Incremental Shuttle Walk Test Distance Research Articles

Associations between the distance covered in the incremental shuttle walk test and lung function and health status in patients with chronic obstructive pulmonary disease.

Field walk tests such as the incremental shuttle walk test (ISWT) are simple tests for assessing the degree of disability in individuals with chronic obstructive pulmonary disease (COPD). In the present study, the correlations between exercise performance in the ISWT, lung function, and health status were examined in patients with COPD of varying severities. A retrospective examination of 277 COPD patients was performed using the ISWT and lung function tests along with assessment of health status using St. George׳s Respiratory Questionnaire (SGRQ). In addition, we assessed the correlations between the walking distance, lung function parameters, and SGRQ scores. ISWT distances were poorly correlated with lung function parameters and SGRQ scores in mild COPD patients. In contrast, ISWT distances were significantly correlated with pulmonary function parameters, such as vital capacity (%predicted) and forced expiratory volume in one second, and SGRQ scores in moderate and severe COPD patients. The ISWT is more independent of health status and pulmonary function in patients with mild COPD compared to moderate or severe cases. Therefore, the exercise capacity of patients with mild COPD should be estimated by the ISWT.

Incremental shuttle walk test as an indicator of decreased exercise tolerance in patients with chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is accompanied by a number of clinical symptoms, from cough and breathlessness to system disorders as a result of comorbidities. These manifestations have a significant effect on decreased exercise tolerance. Patients are limited in activities of daily living and in physical activities, especially walking, walking upstairs and uphill. Objective: The objective of this study was to assess exercise tolerance and compare the results of the Incremental shuttle walk test (ISWT) in patients with severe COPD and a group of healthy individuals. The next aim was focused on the changes in haemoglobin oxygen saturation during the test, Borg scale values and reasons for termination of the test. Methods: The research sample consisted of 17 patients (mean age 65.5 ± 7.3 years) with severe COPD (post-bronchodilator forced expiratory volume in one second less than 60%). The group of healthy individuals consisted of 17 healthy individuals (mean age 62.6 ± 2.0 years). The participants underwent ISWT. Throughout the whole test, saturation and heart rate were monitored using a finger oximeter recorder. Results: Patients with COPD covered a significantly shorter distance in ISWT (p < .001), they were subject to more significant decrease in saturation (9%), reported subjective breathlessness more (p < .001), and the test presented greater exertion for them (14.2 ± 3.2 vs. 10.7 ± 1.9).Conclusions: This study confirmed a decreased level of exercise tolerance in patients with severe COPD. Another conclusion of the study is that exercise assessed by means of the ISWT causes greater desaturation in COPD patients compared with healthy individuals.

Sixminute walk test versus incremental shuttle walk test in cystic fibrosis.

Although both self-paced and externally paced field tests are widely used in cystic fibrosis (CF), it is still unclear whether they induce clinically relevant and similar cardiorespiratory responses. The aim of this study was therefore to compare the incremental shuttle walk test (ISWT) and 6min walk test (6MWT), and to determine the factors influencing exercise capacity in CF. Fifty clinically stable CF patients were included in the study. Pulmonary function, peripheral and respiratory muscle strength were assessed, anthropometric measurements were recorded, and 6MWT and ISWT carried out. The CF patients covered significantly more distance in the ISWT than 6MWT (P < 0.001). Heart rate response and dyspnea score at the end of the tests and during the recovery phase were significantly higher in the ISWT compared with the 6MWT (P < 0.05). The 6MWT and ISWT had similar moderate-strong correlations with age, height, weight, pulmonary function, respiratory and peripheral muscle strength (P < 0.05). Forty-nine percent of the variance in 6MWT distance was explained by age and forced expiratory volume in 1s (FEV1 ; R(2) =0.49, F(2-48) = 22.033, P < 0.001). The variables contributing to ISWT distance were FEV1 , inspiratory muscle strength, and body mass index (R(2) =0.596, F(3-44) = 20.176, P < 0.001). The ISWT is a better reflection of exercise tolerance in CF than 6MWT. ISWT is a preferable alternative assessment of exercise tolerance in terms of cardiorespiratory response.

Which field walking test should be used to assess functional exercise capacity in lung cancer? An observational study.

BackgroundThere is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer (NSCLC). Cardiopulmonary exercise testing (CPET) is the gold standard measure of exercise capacity; however this laboratory test has limitations for use in research and clinical practice. Alternative field walking tests are the six-minute walk test (6MWT), incremental-shuttle walk test (ISWT) and endurance-shuttle walk test (ESWT); however there is limited information about their clinimetric properties in NSCLC. Aims: In NSCLC to determine the 1) criterion validity of the 6MWT, ISWT and ESWT against CPET; 2) construct validity of the 6MWT, ISWT and ESWT against measures of function, strength, respiratory function and health-related quality of life (HRQoL); and 3) clinical applicability of the tests.MethodsTwenty participants (40 % male, mean ± SD age 66.1 ± 6.5 years) with stage I-IIIb NSCLC completed the 6MWT, ISWT, ESWT and CPET within six months of treatment. Testing order was randomised. Additional measures included Eastern Cooperative Oncology Group Performance-Status (ECOG-PS, function), respiratory function, hand-grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships.ResultsThe ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption (r = 0.61, p = 0.007). Relationships between CPET and six minute walk distance (6MWD) (r = 0.24, p = 0.329) or ESWT time (r = 0.02, p = 0.942) were poor. Moderate construct validity existed for the 6MWD and respiratory function (forced vital capacity % predicted r = 0.53, p = 0.019; forced expiratory volume in the first second % predicted r = 0.55, p = 0.015). There were no relationships between the walking tests and measures of function, strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time. No floor effects were seen in the tests. The mean ± SD time required to perform the individual 6MWT, ISWT and ESWT was 12.8 ± 2.5, 14.7 ± 3.7 and 16.3 ± 5.0 min respectively; in comparison to CPET which was 51.2 ± 12.7 min. Only one assessor was required to perform all field walking tests and no adverse events occurred.ConclusionsThe ISWT is a promising measure of functional exercise capacity in lung cancer. Findings need to be confirmed in a larger sample prior to translation into practice.

Neuromuscular electrical stimulation as an adjunct to endurance and resistance training during pulmonary rehabilitation in stable chronic obstructive pulmonary disease

Aim: The purpose of this study was to investigate whether adding neuromuscular electrical stimulation (NMES) to a comprehensive pulmonary rehabilitation (cPR) program would have additive effects on clinical-functional outcomes. Methods: Twenty-seven chronic obstructive pulmonary disease patients participating in a 10-week cPR program were randomly allocated to NMES + cPR (n = 13) or Sham + cPR (n = 14) groups. Quadriceps strength, exercise capacity, symptoms, mood, activities of daily living and quality of life were evaluated pre- and post-interventions. Results: There were no significant differences in any of the physiological and subjective improvements induced by NMES + cPR versus Sham + cPR (p > 0.05). In fact, the NMES + cPR group showed lower increases in incremental shuttle walk test (ISWT) distance (38.4 vs 69.2 m, respectively) and %ISWT distance (5.1 vs 9%, respectively) compared with the Sham + cPR group (p < 0.05). Conclusion: The increase in exercise capacity is less important when NMES is used as an adjunct to the cPR.

Assessment of pulmonary rehabilitation efficacy in chronic obstructive pulmonary disease patients using the chronic obstructive pulmonary disease assessment test

Aim: We evaluated the relationship between chronic obstructive pulmonary disease (COPD) assessment test (CAT) and improvements after pulmonary rehabilitation (PR) and PR efficiency in COPD patients. Methods & results: Forty COPD patients completed PR. After PR, mean change in CAT score was found to be 13 (p < 0.001), Medical Research Council (MRC), St George’s Respiratory Questionnaire (SRGQ) and London Chest Activity Daily Living (LCADL) scores decreased, while Endurance Shuttle Walking Test (ESWT) time and Incremental Shuttle Walking Test (ISWT) distance increased significantly. Baseline CAT scores correlated with MRC, SRGQtotal, %FVC, ISWT, ESWT, LCADL. Change in CAT was significantly correlated with changes in MRC, SGRQtotal, LCADL-leisure scores, and ESWT. Conclusion: CAT score shows moderate degree correlation with some measures of outcome of PR and response to PR efficacy.

Maintaining Gains Following Pulmonary Rehabilitation.

Pulmonary rehabilitation (PR) is an accepted intervention for individuals with chronic obstructive pulmonary disease. Despite initial improvements following PR, many patients eventually return to baseline function or decline even further. The aim of this study is to look at long-term (>1 year) outcomes following PR. This was a prospective cohort study of patients who had completed PR. Participants were invited for an assessment consisting of participant interviews and clinical assessments using standardised instruments. 129 patients between 2003 and 2012 completed rehabilitation and were eligible. 88 patients were included in the analysis. The mean time of the long-term assessment was 22 months following PR. The mean age was 71 years. Mean FEV1 was 46%. There was a statistically significant (p < 0.001) increase in the incremental shuttle walk test distance of 29.0 m following PR but this gain was lost at the long-term reassessment. Chronic Respiratory Questionnaire (CRQ) scores showed a statistically significant (p < 0.001) increase in all four domains but only the domains of dyspnoea and fatigue remained statistically significant (p < 0.001, p < 0.01, respectively) at the long-term reassessment. Hospital Anxiety and Depression Scale scores reduced following rehabilitation but only the anxiety component was statistically significant (p < 0.01). These improvements persisted at the long-term reassessment but were not statically significant. This study confirms that many of the functional gains achieved in PR are lost in the longer term. Regular surveillance or monitoring of these patients post-PR is important to identify those requiring further intervention.

S121 The Utility Of The Incremental Shuttle Walking Test In Pulmonary Hypertension: Results From The Aspire Registry

Introduction The Incremental Shuttle Walk Test (ISWT) has been evaluated in a number of diseases and found to be a safe, reproducible test which correlates better with VO 2 max than the Six-Minute Walk Test (6MWT). We aimed to evaluate the utility of the ISWT as a prognostic indicator in pulmonary hypertension (PH). Methods Data was retrieved for consecutive cases of PH diagnosed in our unit from 2001–2010, a cohort previously described. 1 ISWT was performed routinely as part of baseline assessment according to a modified protocol of Singh et al . 2 Data was analysed in 5 Groups according to the distance achieved based on ISWT level. A p-value of was deemed statistically significant. Results 1002 of 1,344 patients diagnosed with PH underwent baseline ISWT within 3 months of cardiac catheterization and prior to pulmonary vascular therapy. Complete baseline data was available for 998 patients. Kaplan-Meier analysis showed that increasing level of ISWT was associated with increased survival (Figure 1), including the PAH sub-group, with no ceiling effect. ISWT distance correlated with WHO Functional Class, right atrial pressure, pulmonary vascular resistance, cardiac index, mixed venous oxygen saturation and percent predicted carbon monoxide diffusion (DLco) (p all ≤0.01). Multivariate Cox regression survival analysis including sex, body mass index, age, haemodynamic parameters and percent predicted DLco, demonstrated that ISWT distance was an independent predictor of survival. One year follow-up data was available for 397 patients. Kaplan-Meier analysis showed that ISWT level on treatment at 1 year was predictive of survival (p Conclusion Baseline ISWT distance correlates with WHO functional class and pulmonary haemodynamics with no ceiling effect. It is an independent predictor of survival and change in ISWT predicts outcome. These features make it a viable alternative to the 6MWT in the assessment of patients with pulmonary hypertension, with a number of potential advantages. References Hurdman et al . Eur Respir J 2012:39:945–955 Singh et al Thorax 1992:47:1019–1024

S55 Neural Respiratory Drive Using Parasternal Electromyography In Clinically Stable Cystic Fibrosis Patients: A Physiological Marker Of Lung Disease Severity And Exercise Capacity

Introduction Measurement of neural respiratory drive, using parasternal intercostal muscle electromyography (EMGpara), has previously been shown to relate to pulmonary function impairment and exercise-induced breathlessness in advanced cystic fibrosis (CF). This measure reflects the load on the respiratory system and the capacity of the respiratory muscles and therefore may provide a composite measure of overall lung disease severity. In order to utilise EMGpara clinically in CF, its relationship to standard physiological outcome measures requires further investigation across a broad range of disease severities. Aim: To investigate the relationships between EMGpara and standard measures of pulmonary function and exercise performance in patients with CF. Methods Thirty patients with clinically stable CF were recruited. EMGpara was recorded during five minutes of tidal breathing using electrodes positioned in the second intercostal space directly lateral to the sternum. Peak EMGpara per breath was averaged over the final minute of the recording and expressed as a percentage of EMGpara recorded during a maximal inspiratory manoeuvre (EMGpara%max). Spirometry, lung volumes by body plethysmography and an incremental shuttle walking test (ISWT) with breath by breath metabolic data were also performed. Results Patient characteristics, EMGpara%max, measures of pulmonary function and exercise performance are shown in Table 1. EMGpara%max was significantly associated with residual volume/total lung capacity ratio (RV/TLC, r = 0.724, p 1 % pred. r = -0.648, p pleth /TLC, r = 0.625, p 2peak, r = -0.665, p = 0.001). Weaker relationships were observed between ISWT distance and pulmonary function (FEV 1 r = 0.518 p = 0.006, RV/TLC r = -0.451 p = 0.024, FRC pleth /TLC r = -0.299 p 0.147) and VO 2peak (FEV 1 r = 0.521 p = 0.008, RV/TLC r = -0.505 p = 0.014, FRC pleth /TLC r = -0.389 p = 0.066). Conclusion EMGpara correlates strongly with conventional pulmonary function measures in CF and has a closer relationship with exercise capacity than standard pulmonary function parameters. EMGpara%max therefore represents a promising marker of CF lung disease severity.

P170 Heart Rate Recovery At One Minute Following Incremental Shuttle Walk Test Predicts Outcome In Pulmonary Hypertension

Background Heart-rate recovery during the first minute of rest (HRR1) after a six minute walk test (6MWT) has been shown to be a strong predictor of clinical worsening in patients with pulmonary arterial hypertension.1 No data as yet has been published regarding the utility of HRR1 as a predictor of mortality. Aim To assess the prognostic value of HRR1 after an Incremental Shuttle Walk Test (ISWT) in patients with pulmonary hypertension (PH). Methods Data was retrieved for consecutive cases of PH diagnosed in our unit from 2001–2010. ISWT was performed routinely as part of baseline assessment according to a modified protocol of Singh et al .2 Only treatment-naive patients with ISWT and HRR data from -90 to +30 days from date of diagnosis were included. HRR1 was defined as the difference between maximum heart rate during the ISWT and heart rate after 1 min of rest following the termination of ISWT. Results Data was available for 491 patients (including patients from each of the 5 main PH diagnostic groups). HRR1 correlated significantly with ISWT distance, highest heart-rate, maximal change in heart-rate,% predicted carbon monoxide diffusion (DLco%pred), pulmonary vascular resistance, cardiac output and mixed venous oxygen saturation (p all ≤0.01). Using a cut-off point of 18bpm the Kaplan Meier graph for survival for patients with HRR1 >18 bpm (n = 179) was significantly better than HRR1 ≤18 bpm (n = 312), p = 0.007 ([Figure 1][1]) for all patients and for diagnostic Groups 1 and 2 separately (p = 0.045, p = 0.006). Using univariate Cox proportional hazard analysis for all patients HRR1 (continuous data) had a Hazard Ratio for mortality (HR) of 0.990 with a confidence interval (CI) of 0.962–0.997, p = 0.008. Compared to patients with HRR1 >18, those with HRR1≤18 had a HR of 1.559 (CI 1.127–2.156) p = 0.007. Grouping patients by median distance walked and HRR1–18 demonstrated that the HRR1 proved a useful predictor only in patients who walked less than 180 m. Conclusion HRR1 following ISWT predicts outcome in patients with pulmonary hypertension with more severe disease.

Evaluating the interactive web-based program, activate your heart, for cardiac rehabilitation patients: a pilot study.

BackgroundConventional cardiac rehabilitation (CR) programs are traditionally based on time-constrained, structured, group-based programs, usually set in hospitals or leisure centers. Uptake for CR remains poor, despite the ongoing evidence demonstrating its benefits. Additional alternative forms of CR are needed. An Internet-based approach may offer an alternative mode of delivering CR that may improve overall uptake. Activate Your Heart (AYH) is a Web-based CR program that has been designed to support individuals with coronary heart disease (CHD).ObjectiveThe aim of this pilot study was to observe the outcome for participants following the AYH program.MethodsWe conducted a prospective observational trial, recruiting low-risk patients with CHD. Measures of exercise, exercise capacity, using the Incremental Shuttle Walk Test (ISWT), dietary habits, and psychosocial well-being were conducted by a CR specialist at baseline and at 8 weeks following the Web-based intervention.ResultsWe recruited 41 participants; 33 completed the program. We documented significant improvements in the ISWT distance (mean change 49.69 meters, SD 68.8, P<.001), and Quality of Life (QOL) (mean change 0.28, SD 0.4, P<.001). Dietary habits improved with an increased proportion of patients consuming at least 5 portions of fruit and vegetables per day, (22 [71%] to 29 [94%] P=.01) and an increased proportion of patients consuming at least 2 portions of oily fish per week (14 [45%] to 21 [68%], P=.01). We did not detect changes in anxiety and depression scores or exercise behavior.ConclusionsWe observed important improvements in exercise capacity, QOL, and dietary habits in a group of participants following a Web-based CR program. The program may offer an alternative approach to CR. A mobile version has been developed and we need to conduct further trials to establish its value compared to supervised CR.

Shuttle walking test in obese women: test‐retest reliability and concurrent validity with peak oxygen uptake

The aim of this study was to evaluate the test-retest reliability, concurrent validity and agreement with peak oxygen uptake (VO2 ) obtained during cardiopulmonary exercise testing (CPX) on a treadmill for the incremental shuttle walking test (ISWT) in obese women. Prospective study with a convenient sample of 46 community-dwelling obese women (BMI > 30 kg m(-2) ). The main outcome measures were walking distance on the ISWT and peak VO2 . Test-retest reliability was good to excellent for the exercise tests (ISWT distance ICC: 0.90; and CPX peak VO2 ICC: 0.90). Peak VO2 obtained during CPX correlated significantly with ISWT distance (r = 0.54, P<0.05) and peak VO2 obtained during the ISWT (r = 0.64, P<0.05). Bland and Altman plots demonstrated a high degree of repeatability. The ISWT had excellent reliability as well as good concurrent validity and agreement. The ISWT may be a potential tool for monitoring clinical status and intervention efficacy (e.g. programmes for weight loss and rehabilitative strategies) in this population.

Assessment of body composition, functional capacity and pulmonary function in patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is related to a low body mass index (BMI), reduced functional capacity and reduced bone density, thus justifying the importance of evaluating all of these parameters in the patients with the disease. This is a cross-sectional study, with sample consisting of 20 patients who performed measurement of body composition by bioelectrical impedance, evaluation of functional capacity by the distance traveled in the Incremental Shuttle Walk Test (ISWT) and assessment of severity of obstruction by spirometry. Significant differences were found between the travelled and scheduled distance in the ISWT (p&lt;0.01), positive correlations between muscle mass and distance walked in ISWT (r=0.54 with p=0.01), with FEV1 (r=0.488 with p=0.02), FEV1 and bone mass (r=0.497 with p=0.02) and distance traveled with FEV1 (r=0,541 with p=0.01). The correlations found in this study, besides confirming the hypothesis that the severity of the obstruction presented by the change in the lung parenchyma in patients with COPD is related to changes in body composition and functional capacity reduction, also highlight the correlation with bone mass.

Kronik obstrüktif akciğer hastalığı olan hastalarda farklı yöntemlerle saptanan maksimal oksijen tüketim kapasitesinin karşılaştırılması

Background: This study aims to assess the correlation between maximal oxygen uptake (peakVO2) during cardiopulmonary exercise test (CPET) and peakVO2 obtained from incremental shuttle walking test (ISWT) in patients with chronic obstructive pulmonary disease (COPD) and to investigate their relationship with quality of life. Methods: Data of 38 stable COPD patients (35 males, 3 females; mean age 64.6±8.3 years; range 48 to 82 years) who completed outpatient pulmonary rehabilitation (PR) program and assessed by CPET and ISWT through treadmill test was retrospectively analyzed. Pulmonary rehabilitation was performed during eight weeks. PeakVO2 measured via breath-by-breath technique during CPET. PeakVO2 from ISWT distance was calculated by the formula &#8220;4.19+ [0.025x ISWT distance]&#8221;. Borg scale was used for the evaluation of dyspnea severity before and after PR, whereas St. George&#8217;s Respiratory Questionnaire was used for quality of life. Results: PeakVO2 on CPET were found 15.9±5.1 ml/min/kg before PR and 17.3±5.3 ml/min/kg after PR (p=0.001). The peakVO2 calculated with ISWT was 11.6±3.2 m l/min/kg before PR and 13.4±3.2 ml/min/kg after PR (p

Physical Function Traits of Long-term Officially Acknowledged Victims of Pollution-related Illnesses Compared with Elderly Patients with Chronic Obstructive Pulmonary Disease.

[Purpose] To examine the long-term effects of air pollution on the physical functioning of a group of officially acknowledged victims of pollution-related illnesses (Victims group) who were exposed to air pollution more than 50 years ago, we compared them with age-matched patients with chronic obstructive pulmonary disease (COPD group). [Subjects and Methods] The Victims group comprised 34 subjects and the COPD group 24, all of whom were aged over 65 years. Respiratory function, muscle strength, exercise capacity and physical activity were measured and compared between the groups. [Results] The Victims group had significantly higher forced expiratory volume in the first second (FEV1), proportion of predicted FEV1, proportion of predicted vital capacity (VC), and ratio of FEV1 to forced VC than the COPD group. Surprisingly, the muscle strength of the Victims group was significantly weaker, their incremental shuttle walking test distance was significantly shorter, and their physical activity was significantly less than those of the COPD group. [Conclusion] Although the pulmonary function of Victims was better than that of the COPD group, their physical functioning was worse. Exposure to air pollution 50 years ago appears to continue to adversely affect their physical function. It is particularly important to offer Victims rehabilitation to improve their exercise performance and physical activity.

P39 A comparison of the repeatability and responsiveness of field and laboratory incremental exercise tests between COPD and Chronic Heart Failure

AimTo describe and compare the repeatability and responsiveness of the Incremental Shuttle Walk Test (ISWT) and incremental cardiopulmonary exercise test between COPD and Chronic Heart Failure (CHF).HypothesisThe null hypothesis, no...

Age-Specific Normal Values for the Incremental Shuttle Walk Test in a Healthy British Population

The Incremental Shuttle Walk Test (ISWT) is an important functional and prognostic marker in chronic disease. Aging has a detrimental effect on exercise performance. The objective of this study was to produce normal age-specific values for the ISWT in a healthy British population and to explore whether additional variables improve the accuracy of a predictive equation. Healthy subjects (N = 152), aged 40 to 90 years, were recruited. Data collection occurred over 2 study visits. Anthropometric and demographic data were collected, and lung function and quadriceps maximal voluntary contraction were measured. An accelerometer was worn for 2 consecutive days at home. The Duke Activity Status Index was completed, and the greatest distance from 2 ISWTs was recorded. One hundred forty subjects (56 men) with mean age (SD) of 59.4 (11.0) years completed 2 ISWTs. Forced expiratory volume in 1 second (FEV(1)) was 109.1% (14.56%) predicted and ISWT distance was 737 m (183 m). Age-specific normal values for the ISWT were observed: mean (lower limit of normal)--40 to 49 years, 824 m (765 m); 50 to 59 years, 788 m (730 m); 60 to 69 years, 699 m (649 m); and 70 years and older, 633 m (562 m). A predictive equation was developed from 114 subjects. Age, body mass index, FEV(1), quadriceps maximal voluntary contraction, and Duke Activity Status Index contributed to ISWT distance predicting 50.4% of the variation in performance. We have developed age-specific normal values for performance on the ISWT in a healthy British population. However, even using practical, clinically relevant variables, it is not possible to accurately predict exercise capacity from a regression equation.

Effects of nutritional supplementation combined with conventional pulmonary rehabilitation in muscle‐wasted chronic obstructive pulmonary disease: A prospective, randomized and controlled study

Nutritional depletion in chronic obstructive pulmonary disease (COPD) adversely affects health status and mortality. We aimed to evaluate the effects of nutritional supplementation (NS) with pulmonary rehabilitation (PR) on body composition, mid-thigh cross-sectional area (CSA), dyspnoea, exercise capacity, health-related quality of life, anxiety and depression in advanced COPD patients. Forty-six patients were randomized to PR and nutritional support (PRNS), PR or the control group. Dyspnoea was measured with Medical Research Council and BORG scales. Exercise capacity was measured through 6-min walk test and shuttle tests; health-related quality of life was assessed with St. George's Respiratory Questionnaire. Psychological status was measured with Hospital Anxiety and Depression Scale. Body weight and body mass indexes (BMI) were also evaluated. Fat-free mass was measured through bioelectrical impedance analyser. The CSA of quadriceps was calculated in mid-level of the thigh with magnetic resonance imaging. Dyspnoea and total scores of St. George's Respiratory Questionnaire improved in both groups (P < 0.05). Six-minute walk test and incremental shuttle walk test distances in PRNS and PR patients increased significantly as (62.6 ± 42.4 m, 43.3 ± 59.2 m, both P = 0.001; and 63.3 ± 70.1 m and 69.3 ± 69.7 m, both P = 0.001). Although anxiety improved in both groups (P < 0.05), there was no change in depression. Body weight, BMI and fat-free mass index (FFMI) (1.1 ± 0.9 kg, 0.2 ± 1.4 kg/m(2) and 0.6 ± 0.5 kg/m(2), P < 0.05) in PRNS, whereas body weight and FFMI (0.6 ± 0.7 kg, 0.1 ± 0.6 kg/m(2) P < 0.05) increased in PR after the intervention. There was a significant increase in mid-thigh CSA (2.5 ± 4.1 cm(2)) only in PRNS (P = 0.04). The combination of NS with PR resulted in improvements particularly in lean body mass and mid-thigh CSA. This study suggests combining NS with PR in reversing weight loss and muscle wasting in COPD.

A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients

Pulmonary rehabilitation (PR) has positive effects on exercise capacity in Chronic Obstructive Pulmonary Disease (COPD). However, not all COPD patients benefit from PR to the same extent. We investigated whether there is a patient profile, which is associated with the improvement in endurance exercise capacity. In this observational study, we included 102 COPD patients who followed PR (age 60±10 (mean±SD) years, FEV(1)%predicted 44±16%, 54 men). Lung function, maximal incremental cycle testing (Wpeak, VO(2)peak, Δlactate), quadriceps force and incremental and endurance shuttle walk test (ISWT/ESWT) were performed at the start of PR. The ESWT was repeated after 7 weeks of PR. Mean change in ESWT (ΔESWT) was 100±154%. Four variables showed a statistically significant negative correlation with ΔESWT: FEV(1)%pred. (ρ=-0.20), Wpeak (ρ=-0.24), Δlactate (ρ=-0.33) and incremental shuttle walk test (ISWT) (ρ=-0.31). A cluster analysis identified two patient profiles: A profile with high ΔESWT, TLC and RV and low FEV(1), VO(2)peak, quadriceps force, Δlactate, HR(peak)%pred. and ISWT distance and a profile with low ΔESWT, TLC and RV and high FEV(1), VO(2)peak, quadriceps force, Δlactate, HR(peak)%pred. and ISWT distance. Single variables from lung function or exercise testing at baseline have limited predictive value for response to exercise training. However, patients with worse disease status (i.e. a combination of lower FEV(1), more hyperinflation, lower exercise capacity and worse quadriceps force) improve more in endurance exercise capacity.

Matrix metalloproteinase-9 predicts pulmonary status declines in α1-antitrypsin deficiency

BackgroundMatrix metalloproteinase-9 (MMP-9) may be important in the progression of emphysema, but there have been few longitudinal clinical studies of MMP-9 including pulmonary status and COPD exacerbation outcomes.MethodsWe utilized data from the placebo arm (n = 126) of a clinical trial of patients with alpha1-antitrypsin deficiency (AATD) and emphysema to examine the links between plasma MMP-9 levels, pulmonary status, and COPD exacerbations over a one year observation period. Pulmonary function, computed tomography lung density, incremental shuttle walk test (ISWT), and COPD exacerbations were assessed at regular intervals over 12 months. Prospective analyses used generalized estimating equations to incorporate repeated longitudinal measurements of MMP-9 and all endpoints, controlling for age, gender, race-ethnicity, leukocyte count, and tobacco history. A secondary analysis also incorporated highly-sensitive C-reactive protein levels in predictive models.ResultsAt baseline, higher plasma MMP-9 levels were cross-sectionally associated with lower FEV1 (p = 0.03), FVC (p < 0.001), carbon monoxide transfer factor (p = 0.03), resting oxygen saturation (p = 0.02), and ISWT distance walked (p = 0.02) but were not associated with radiographic lung density or total lung capacity (TLC). In longitudinal analyses, MMP-9 predicted a further decline in transfer factor (p = 0.04) and oxygen saturation (p < 0.001). MMP-9 also predicted worsening lung density (p = 0.003), increasing TLC (p = 0.02), and more frequent COPD exacerbations over follow-up (p = 0.003). Controlling additionally for hs-CRP levels did not substantively change the longitudinal associations between MMP-9 and these outcomes.ConclusionsIncreased plasma MMP-9 levels generally predicted pulmonary status declines, including worsening transfer factor and lung density as well as greater COPD exacerbations in AATD-associated emphysema.