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Trajectories of functional exercise capacity in patients undergoing pulmonary rehabilitation.

ABSTRACT: Background: Pulmonary rehabilitation (PR) is now considered fundamental when managing patients with chronic respiratory disease. The individual variation in functional exercise capacity (FEC) response to PR within the cohort is unknown. The purpose of this study was to identify FEC patterns in response to PR in patients with chronic respiratory disease using the trajectory modeling method. Methods: The data of 67 patients with the chronic respiratory disease were retrospectively reviewed and analyzed in this study. All patients received once-weekly supervised training for 8 weeks. Six-minute walk distance (6MWD) was used to measure FEC. Muscle strength and 6MWD were assessed at baseline, Week 4, Week 8 and monthly for two months after PR completion. Group-based trajectory modeling (GBTM) was used to identify patterns in 6MWD in response to PR. The generalized estimating equation method was then used to detect the differences within and between the trajectories of identified groups across time. Results: Patients were grouped into low- (n=13), moderate- (n=34) and high- (n=20) FEC group based on GBTM analysis. All groups demonstrated significant improvements in 6MWD and leg muscle strength after 8-week PR. Compared to the high-FEC group, a greater proportion of the patients in the low-FEC group required oxygen supplementation during training and had worse baseline leg muscle strength. Conclusions: Patients showed distinct patterns of 6MWD changes in response to 8-week PR. Distinct characteristics for the low-FEC group included poor lower extremity strength and a greater proportion of required oxygen use at home and during training.

SUBMITTER: Lee CT

PROVIDER: S-EPMC6489669 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Trajectories of functional exercise capacity in patients undergoing pulmonary rehabilitation.

Lee Chien-Tzu CT Hsieh Ping-Lun PL Chien Meng-Yueh MY Chien Jung-Yien JY Wu Huey-Dong HD Lin Jia-Shin JS Lin Hsiao-Chen HC Yang Pei-Yu PY Wang Li-Ying LY

International journal of chronic obstructive pulmonary disease 20190417

<b>Background:</b> Pulmonary rehabilitation (PR) is now considered fundamental when managing patients with chronic respiratory disease. The individual variation in functional exercise capacity (FEC) response to PR within the cohort is unknown. The purpose of this study was to identify FEC patterns in response to PR in patients with chronic respiratory disease using the trajectory modeling method. <b>Methods:</b> The data of 67 patients with the chronic respiratory disease were retrospectively re ...[more]

PMID: 31114184

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Project description:BackgroundCOVID-19 survivors face the risk of long-term sequelae including fatigue, breathlessness, and functional limitations. Pulmonary rehabilitation has been recommended, although formal studies quantifying the effect of rehabilitation in COVID-19 patients are lacking.MethodsWe conducted a prospective observational cohort study including consecutive patients admitted to an outpatient pulmonary rehabilitation center due to persistent symptoms after COVID-19. The primary endpoint was change in 6-min walk distance (6MWD) after undergoing a 6-week interdisciplinary individualized pulmonary rehabilitation program. Secondary endpoints included change in the post-COVID-19 functional status (PCFS) scale, Borg dyspnea scale, Fatigue Assessment Scale, and quality of life. Further, changes in pulmonary function tests were explored.ResultsOf 64 patients undergoing rehabilitation, 58 patients (mean age 47 years, 43% women, 38% severe/critical COVID-19) were included in the per-protocol-analysis. At baseline (i.e., in mean 4.4 months after infection onset), mean 6MWD was 584.1 m (±95.0), and functional impairment was graded in median at 2 (IQR, 2-3) on the PCFS. On average, patients improved their 6MWD by 62.9 m (±48.2, p < 0.001) and reported an improvement of 1 grade on the PCFS scale. Accordingly, we observed significant improvements across secondary endpoints including presence of dyspnea (p < 0.001), fatigue (p < 0.001), and quality of life (p < 0.001). Also, pulmonary function parameters (forced expiratory volume in 1 s, lung diffusion capacity, inspiratory muscle pressure) significantly increased during rehabilitation.ConclusionIn patients with long COVID, exercise capacity, functional status, dyspnea, fatigue, and quality of life improved after 6 weeks of personalized interdisciplinary pulmonary rehabilitation. Future studies are needed to establish the optimal protocol, duration, and long-term benefits as well as cost-effectiveness of rehabilitation.

Project description:BackgroundPatients with chronic obstructive pulmonary disease (COPD) experience deficits in exercise capacity and physical activity as their disease progresses. Pulmonary rehabilitation (PR) can enhance exercise capacity of patients and it is crucial for patients to maintain a lifestyle which is long-term physically active. This study aimed to develop a home-based rehabilitation mHealth system incorporating behavior change techniques (BCTs) for COPD patients, and evaluate its technology acceptance and feasibility.MethodsGuided by the medical research council (MRC) framework the process of this study was divided into four steps. In the first step, the prescription was constructed. The second step was to formulate specific intervention functions based on the behavior change wheel theory. Subsequently, in the third step we conducted iterative system development. And in the last step two pilot studies were performed, the first was for the improvement of system functions and the second was to explore potential clinical benefits and validate the acceptance and usability of the system.ResultsA total of 17 participants were enrolled, among them 12 COPD participants completed the 12-week study. For the clinical outcomes, Six-Minute Walk Test (6MWT) showed significant difference (P = .023) over time with an improvement exceeded the minimal clinically important difference (MCID). Change in respiratory symptom (CAT score) was statistically different (P = .031) with a greater decrease of - 3. The mMRC levels reduced overall and showed significant difference. The overall compliance of this study reached 82.20% (± 1.68%). The results of questionnaire and interviews indicated good technology acceptance and functional usability. The participants were satisfied with the mHealth-based intervention.ConclusionsThis study developed a home-based PR mHealth system for COPD patients. We showed that the home-based PR mHealth system incorporating BCTs is a feasible and acceptable intervention for COPD patients, and COPD patients can benefit from the intervention delivered by the system. The proposed system played an important auxiliary role in offering exercise prescription according to the characteristics of patients. It provided means and tools for further individuation of exercise prescription in the future.

Project description:OBJECTIVE:Pulmonary rehabilitation is a cornerstone treatment in the management of chronic obstructive pulmonary disease (COPD). Acute bouts of exercise can lead to short bursts of inflammation in healthy individuals. However, it is unclear how COPD patients respond to acute bouts of exercise. This study assessed inflammatory responses to exercise in COPD patients at the start (phase 1) and end (phase 2) of pulmonary rehabilitation. METHODS:Blood samples were collected before and after an acute exercise bout at the start (phase 1, n?=?40) and end (phase 2, n?=?27) of pulmonary rehabilitation. The primary outcome was change in fibrinogen concentrations. Secondary outcomes were changes in CRP concentrations, total/differential leukocyte counts, markers of neutrophil activation (CD11b, CD62L and CD66b), and neutrophil subsets (mature, suppressive, immature, progenitor). RESULTS:Acute exercise (phase 1) did not induce significant changes in fibrinogen (p?=?0.242) or CRP (p?=?0.476). Total leukocyte count [mean difference (MD), 0.5?±?1.1 (109 L-1); p?=?0.004], neutrophil count [MD, 0.4?±?0.8 (109 L-1); p?<?0.001], and immature neutrophils (MD, 0.6?±?0.8%; p?<?0.001) increased post-exercise. Neutrophil activation markers, CD11b (p?=?0.470), CD66b (p?=?0.334), and CD62L (p?=?0.352) were not significantly altered post-exercise. In comparison to the start of pulmonary rehabilitation (phase 2), acute exercise at the end of pulmonary rehabilitation led to a greater fibrinogen response (MD, 84 mg/dL (95% CI -?14, 182); p?=?0.045). CONCLUSION:An acute bout of exercise does not appear to induce significant alterations in the concentrations of inflammatory mediators but can increase white blood cell subsets post-exercise. A greater fibrinogen response to acute exercise is seen at the end of pulmonary rehabilitation when compared to the start. Further research is required to understand the clinical context of these acute inflammatory responses to exercise.

Project description:This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) for pneumoconiosis. We systematically searched PubMed, Embase, The Cochrane Library, Web of Science, SinoMed, CNKI, VIP databases and Wanfang Data from their inception to June 1, 2019. A systematic review and meta-analysis of randomized controlled trials (RCTs) of PR for pneumoconiosis was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently screened literature, extracted data, and assessed bias risk. All statistical analyses were performed using the RevMan software. Sixteen RCTs with 1307 subjects were ultimately included for analysis. Compared with routine treatment, PR was able to improve the 6-minute walking distance (mean difference (MD) 69.10, 95% confidence interval (CI) 61.95-76.25); the 36-Item Short Form Health Survey total score (MD 17.60, 95% CI 13.59-21.61); physical function score (MD 15.45, 95% CI 3.20-27.69); role physical score (MD 17.87, 95% CI 12.06-23.69); body pain score (MD 14.34, 95% CI 10.33-18.36); general health score (MD 20.86, 95% CI 16.87-24.84); vitality score (MD 11.66, 95% CI 0.18-23.13); social function score (MD 9.67, 95% CI 1.27-18.08); mental health score (MD 20.60, 95% CI 13.61-27.59); forced vital capacity (FVC) (MD 0.20, 95% CI 0.12-0.29); forced expiratory volume in 1 s (FEV1) (MD 0.23, 95% CI 0.09-0.38); FEV1% (MD 5.19, 95% CI 1.48-8.90); maximal voluntary ventilation (MD 4.47, 95% CI 1.14-7.81); reduction in the St. George's Respiratory Questionnaire score (MD -9.60, 95% CI -16.40 to -2.80); and the modified Medical Research Council Scale score. Furthermore, PR did not increase the FEV1/FVC (MD 3.61, 95% CI -3.43 to 10.65), nor the emotional score (MD 6.18, 95% CI -23.01 to 35.38) compared with the control. We found no reports of adverse events associated with PR. Thus, to some extent, PR can improve functional capacity and quality of life in patients with pneumoconiosis. However, these results should be interpreted with caution because of high heterogeneity. This trial is registered with registration number CRD42018095266.

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Trajectories of functional exercise capacity in patients undergoing pulmonary rehabilitation.

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Trajectories of functional exercise capacity in patients undergoing pulmonary rehabilitation.

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