Pulmonary Rehabilitation Exercise Research Articles

Body Mass Index and Thoracic Expansion in Post-COVID Dyspnea: A Secondary Analysis.

Dyspnea secondary to lung impairment can persist following the acute phase of COVID-19. Thoracic expansion measurements have been used as a diagnostic tool to evaluate chest wall mobility, respiratory function, and the effects of respiratory muscle strength training. Changes in chest wall mobility may occur because of altered chest biomechanics in individuals with respiratory diseases and an elevated body mass index (BMI). The purpose of this secondary analysis was to evaluate whether BMI influences thoracic expansion or forced expiratory volume over 1 second (FEV1) in individuals with persistent dyspnea following COVID-19. This study assessed the relationship between BMI and thoracic expansion, pulmonary symptoms, and exercise capacity following a home-based pulmonary rehabilitation intervention. A secondary data analysis was conducted with a sample of 19 adults with persistent dyspnea following COVID-19 infection who participated in a 12-week, home-based pulmonary rehabilitation study. Participants received expiratory muscle strength training devices and were instructed to perform pulmonary rehabilitation exercises three times per week over the study period. Pulmonary function, pulmonary symptoms, exercise capacity, and BMI measurements were collected. For analysis, study participants were divided into obese (BMI > 30 kg/m2) or nonobese (BMI < 30 kg/m2) categories. Correlations using the change scores from baseline to 12 weeks between thoracic expansion, FEV1, pulmonary symptoms, and exercise capacity were assessed. In addition, the minimal detectable change (MDC) in thoracic expansion was explored. Thoracic expansion was significantly improved after 12 weeks of training (p = .012) in the nonobese group. There was a significant correlation between the change in walking distance and pulmonary symptoms (r = -.738, p < .001) and in thoracic expansion (r = .544, p = .020), and walking distance, when controlling for BMI, but no change in FEV1. Average MDC was 1.28 for inspiration and 0.91 for expiration. Measurements of thoracic expansion were significantly lower in post-COVID individuals with an increased BMI. Individuals with persistent dyspnea and a higher BMI may require additional measures to increase chest mobility or to detect pulmonary changes following COVID-19.

Effect of home-based pulmonary rehabilitation on exercise capacity in post COVID-19 patients: a randomized controlled trail

BackgroundCoronavirus 2019 (COVID-19) is an epidemic condition that compromises various consequences. The goal of this study was to investigate the effect of home-based pulmonary rehabilitation on exercise capacity in patients with post COVID-19 syndrome.MethodsThe study was designed as a randomized control trial. A total of sixty-eight patients with post COVID-19 syndrome complaining of fatigue, dyspnea, and exercise intolerance participated in this study. Their ages ranged from 40 to 70 years old. The patients were randomly classified into two equal groups. The control group received usual medical care only, whereas the rehabilitation group received a selected home-based pulmonary rehabilitation exercise program plus the same usual medical care. The Physical Fitness Index (PFI), Chalder fatigue index, SF-36 questionnaire, dyspnea scale, and six-minute walk test (6 MWT) were measured before and after 12 weeks of intervention.ResultsThe rehabilitation group showed a significant lower mean of Chalder fatigue (11.1 ± 0.94) and a higher mean of 6MWT (439.7 ± 25.3) and PFI (52.3 ± 10.2), in addition to a higher mean of the SF-36 Questionnaire (66.4 ± 3.7) and a significant improvement of dyspnea in the mMRC score (26.7%), grade 2, (63.3%), grade 1 (10%), and grade 0 with a p-value < 0.001 when compared to the control group.ConclusionHome-based pulmonary rehabilitation (HBPR) for patients with post COVID-19 syndrome is effective and has a potential direct influence on exercise capacity, fatigue, dyspnea, and quality of life. HBPR could be considered an adjunctive, applicable, and low-cost therapy for patients with post COVID-19 syndrome.Trial registration: The study was registered in Pan African Clinical Trial Registry as a clinical trial ID (PACTR202111640499636), November 2021.

Effects of Home-Based Pulmonary Training Program on Functional Exercise Capacity and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, characterized by persistent respiratory symptoms and airflow limitation. Despite the availability of various treatments, there is a growing interest in exploring more effective strategies to manage symptoms, enhance exercise capacity, and improve the quality of life for COPD patients. Pulmonary rehabilitation, including both supervised and home-based exercises, has emerged as a promising approach. Objective: The aim of this study was to evaluate the effectiveness of a combined approach of Active Cycle of Breathing Technique (ACBT) with a home-based exercise regimen in improving functional exercise capacity and quality of life in patients with COPD, compared to ACBT alone. Methods: This was a randomized controlled trial involving 44 COPD patients, divided into two groups: Group A received ACBT alone, while Group B participated in ACBT plus a home-based exercise program. The intervention lasted for four weeks. Outcome measures included the St. George’s Respiratory Questionnaire (SGRQ) for quality of life, the 30-second arm curl test for upper extremity function, and the 6-minute walk test (6MWT) for lower extremity function. Data were analyzed using SPSS version 25, with the Mann-Whitney and Wilcoxon tests for between-group and pre-post intervention comparisons, respectively. Results: Group B showed more significant improvements in exercise capacity and respiratory symptoms compared to Group A. Specifically, the 6MWT distances increased from an average of 365.60±57.81 meters to 370.40±54.29 meters in Group B, indicating enhanced lower extremity function. Similarly, the SGRQ scores, reflecting quality of life, demonstrated more substantial improvement in Group B, though specific numerical results for this and the 30-second arm curl test were not significantly different between groups. Conclusion: The study concludes that combining ACBT with a home-based exercise regimen significantly benefits COPD patients by improving functional exercise capacity and potentially enhancing the quality of life. This combined approach could serve as a viable addition to the COPD management strategy, emphasizing the importance of comprehensive, patient-centered care.

Effectiveness of upper arm and breathing exercises to improve inflammatory markers in severe COVID-19 patients.

Studies have suggested associations between inflammatory markers with the severity of coronavirus disease 2019 (COVID-19). Therefore, exercises that could reduce the level of inflammatory markers might be beneficial. The aim of this study was to determine the effect of upper arm and breathing exercises on inflammatory markers such as ferritin, lactate dehydrogenase (LDH), and C-reactive protein (CRP) in severe COVID-19 patients. A quasi-experimental with pre-test and post-test control group design was conducted among severe COVID-19 aged 18-70 years old, with or without comorbidities. Baseline data of inflammatory markers (ferritin, LDH, and CRP) were measured before the exercises and repeated post-exercise. The upper arm and breathing exercises were performed for ten days, twice a day (morning and evening) for ten minutes. A paired Student t-test was used to assess the changes in the inflammatory markers' levels. Our data indicated that levels of ferritin and CRP were not significantly different between pre- and post-exercise. However, the level of LDH decreased significantly from 481.35 U/L to 331.80 U/L (p=0.001). This study highlights that pulmonary rehabilitation exercises might be beneficial to enhance the recovery process in severe COVID-19 patients.

Pulmonary Rehabilitation Exercises Effectively Improve Chronic Cough After Surgery for Non-small Cell Lung Cancer.

Cough is a major complication after lung cancer surgery, potentially impacting lung function and quality of life. However, effective treatments for managing long-term persistent postoperative cough remain elusive. In this study, we investigated the potential of a pulmonary rehabilitation training program to effectively address this issue. Between January 2019 and December 2022, a retrospective review was conducted on patients with non-small cell lung cancer (NSCLC) who underwent lobectomy and lymph node dissection via video-assisted thoracoscopic surgery (VATS) at Daping hospital. Based on their postoperative rehabilitation methods, the patients were categorized into 2 groups: the traditional rehabilitation group and the pulmonary rehabilitation group. All patients underwent assessment using the Leicester cough questionnaire (LCQ) on the third postoperative day. Additionally, at the 6-month follow-up, patients' LCQ scores and lung function were re-evaluated to assess the long-term effects of the pulmonary rehabilitation training programs. Among the 276 patients meeting the inclusion criteria, 195 (70.7%) were in the traditional rehabilitation group, while 81 (29.3%) participated in the pulmonary rehabilitation group. The pulmonary rehabilitation group showed a significantly lower incidence of cough on the third postoperative day (16.0% vs 29.7%, P = .018) and higher LCQ scores in the somatic dimension (5.09 ± .81 vs 4.15 ± 1.22, P = .007) as well as in the total score (16.44 ± 2.86 vs 15.11 ± 2.51, P = .018, whereas there were no significant differences in psychiatric and sociological dimensions. At the 6-month follow-up, the pulmonary rehabilitation group continued to have a lower cough incidence (3.7% vs 12.8%, P = .022) and higher LCQ scores across all dimensions: somatic (6.19 ± .11 vs 5.75 ± 1.20, P = .035), mental (6.37 ± 1.19 vs 5.85 ± 1.22, P = .002), sociological (6.76 ± 1.22 vs 5.62 ± 1.08, P < .001), and total (18.22 ± 2.37 vs 16.21 ± 2.53, P < .001). Additionally, lung function parameters including FVC, FVC%, FEV1, FEV1%, MVV, MVV%, DLCO SB, and DLCO% were all significantly higher in the pulmonary rehabilitation group compared to the traditional group. Pulmonary rehabilitation exercises significantly reduced the incidence of postoperative cough and improved cough-related quality of life in patients undergoing lobectomy, with sustained benefits observed at the 6-month follow-up. Additionally, these exercises demonstrated superior lung function outcomes compared to traditional rehabilitation methods.

A Magnetic Field-Based Wearable Respiration Sensor for Real-Time Monitoring During Pulmonary Rehabilitation.

This work explores Hall effect sensing paired with a permanent magnet, in the context of pulmonary rehabilitation exercise training. Experimental evaluation was performed considering as reference the gold-standard of respiratory monitoring, an airflow transducer, and performance was compared to another wearable device with analogous usability - a piezoelectric sensor. A total of 16 healthy participants performed 15 activities, representative of pulmonary rehabilitation exercises, simultaneously using all devices. Evaluation was performed based on detection of flow reversal events and key respiratory parameters. Overall, the proposed sensor outperformed the piezoelectric sensor with a mean ratio, precision, and recall of 0.97, 0.97, and 0.95, respectively, against 0.98, 0.90, and 0.88. Evaluation regarding the respiratory parameters indicates an adequate accuracy when it comes to breath cycle, inspiration, and expiration times, with mean relative errors around 4% for breath cycle and 8% for inspiration/expiration times, despite some variability. Bland-Altman analysis indicates no systematic biases. Characterization of the proposed sensor shows adequate monitoring capabilities for exercises that do not rely heavily on torso mobility, but may present a limitation when it comes to activities such as side stretches. This work provides a comprehensive characterization of a magnetic field-based respiration sensor, including a discussion on its robustness to different algorithm thresholds. It proves the viability of the sensor in a range of exercises, expanding the applicability of Hall effect sensors as a feasible wearable approach to real-time respiratory monitoring.

Exercise training influence on cognitive capacity and mental health within chronic obstructive pulmonary disease - A pilot study.

Although pulmonary rehabilitation and regular exercise have improved negative emotions and cognitive capacity within cases of chronic obstructive pulmonary disease (COPD), influence by exercise training upon different cognitive and memory functions in COPD is still controversial. This investigation aimed to assess whether cognitive performance and mental health are affected by the benefits of exercise training within cases of COPD. This pilot investigation included thirty-three patients with Global Initiative for Chronic Obstructive Lung Disease stage ≥B. Based on the subjects' rights, all included patients could choose to join either the exercise group or the control group, according to their free will. Twelve patients were assigned to receive exercise treatment over a 2-month period, while the remaining 16 patients were assigned to the control group. Cognitive capacity outcomes were measured using the Wechsler Memory Scale-III Word List Test, Stroop task, and psychomotor vigilance task (PVT). Mood states were assessed through the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Most cases demonstrated major improvement for BDI and BAI scorings post-60-day therapy. During PVT, the omission rate decreased, while the hit rate increased, indicating an improvement in attention performance. Furthermore, this investigation found a significant increase in immediate verbal and recognition memory for word-list test. However, no major performance shifts were found on Stroop analysis. This investigation demonstrated that a 2-month exercise training program resulted in significant improvement in negative emotions, immediate memory, recognition memory, and attention.

Mixed-Methods Assessment of a Virtual Reality-Based System for Pulmonary Rehabilitation.

Barriers to pulmonary rehabilitation (PR) (e.g., finances, mobility, and lack of awareness about the benefits of PR). Reducing these barriers by providing COPD patients with convenient access to PR educational and exercise training may help improve the adoption of PR. Virtual reality (VR) is an emerging technology that may provide an interactive and engaging method of supporting a home-based PR program. The goal of this study was to systematically evaluate the feasibility of a VR app for a home-based PR education and exercise program using a mixed-methods design. 18 COPD patients were asked to complete three brief tasks using a VR-based PR application. Afterward, patients completed a series of quantitative and qualitative assessments to evaluate the usability, acceptance, and overall perspectives and experience of using a VR system to engage with PR education and exercise training. The findings from this study demonstrate the high acceptability and usability of the VR system to promote participation in a PR program. Patients were able to successfully operate the VR system with minimal assistance. This study examines patient perspectives thoroughly while leveraging VR-based technology to facilitate access to PR. The future development and deployment of a patient-centered VR-based system in the future will consider patient insights and ideas to promote PR in COPD patients.

Tai Chi as a complementary exercise for pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomised controlled trial

ObjectivesWith the characteristics of mindfulness and breathing techniques, Tai Chi has been recommended with therapeutic values in chronic obstructive pulmonary disease (COPD). However, its strengths as a complementary exercise for conventional pulmonary rehabilitation (PR) remain unclear. Design and settingThis single-blinded randomised controlled trial recruited patients with mild to severe stable COPD. Eligible participants were randomly assigned to the group with usual care (control), total body recumbent stepper (TBRS) exercise, Tai Chi (TC), or combined TBRS exercise and Tai Chi (TBRS-TC). Patients received a two-month hospital-based supervised exercise, followed by a ten-month community- or home-based rehabilitation program. ResultsA total of 120 participants were recruited, and 102 were included in the per-protocol analysis. The mean changes in St George’s Respiratory Questionnaire (SGRQ) total score from baseline to the post-hospital exercise in the control group, TBRS group, TC group, and TBRS-TC group was 2.62 (95 % CI −8.99 to 8.99), −9.28 (95 % CI −13.96 to −4.60), −10.19 (95 % CI −13.72 to −6.67), and −16.75 (95 % CI −20.25 to −13.24), respectively, with a statistically significant difference between groups in favor of the TBRS-TC exercise (P < 0.001). The remarkable effect of TBRS-TC exercise in improving the quality of life maintained until the end of the community- or home-based rehabilitation training (P < 0.001). Besides, a statistically better effect with the TBRS-TC exercise was also observed in the outcomes regarding exercise capacity, pulmonary function, symptom burden, and systemic inflammation after the whole process of 12-month integrative PR exercise programme. ConclusionsBased on the results, a novel integrated exercise modality combining Tai Chi and conventional pulmonary rehabilitation was developed. It might contribute to more positive effects in patients with stable COPD. RegistrationThe study was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-15006874) prior to commencing recruitment.

The effect of exercise using incentive spirometry on heart rate variability in patients after COVID-19 infection

Background: COVID-19 infection causes various sequelae and complications after recovery. Changes in heart rate variability (HRV) were found in patients with COVID-19 infection, suggesting a disturbance in the autonomic system. Breathing exercises with diaphragmatic breathing and incentive spirometry have been shown to increase HRV by increasing lung capacity, respiratory muscle strength, and pulmonary O2 pressure, which can affect baroreflex signals. Incentive spirometry is one of the easy-to-use, safe, inexpensive pulmonary rehabilitation exercises that can be done at home without supervision and are accompanied by a visual display as a guide to the patient. The purpose of the study was to determine the effect of giving breathing exercises using Incentive Spirometry for four weeks on Heart Rate Variability in patients post COVID-19 infection Method: This research is an experimental study with a pre-post-test control group design. The treatment group was given breathing exercises using Incentive Spirometry, while the control group used diaphragmatic breathing five times a day, seven times per week, for four weeks in each group. HRV measurement was performed before and after four weeks of intervention, using the parameter Root Mean Square of Successive Differences between normal heartbeats (RMSSD), Standard Deviation of N-N intervals (SDNN), and LF/HF ratio of Heart Rate Variability (HRV). Result: There subject of this study was 20 post-COVID-19 patients divided into a treatment group (n=10) and a control group (n=10). There was no significant increase in RMSSD, SDNN, and LF/HF ratio pre and post-intervention in both groups, suggesting no significant increase in HRV. Conclusion: Exercise with Incentive Spirometry and Diaphragmatic Breathing for four weeks did not increase the Heart Rate Variability value in post-COVID-19 patients.

Pulmonary rehabilitation integrated coached exercise training for patients with COPD: a study protocol for a randomized controlled trial

BackgroundChronic obstructive pulmonary disease (COPD) is the most common chronic lung disease creating an immense burden on social health care systems. Pulmonary rehabilitation (PR) has proven to be effective in patients with COPD. However, exercise training as the basis of PR becomes extremely tedious, occasionally causing a loss of perseverance in patients. Therefore, we considered an approach that makes this technique interesting and easier to persist. The aim of this project was to explore an exercise training approach based on PR-integrated coached exercise training to promote the new exercise training approach as a form of group rehabilitation activity in the future.MethodsParticipants will be randomly divided into the trial and control groups. The trial group will be treated with PR-integrated coached exercise training (plus usual care). All exercise programs will be guided by sports coaches with a physical education background. Meanwhile, the control group will receive traditional PR and home exercises, including walking and swimming. The study will last for 12 weeks. The primary outcome measure is exercise tolerance using the 6-min walking test and secondary outcomes are the peak oxygen uptake of cardiopulmonary exercise tests, the COPD Assessment Test, and the St. Georges Respiratory Questionnaire. Other evaluated outcomes include changes in postbronchodilator forced expiratory volume at 1st second, forced vital capacity, body fat and muscle composition, and mental status measured using the Hamilton Anxiety and Depression Scales.DiscussionThis study provides a simple, feasible, repeatable, and fun exercise training approach. To the best of our knowledge, there are no randomized controlled trials in the existing literature on PR-integrated coached exercise. The protocol shared in our study can be used as a reference for exercise training in patients with COPD.Trial registrationEthical approval (BF2020-236–02) was obtained from the Guangdong Provincial Hospital of Chinese Medicine Human Research Ethics Committee. All participants signed an informed consent form. ChiCTR-2100043543. The registration date is 2021/02/21 and it is the third version.

Clinical Indicators of Effects of Yoga Breathing Exercises on Patients With Lung Cancer After Surgical Resection: A Randomized Controlled Trial.

Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery. One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge. Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point. Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect. Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.

Characterization and reliability of internet resources on pulmonary rehabilitation for individuals with chronic lung disease.

Individuals with lung disease commonly use the internet as a source of health information on pulmonary rehabilitation (PR). The objective of this study was to characterize internet resources on PR, and to assess the content, readability, and quality of patient-directed PR resources. The first 200 websites for the search term 'pulmonary rehabilitation resources and exercise' were analyzed on Google, Yahoo, and Bing. Website content was assessed based on 30 key components of PR from the 2013 and 2021 international consensus statements. Website quality was determined using DISCERN, JAMA benchmarks, and Global Quality Scale (GQS). 66 unique PR websites were identified with the two most common categories being scientific resources (39%) and foundation/advocacy organizations (33%). The average reading level of websites was 11 ± 3. PR content varied significantly across websites (mean range 13.4-21.5). Median DISCERN total score and GQS score were 4 (IQR 3-4) and 3.5 (IQR 2-4), respectively, representing moderate-good quality. Foundation/advocacy websites had higher DISCERN and GQS scores compared to other websites. Foundation/advocacy websites had the highest quality and reliability metrics; however, the higher-than-recommended reading levels may compromise patient comprehension and utilization. This study provides critical insight on the current state of online PR health-related information.

Pulmonary Rehabilitation and Breathing Exercise Effectiveness for Post COVID-19 survivors

<h3>Objective(s)</h3> Residual effects of Covid-19 on respiratory system are often destructive and depilating. Several rehabilitation approach are suggested in literature. This review aims to summarize and compare the available evidence on the current pulmonary rehabilitation therapy following COVID-19. <h3>Data Sources</h3> A computer search was conducted using PubMed, CINAHL, and ERIC using keywords ‘COVID-19',‘respiratory therapy,' OR ‘rehabilitation,' OR ‘physiotherapy,' OR ‘physical therapy,' OR ‘corticosteroid,' OR ‘respiratory rehabilitation,' OR ‘traditional Chinese medicine,' OR ‘aerobic therapy' AND ‘COVID-19 patients'. A narrative synthesis was used to evaluate the selected literature. The search was limited to the English language, human, and the year 2010 to present. <h3>Study Selection</h3> Studies were reviewed independently and those with the focus of COVID-19 and medication, traditional Chinese Medication, respiratory rehabilitation, and aerobic exercise interventions were included. Total of 27 articles were included in the final review. <h3>Data Extraction</h3> An independent extraction of data was performed on demographics, methodology, intervention, and outcomes. <h3>Data Synthesis</h3> Methods of medication (i.e. corticosteroids, antivirals, and Cardiopulmonary [CP] therapy), traditional Chinese Medicine (i.e. herbal medicine and pediatric massage and acupuncture), respiratory rehabilitation (i.e. incentive spirometer use, pursed-lip breathing, diaphragmatic techniques, and airway clearance techniques) and aerobic exercise were reviewed. Although all approaches showed some level of effectiveness, in medication approach, antivirals and CP therapy seems to be most effective for severe cases of COVID-19. Respiratory rehabilitation appears to best benefit inpatient/acute cases of COVID-19. Aerobic exercise is reported to have a promising positive effects, but a clear outline and parameters are yet to be determined. <h3>Conclusions</h3> Post COVID-19 pulmonary rehabilitation appears to vary significantly based on the severity of COVID-19 infection/symptoms and individual responses. There is a limited knowledge of the field due to recent occurrence of the disease and lack of information on the new strains of the virus. <h3>Author(s) Disclosures</h3> There is no conflict of interest associate with this study for any of the authors.

Response to Moderate and Vigorous Aerobic/Resistance Exercise in a Woman With Long-COVID

Response to Moderate and Vigorous Aerobic/Resistance Exercise in a Woman With Long-COVID

Evaluation of biochemical markers and quality of life in different pulmonary rehabilitation exercises for COPD patients

Background: Chronic obstructive pulmonary disease (COPD) affects millions of people worldwide, causing gradual muscle dysfunction deterioration. Muscle impairment may be controlled after a specific and individualized pulmonary rehabilitation training program, which is essential for the management of COPD. This study aimed to assess indirect biochemical parameters related to muscle behavior and quality of life in patients with COPD in different pulmonary rehabilitation training programs. Methods: Thirty patients (GOLD stages II-IV) were prospectively included in a 12-week multidisciplinary pulmonary rehabilitation program. Patients who performed high-intensity training (n=15) were assigned to Group A and those performing low-intensity training (n=15) were placed in Group B. Besides clinical evaluation, serum creatine kinase, lactate, fibrinogen, and vitamin D levels, cardiopulmonary test and 6-minute walk test results, and quality of life were assessed before and after intervention. Results: There was a significant reduction in fibrinogen (458 vs. 284 mg/dl) (p&lt;0.001) associated with an improvement in quality of life (27.9 vs. 19.3 points) (p=0.024) in group A. Conclusions: Pulmonary rehabilitation with a structured program that included high-intensity training was well tolerated by the patients and was more efficient in reducing fibrinogen as an inflammatory marker, improving quality of life.

Patient-controlled intravenous analgesia with opioids after thoracoscopic lung surgery: a randomized clinical trial

BackgroundOpioids remain the mainstream therapy for post-surgical pain. The choice of opioids administered by patient-controlled intravenous analgesia (PCIA) for thoracoscopic lung surgery is unclear. This study compared 3 opioid analgesics for achieving satisfactory analgesia with minimal emesis (SAME).MethodsThis randomized clinical trial enrolled patients scheduled for thoracoscopic lung surgery randomized to receive 1 of 3 opioids for PCIA: oxycodone (group O), hydromorphone (group H), and sufentanil (group S). The primary outcome was the proportion of subjects achieving SAME, i.e., no-to-mild pain (pain score < 4/10) with minimal nausea/vomiting (PONV score < 2/4) when coughing during the pulmonary rehabilitation exercise in the first 3 postoperative days.ResultsOf 555 enrolled patients, 184 patients in group O, 186 in group H and 184 in group S were included in the final analysis. The primary outcome of SAME was significantly different among group O, H and S (41.3% vs 40.3% vs 29.9%, P = 0.043), but no difference was observed between pairwise group comparisons. Patients in groups O and H had lower pain scores when coughing on the second day after surgery than those in group S, both with mean differences of 1 (3(3,4) and 3(3,4) vs 4(3,4), P = 0.009 and 0.039, respectively). The PONV scores were comparable between three groups (P > 0.05). There were no differences in other opioid-related side effects, patient satisfaction score, and QoR-15 score among three groups.ConclusionsGiven clinically relevant benefits detected, PCIA with oxycodone or hydromorphone is superior to sufentanil for achieving SAME as a supplement to multimodal analgesia in patients undergoing thoracoscopic lung surgery.Trial registrationThis study was registered at (ChiCTR2100045614, 19/04/2021).

Effect of a home-based pulmonary rehabilitation program on functional capacity and health-related quality of life in people with interstitial lung disease – A randomized controlled trial protocol

BackgroundCentre-based pulmonary rehabilitation is an effective, non-pharmacological intervention in improving outcomes for people with interstitial lung disease (ILD). Home-based pulmonary rehabilitation (PR) is a lower-cost rehabilitation alternative for people with chronic respiratory diseases. The aims of this study are to evaluate the efficacy of home-based PR on functional capacity and health-related quality of life in people with ILD, as well as to assess changes in dyspnea and fatigue, muscle strength, activities of daily living, depression, and anxiety after completing a home-based PR program. MethodsNinety-six individuals with ILD will be randomly assigned to either an intervention group (home-based PR exercise training program) or a control group (usual care). An assessor blind to group allocation will measure the 6-min walk distance, peripheral muscular strength, health-related quality of life, dyspnoea, anxiety and depression, fatigue, activities of daily living, upper limb and lower limb endurance at baseline, at program completion one month, and three months after the intervention. DiscussionIf home-based PR programs are proven to be beneficial over time, they will address a critical gap by giving a readily accessible and viable choice of rehabilitation to people with ILD, enabling more people to participate in an exercise program.

The Effect of a Short-Term Pulmonary Rehabilitation on Exercise Capacity and Quality of Life in Patients Hospitalised with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Recent research shows that pulmonary rehabilitation (PR) programmes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), reduced dyspnoea, improved exercise capacity, and prevented occurrence of further exacerbations. To evaluate the utility of a 3-week PR programme in patients with AECOPD. Patients admitted with AECOPD, following clinical stabilisation in the respiratroy intensive care unit (RICU), were alternately assigned to intervention (n=15); and control groups (n=15), respectively. Baseline assessment included spirometry, six-minute walk test (6MWT), symptom limited cardiopulmonary exercise test (CPET), health-related quality of life (HRQoL) assessment by generic questionnaire medical outcomes study short form (S-F 36) questionnaire and dyspnoea evaluation by Borg score. The intervention group patients were treated with usual care plus PR exercises in the form of 20 minutes each of walking, bicycle ergometry and resistance exercises, thrice-weekly for three weeks. The control group patients were treated with only the usual care. After discharge from hospital the treatment regimens were continued on alternate days on outpatient basis, for a total of three weeks. The assessment was repeated in both the groups after three weeks. Nine sessions of PR exercises produced statistically significant improvement in general well-being, forced expiratory volume in the first second (FEV1), 6MWT parameters, exercise capacity, peak oxygen uptake and volume of oxygen consumption (VO2)/Watts slope on CPET in patients with AECOPD. Short duration PR programmes appear to be helpful in the management of AECOPD.

Nursing Experience of Pulmonary Rehabilitation Applied to a Patient with Chronic Obstructive Pulmonary Disease

&lt;p&gt;本文探討一位罹患慢性阻塞肺病,首次因急性呼吸衰竭,放置氣管內管入住加 護病房之護理經驗,於 2017/12/18 至 2018/01/20 護理期間,以直接照護、觀察、 身體評估與家屬會談及病歷查閱等方式蒐集資料。運用羅氏適應模式進行整體性系 統評估,確立護理問題有:呼吸道清除功能失效、活動無耐力及家庭因應能力失 調。照護過程中,透過良好護病關係的建立,提供照護措施,在呼吸道清除功能失 效方面:教導正確呼吸且有效的咳嗽技巧及胸腔物理治療,以利清除痰液;在活動 無耐力方面:偕同跨領域團隊與個案及家屬規劃肺部復健運動,增強呼吸肌耐力, 順利拔除氣管內管;在家庭因應能力失調方面 : 安排家庭會議,增加家人間對後續返 家的共識及照護,增強其家庭因應能力。建議運用跨團隊合作建立一套國台語雙聲 帶的肺部復健運動多媒體影音光碟,在急重症等重負荷的工作下,短時有效的指導 此類個案,又能提升個案之學習成效,因此改善呼吸道症狀與減少急性發作次數及 再住院率,得以減輕家庭負擔,藉此照護經驗分享,以供臨床實務參考之用。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;This paper aims to explore the nursing experience for a patient with chronic obstructive pulmonary disease who was hospitalized in an intensive care unit for the first time because of acute respiratory failure requiring endotracheal tube intubation. The data were collected through direct nursing care, observations,physical evaluations, interviews and reviews of medical record during the nursing period from December 18 2017 to January 20 2018. Roy&amp;rsquo;s adaptation model was applied to carry out comprehensive system assessments. The problems observed from the nursing process were as follows: ineffective airway clearance, activity intolerance and family adjustment disorders. During the nursing processes, good relationships were established between medical staff and the patient in order to provide necessary nursing measures. Regarding ineffective airway clearance, the patient was taught to breath in an appropriate way, effective coughing techniques and chest physical therapy for better sputum clearance. As to activity intolerance, an inter-professional collaborative team was invited to work with the patient and the family for planning pulmonary rehabilitation exercises in order to strengthen respiratory muscle endurance followed by smoothly removing the endotracheal tube. When it comes to improving family adjustment disorders, meetings with the family were arranged to enhance the family&amp;rsquo;s consensus and nursing skills for the patient after returning home. It is suggested that an inter-professional team can work together to produce a set of multimedia DVDs both in Chinese and Taiwan- ese to provide guidance on pulmonary rehabilitation exercise. This set of DVDs can help effectively instruct patients like this case for the short-term when there are heavy workloads from acute and severe diseases and then increase patients&amp;rsquo;learning results. Therefore, respiratory tract symptoms can be improved and the numbers of acute attacks and readmission rates can be reduced. After these steps, the burdens imposed on families can be relieved accordingly. This nursingexperi- ence is hereby shared and serves as a reference for clinical practices.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;