was a significant improvement in functional exercise capacity as manifested on the 6-minute walking distance and distance on treadmill, bicycle and arm ergometer and significantly better utilization of health care resources (fewer emergency department and outpatient department visits) over the 12 months after completion of the programme.

Response of the respiratory muscles to rehabilitation in COPD

Respiratory rehabilitation is known to improve outcomes in patients with chronic obstructive pulmonary disease (COPD). The question addressed in the present review is whether these beneficial effects are related to improvements in inspiratory muscle function. Respiratory muscle fatigue often did not occur during exercise in patients with COPD, since exercise limitation usually occurred when significant force reserve in the inspiratory muscles was still present. Notwithstanding, a number of observations may provide indirect evidence that respiratory muscle fatigue may occur during exercise. Some evidence is present that, in normal humans, whole body exercise training improved inspiratory muscle endurance, but no studies are available in patients with COPD. Animal studies invariably demonstrated that exercise training increased the number of oxidative fibers and oxidative enzyme activity in inspiratory muscles. These effects, however, were considerably smaller than the effects found on peripheral muscles with similar fiber composition. Clear evidence indicated that inspiratory muscle training (IMT) improved inspiratory muscle function. Two large meta-analyses indicated that, if the training load was properly controlled, IMT alone or combined with general exercise reconditioning improved inspiratory muscle strength and endurance and dyspnea. The combination did not result in greater improvements in functional exercise capacity. Animal studies and one patient study confirmed the occurrence of structural remodeling of the inspiratory muscles in response to IMT. The final question is whether improvements in inspiratory muscle function produced by IMT lead to improved outcomes in COPD. In all five studies in which training load was adequately controlled, a significant reduction of dyspnea during activities of daily living was found. Eight randomized studies examined the effects of the combination. Greater improvements in exercise capacity were only found in three studies, and none showed a greater reduction in dyspnea.

Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: A multidisciplinary approach

Purpose People with schizophrenia/schizoaffective disorders have a higher risk of morbidity and premature mortality compared to the general population in part due to sedentary lifestyles. The aim of this pilot study was to investigate the feasibility and effects of aerobic (AT) and resistance training (RT) on individuals with schizophrenia/schizoaffective disorders. Methods Eight males and five females (mean age 44.6 ± 3 years) were randomized to either twice weekly exercise ( n = 7) or usual care (control) ( n = 6). Functional exercise capacity (six minute walk distance (6MWD)), muscular strength, anthropometric measures, and domains of mental health were measured at baseline and after 12 weeks. Data are presented as means ± SEM. Results The exercise group demonstrated a 27.7 ± 22.3 m increase in 6MWD while the control group showed a decrease of 28.3 ± 26.6 m (between-group difference, p = 0.1). There was a significant strength increase for exercise (28.3 ± 8.8%, p = 0.01) but not for control (12.5 ± 8.5%, p = 0.2). The exercise group had a significant improvement in total Mental Health Inventory (MHI) score ( p < 0.03) with no change for control. Gain in 6MWD was directly associated with improvement in total MHI score ( r = 0.8, p = 0.009) as was reduction in depressive symptoms ( r = −0.9, p < 0.001) among all participants. Attendance at exercise sessions averaged 72 ± 4.4% with no dropouts. Reduction in depressive symptoms correlated with greater adherence to exercise ( r = −0.93, p = 0.02). Conclusions A 12-week community-based AT and RT program results in significant improvements in overall mental health, muscular strength and a trend for improvement in functional exercise capacity. Among all participants, improvement in functional exercise capacity was associated with improvement in overall mental health as well as a reduction in depressive symptoms. Reduction in depressive symptoms was associated with greater adherence to exercise. A group exercise program for individuals with schizophrenia/schizoaffective disorder is feasible when implemented by a multidisciplinary team.