Loss Of Exercise Capacity Research Articles

Understanding the Gaps in the Reporting of COPD Exacerbations by Patients: A Review.

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them. Newly developed tools, such as the COPD Exacerbation Recognition Tool (CERT) have been designed to achieve this objective. This review focuses on the underreporting of COPD exacerbations by patients, the factors associated with this, the consequences of underreporting, and potential solutions.

A protocol for randomized controlled trial on multidisciplinary interventions for mobility limitation in the older adults (M-MobiLE)

BackgroundMobility limitation—the loss of exercise capacity or independent living ability—is a common geriatric syndrome in older adults. As a potentially reversible precursor to disability, mobility limitation is influenced by various factors. Moreover, its complex physiological mechanism hinders good therapeutic outcomes with a single-factor intervention. Most hospitals have not incorporated the diagnosis and evaluation of mobility limitation into medical routines nor developed a multidisciplinary team (MDT) treatment plan. We aim to conduct a clinical trial titled “A Multidisciplinary-team approach for management of Mobility Limitation in Elderly (M-MobiLE)” to explore the effect of the MDT decision-making intervention for mobility limitation.MethodsThe M-MobiLE study will be a multicenter, randomized, and controlled trial. We will recruit a minimum of 66 older inpatients with mobility limitation from at least five hospitals. Older patients with mobility limitation admitted to the geriatrics department will be included. Short-Physical Performance Battery (SPPB), Activities of Daily Living (ADL), Function Impairment Screening Tool (FIST), Geriatric Depression Scale (GDS-15), Short Form − 12 (SF-12), Fried frailty phenotype, social frailty, Morse Fall Risk Scale, SARC-CalF, Mini-Mental State Examination (MMSE), Mini-Nutritional Assessment Short-Form (MNA-SF), and intrinsic capacity will be assessed. The intervention group will receive an exercise-centered individualized MDT treatment, including exercise, educational, nutritional, medical, and comorbidity interventions; the control group will receive standard medical treatment. The primary outcome is the change in the SPPB score, and the secondary outcomes include increased SF-12, ADL, FIST, MMSE, MNA-SF, and intrinsic capacity scores and decreased GDS-15 and SARC-CalF scores.ConclusionOur results will help develop a multidisciplinary decision-making clinical pathway for inpatients with mobility limitation, which can be used to identify patients with mobility limitation more effectively, improve mobility, and reduce the risk of falls, frailty, and death in older inpatients. The implementation of this MDT strategy may standardize the treatment of mobility limitation, reduce adverse prognosis, and improve quality of life.Trial registrationChiCTR, ChiCTR2200056756, Registered 19 February 2022.

Risk Assessment for Loss-of-Exercise Capacity After Lung Cancer Surgery: Current Advances in Surgery and Systemic Treatment.

Considering advances in current post-recurrence treatment, we examined the prognostic significance of the number of risk factors for loss-of-exercise capacity (LEC) after lung cancer surgery, which were identified by our previous prospective observational study. Risk factors for LEC were defined as a short baseline 6-min walk distance (<400m), older age (≥75years), and low predicted postoperative diffusing capacity for carbon monoxide (<60%). Patients were classified as Risk 0/I/II/III according to the number of risk factors. The survival data were retrospectively analyzed. Between 2014 and 2017, 564 patients (n = 307, 193, 57, 7; Risk 0/I/II/III) who underwent lung cancer surgery were included in the study. The number of risk factors was associated with smoking status, predicted postoperative forced expiratory volume in 1s, histology, pathological stage, and adjuvant therapy. In a multivariate Cox regression analysis, compared to Risk 0, Risk I/II/III showed significant associations with overall survival (hazard ratios: 1.92, 3.35, 9.21; 95% confidence interval: 1.27-2.92, 2.01-5.58, 3.64-23.35; Risk I/II/III, respectively). In 141 patients with recurrence, molecular targeted therapies (MTTs) or immune checkpoint inhibitors (ICIs) were included in 58%, 47%, 32%, and 0% (Risk 0/I/II/III) during the course of treatment. In patients with MTT/ICI treatment, the estimated 1-year and 3-year post-recurrence survival rates were 88% and 58%, respectively. Risk classification for LEC was associated with survival after lung cancer surgery, as well as post-recurrence treatment. The concept of physical performance-preserving surgery may contribute to improving the outcomes of current lung cancer treatment.

Exercise Interventions With Trained Home Helpers for Preventing Loss of Autonomy and Falls in Community-Dwelling Older Adults Receiving Home Heath Physical Therapy T4H: A Randomized Controlled Pilot Study.

Older adults at risk for falls live independently in the community in their own home and have rehabilitation needs. However, little is known about whether home coaching of older adults can decrease falls at home. We sought to determine whether a novel program for preventing falls and a loss of exercise capacity, the T4H program, in which home helpers act as exercise coaches by using an information technology (IT) device, was acceptable and feasible. Between February 2015 and October 2015, we performed a cluster randomized controlled trial in which home helpers either assisted older adults 75 years and over, to participate in the T4H program, or provided standard home help over 3 months. We assessed levels of acceptability and satisfaction among the older adults and home helpers with regard to the exercise program and the technologies used. To measure efficacy, the main outcome measures for the older adults were the absence of falls requiring medical or paramedical care, unplanned hospitalizations, walking ability in a Timed Up and Go test (TUG), and self-care ability by the Barthel Index at the 3-month follow-up visit. Overall, 35 older adults were included, aged 89 years and with 68.6% women. Eighty-five percent of the respondents were pleased or very pleased to have participated in the T4H exercise program, 70% were satisfied with the IT devices, and 92% were satisfied with their home helper's level of involvement. Two of the 4 home helper respondents were satisfied or very satisfied with the exercise program, and 2 were moderately satisfied. The proportions of older adult participants with no falls or no unplanned hospitalizations were higher in the T4H group (92.3% and 85.7%, respectively) than in the control group (81.8% and 71.4%, respectively), although these intergroup differences were not statistically significant. The T4H and control groups did not differ significantly with regard to the TUG time (median [IQR]: 27.6 seconds [17.9-58.6] vs 30.7 seconds [19.7-57.2], respectively) or the Barthel Index (median [IQR]: 90 [75-95] and 90 [75-95], respectively). The novel T4H home help model was feasible and was associated with a high level of participant satisfaction. We observed a trend toward fewer falls and hospitalizations and better quality of life in the older adults.

Time course of cigarette smoke-induced changes of systemic inflammation and muscle structure.

It has become more evident that long-term cigarette smoking (LTCS) has an important extrapulmonary toxicity. The aim of the study was to investigate the time-dependent effects of cigarette smoke exposure on exercise capacity, markers of systemic inflammation, and skeletal muscle structure. c57bl/6j-mice were either exposed to mainstream cigarette smoke for 6 h/day, 5 days/wk [smoke-exposed (SE) group] or assigned to the control, unexposed group (Con group). SE group mice were exposed for 8, 16, 24, and 32 wk to smoke and unexposed Con mice were used as age-matched controls. Exercise capacity was investigated by spiroergometry. Systemic inflammatory status was analyzed by flow cytometry and multiplexed fluorescent immunoassay. For analysis of muscle tissue, histological techniques and microarray analysis were used. Mice of the SE group exhibited a lower increase of body mass and a decrease of V̇o2 max (P < 0.05). An increase of lymphocyte CD62, ICAM, and VCAM expression was found in SE mice (P < 0.05). A biphasic trend of protein up- and downregulation was observed in markers of systemic inflammation, tissue deterioration, and allergic reactions such as C-reactive protein (CRP), eotaxin, haptoglobin, macrophage colony-stimulating factor-1 (M-CSF-1), and macrophage inflammatory protein-1γ (MIP-1γ). Thereby, the expression of several chemotactic proteins in plasma correlated with their expression in muscle. A time-dependent decrease of muscle mass, oxidative type-I fibers, and muscle cross-sectional area was found (P < 0.05). Microarray analysis revealed a SE-induced upregulation of several pathways of metabolic processes and tissue degradation. Taken together it was found that the loss of exercise capacity and systemic inflammation are early events of SE, which might induce muscular atrophy and loss of oxidative muscle capacity.

Exercise Intensities in MS - Comparison between the Physiological Threshold Values of a Cardiopulmonary Exercise Test and the Estimated Values by Training Formulas

Background: Quantification of training intensities via current formulas (e.g. 75% of the estimated maximum heart rate (HR-peak)) is practical and a time saving compromise. However misinterpretations of cardiorespiratory fitness in persons with MS (pwMS) may lead to stagnancy or loss of exercise capacity. Objectives: Feasibility of different training intensities of established training formulas in pwMS using a method comparison according to Bland-Altman. Methods: 83 pwMS were included and the thresholds were determined via breathing gas analysis of peak oxygen consumption (VO2) and carbondioxide (CO2). The sample was divided according to the expandend disability status scale (EDSS) in mildly (EDSS 1.0-4.0) and moderately impaired (EDSS 4.5 - 6.5). The formulas (210 age)*0.65, (210-age)*0.70, (210-age)*0.80, 180-age, 65% of the effective highest heart rate during CPET (HRPeak), 70%HR-peak, 75% HR-peak and 80% HR-peak were used for the estimation of the training heart rates. Method comparisons were performed using Passing-Bablok regression and Bland-Altman plots. All values are expressed as mean and 95% confidence interval (CI). Results: Passing-Bablok regression show that for mildly impaired pwMS 70% and 75% HR-peak show an agreement with the threshold values. For severely impaired pwMS 65% HR-peak showed by trend an agreement with the threshold values. Other formula values missed the criteria for agreement. Conclusion: This study indicates that 70% and 75% HR-peak for moderately impaired PwMS gave adequate training intensities comparable to the threshold values.

Hypergravity resistance training on a human powered centrifuge

Microgravity exposure results in muscular, cardiovascular, and skeletal deconditioning and loss of exercise capacity. The Space Cycle is a human powered centrifuge that can be configured for aerobic or resistance training to offer an integrative countermeasure to microgravity. Healthy male subjects performed 2 weeks of squat resistance training on the Space Cycle (SC, n=9) or using free weights (FW, n=9). Subjects completed 9 workouts, each consisting of 3 sets of squats at 70‐90% of individual 10 repetition maximum (10RM). SC subjects performed squats at 2.3 to 3.9 +Gz (measured at the feet) without additional weights. Biopsies were taken from the right vastus lateralis prior to, 4 h after, and 24 h after the first and last workout for evaluation of acute and chronic cellular responses to SC training. RNA was isolated from biopsy samples, cDNA prepared using RT‐PCR, and gene expression analyzed. Collagen IIIα1 expression was elevated two‐ to three‐fold after two weeks in both training groups. Importantly, no significant differences in collagen IIIα1 were seen when comparing FW and SC groups. Gene expression changes support the efficacy of the Space Cycle as a gravity‐independent resistance training device. Supported by NASA MA00403 and NIH M01 RR00827.

More pressure on pulmonary hypertension: Table. 1—

The European Respiratory Review is structured around a “theme of the month”. I am delighted to introduce pulmonary hypertension (PH) as the first theme of the new Review . PH describes a group of devastating diseases, comprising idiopathic and associated/secondary forms, which cause breathlessness, loss of exercise capacity and death due to elevated pulmonary artery pressure and subsequent right heart failure [1]. Pulmonary arterial hypertension (PAH) is defined by an elevation of the mean pulmonary artery pressure above 25 mmHg at rest and/or 30 mmHg during exercise without elevation of the pulmonary capillary wedge pressure (≤15 mmHg) [1]. The underlying pathophysiological mechanism is extensive pulmonary artery remodelling [2]. PH was previously classified into two categories, namely primary or secondary PH, depending on the absence or presence of identifiable causes or risk factors [1]. In the second (1998), third (2003), and fourth (2008) World Symposium on PH, a detailed clinical classification of the disease was agreed upon. The 2003 version is shown in table 1 [1]. The main subcategories share similarities in pathogenetic mechanisms, clinical presentation and therapeutic options, allowing clinicians to conduct trials using homogeneous groups of patients. Similarly, basic science specialists have attempted to describe pathophysiological mechanisms in the same homogeneous groups of patients with PH. This includes cases without identifiable cause or risk factors, so-called idiopathic PAH (sporadic appearance) and familial PAH [1]. For these subgroups, mutations in the bone morphogenetic protein (BMP)/transforming growth factor-β superfamily (BMPR2, activin receptor-like kinase-1 and endoglin) are now known to play …

Exercise capacity after lobectomy in patients with chronic obstructive pulmonary disease

The aim of this study is to clarify whether patients with chronic obstructive pulmonary disease (COPD) lose less exercise capacity after lobectomy than do those without COPD, to the same extent as ventilatory capacity and lobectomy for selected patients with severe emphysema improve exercise capacity like ventilatory capacity. Seventy non-COPD patients (N group), 16 mild COPD patients (M group), and 14 moderate-to-severe COPD patients (S group) participated. Pulmonary function and exercise capacity tests were performed on the same day preoperatively and six months to one year after lobectomy. The S group lost significantly less FEV(1) (forced expiratory volume in 1 s) after lobectomy than did the N or M group (P<0.0001 and P<0.005). However, their loss of exercise capacity was equivalent to that for the N and M groups. For the S group, there was a significant, negative correlation between preoperative FEV(1) % of predicted and percentage change in FEV(1) and maximum oxygen consumption (VO2 max) after lobectomy (r=-0.93, P<0.0001 and r=-0.64, P=0.01). In moderate-to-severe COPD patients, patients with a lower preoperative FEV(1) % of predicted experienced a smaller decrease in FEV(1) and VO2 max after lobectomy.

The burden of pulmonary hypertension

A rare disease affects less than one in 2,000 individuals within the general population 1, 2. By nature, rare diseases concern a low number of patients, families and healthcare providers. This often has negative consequences for the patients, who may suffer from less than optimal care 1, 2. Rare respiratory diseases are no exception and it is time to improve awareness, as well as understanding of the epidemiology, pathophysiology and management, of these conditions 2. In the current issue of the European Respiratory Journal , Peacock et al. 3 provide novel original data on the epidemiology of pulmonary arterial hypertension (PAH) in Scotland (UK). PAH describes a group of noninfectious, nonmalignant respiratory diseases causing breathlessness, loss of exercise capacity and death due to elevated pulmonary artery pressure and subsequent right heart failure 4. A definite diagnosis of PAH requires strict right heart catheter criteria. Indeed, PAH is defined by an elevation of the mean pulmonary artery pressure >25 mmHg at rest and/or 30 mmHg during exercise without elevation of the pulmonary capillary wedge pressure (<15 mmHg), and elimination of frequent causes such as hypoxia, respiratory diseases and thrombo-embolic disease 4. Half of all PAH cases referred to pulmonary vascular centres have no identifiable risk factor, corresponding to idiopathic (sporadic) and familial PAH. The other …

Stage-related changes in functional capacity in Hodgkin’s disease: assessment by cardiopulmonary exercise testing before initiation of treatment

Our aim was to examine indices of cardiorespiratory capacity at rest and during exercise before initiation of therapy for Hodgkin's disease. We prospectively studied 24 patients divided into two groups according to the disease stage. Group 1 included eight patients in stage IA and four in stage IIA; group 2 included four patients in stage IIB, six in stage III, and two in stage IV. All patients underwent detailed cardiopulmonary evaluations at rest using electrocardiogram, echocardiogram, spirometry, and measurement of pulmonary diffusing capacity (DLCO), and during exercise using a cardiopulmonary exercise test. Groups 1 and 2 were similar with respect to sex distribution (eight women and four men in each), mean age (35+/-36 vs37+/-4.6 years), body mass index, and hemoglobin concentration (12.7+/-0.2 vs 12.1+/-0.3 g l-1). All patients had a normal cardiovascular status. All patients in group 1 had normal cardiorespiratory measurements at rest and during exercise. Forced vital capacity was significantly lower in group 2 (84.8+/-2.7% predicted) than in group 1 (105+/-3%, P<0.0001), without abnormalities in DLCO or in resting and exercise oxygen diffusion. Likewise, percentage predicted VO2max (65+/-4 vs 97+/-6, P<0.0002), oxygen pulse at peak exercise (0.12+/-0.01 vs 0.17+/-0.01, P<0.001), and DeltaVO2/DeltaW slope (8.4+/-0.3 vs 10.2+/-0.4, P<0.003) were significantly lower in group 2 than in group 1. Functional capacity during exercise was markedly reduced in patients suffering from Hodgkin's disease in advanced stages. This loss of exercise capacity appeared mainly related to a peripheral disorder.

Aging‐Induced Adaptations of Microvascular Reactivity

Control of blood flow to skeletal muscle depends on the vasomotor tone present in the resistance vasculature. Although muscle blood flow has been shown to decline with advancing age, our knowledge of how alterations of reactivity of the resistance vasculature contribute to reduced delivery or altered distribution of blood in the aged is limited. Recent work has demonstrated that age alters the reactivity of resistance arteries and arterioles from skeletal muscle, and that impairment of both vasodilator and vasoconstrictor responses occurs with advancing age. The alterations in cellular mechanisms that contribute to age-related impairment of vasoreactive responses encompass both the vascular endothelium and smooth muscle, and differ in muscles of varying function and fiber type. Current research suggests that some degree of age-induced endothelial dysfunction occurs in resistance arteries and arterioles from most skeletal muscle; however, the severity of endothelial impairment appears greater in resistance arteries and arterioles from highly oxidative locomotory muscles. Age-related impairment of vasoconstrictor responses to metabolites and endogenous constrictor agents has also been documented. These age-related reductions in vasoreactivity that occur in the skeletal muscle resistance vasculature may contribute to inadequate delivery or distribution of blood flow during exercise and ultimately be a factor in loss of exercise capacity that occurs with advancing age.

Differing Effects of Airway Obstruction on Physical Work Capacity and Ventilation in Men and Women With COPD

Although the natural history of COPD is thought to be well known, studies assessing differences in the onset and course of the disease by gender are surprisingly lacking. This study is a cross-sectional analysis using progressive cycle ergometry exercise testing to assess male and female patients at specific levels of airway obstruction to see if they differ in their exercise capacity and decline in functional capacity. The study group included 417 patients with COPD, 55 to 85 years of age, who were compared with 29 controls of similar age; all patients had COPD (FEV1/FVC < 75% predicted) without restrictive disease. Exercise testing in groups based on the level of pulmonary dysfunction defined by FEV1/FVC ratios (mild, 60.5 to 69.5%; moderate, 50.5 to 60.5%; severe < 50.5%) was analyzed. Data were evaluated using the Statistical Analysis System, analyzing gender and degree of airway obstruction and adjusting for any difference in age and peak exercise heart rate (covariate analysis of variance). Men demonstrated progressive reductions of body weight, exercise ability (assessed by the VO2), oxygen pulse (O2P, an indicator of stroke volume), and maximum exercise ventilation (VEmax) even with mild pulmonary dysfunction. Women did not lose weight, and maintained usual exercise ability (VO2, VEmax) and O2P until moderate or severe disease was present. Additional confirmation of a decrease in cardiac function for men with mild airway obstruction (p < 0.0001, controls), but not for women with mild airway disease, was obtained by estimation of cardiac output. Further, women presented with COPD at lower levels of tobacco smoke exposure than men for the entire group (43.8 vs 63.0 pack-years, p < 0.0001) and for each subgroup of disease severity. There were proportionally more life-time female nonsmokers than male nonsmokers with COPD (16 vs 5, p < 0.001). Male and female patients with COPD differed in their decline of functional aerobic capacity even at equivalent levels of pulmonary dysfunction. One reason for this appeared to be a decrease in the O2P occurring early in the natural history of the disease in the men and not in the women. Although general body de-conditioning may be the cause, heart disease may also be a contributing aspect. The relative delay in the loss of exercise capacity and body mass by the women may relate to predisease differences in physical activity. Women manifested significant lung disease with less cigarette smoking than men. This may be attributable to a different susceptibility to cigarette smoke between the sexes. These results suggest that there appear to be differences in the natural history of COPD in men and women.