Journal of Clinical Medicine

Editorial

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4 pages, 208 KiB

Open AccessEditorial

Pulmonary Rehabilitation: Time for an Upgrade

by Raquel Sebio-García

J. Clin. Med. 2020, 9(9), 2742; https://doi.org/10.3390/jcm9092742 - 25 Aug 2020

Cited by 10 | Viewed by 3307

Abstract

Pulmonary rehabilitation is a notoriously known but highly underused intervention aimed to restore or improve functional capacity, symptom management and health-related quality of life among patients with chronic respiratory diseases. Since early 1980s, pulmonary rehabilitation has been acknowledged as a comprehensive intervention with [...] Read more.

Pulmonary rehabilitation is a notoriously known but highly underused intervention aimed to restore or improve functional capacity, symptom management and health-related quality of life among patients with chronic respiratory diseases. Since early 1980s, pulmonary rehabilitation has been acknowledged as a comprehensive intervention with hundreds of studies being performed over the past thirty years demonstrating its benefits on multiple outcomes; nevertheless, there are still multiple unresolved challenges, and new ones are currently emerging, with the COVID-19 outbreak now in the spotlight. In this editorial, these issues are summarized and discussed, while presenting some of the latest findings in research and clinical practice, with the ultimate goal of raising awareness of the future of pulmonary rehabilitation in the post COVID-19 era. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

Research

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12 pages, 2219 KiB

Open AccessArticle

Impact of Pulmonary Rehabilitation Services in Patients with Different Lung Diseases

by Diana C. Sanchez-Ramirez

J. Clin. Med. 2022, 11(2), 407; https://doi.org/10.3390/jcm11020407 - 14 Jan 2022

Cited by 13 | Viewed by 3301

Abstract

Background: the effect of pulmonary rehabilitation (PR) services, beyond research contexts, on patients with lung diseases other than COPD requires further study. Objectives: to (i) assess the impact of a publicly funded PR on patients’ exercise capacity, self-efficacy, and health-related quality of life [...] Read more.

Background: the effect of pulmonary rehabilitation (PR) services, beyond research contexts, on patients with lung diseases other than COPD requires further study. Objectives: to (i) assess the impact of a publicly funded PR on patients’ exercise capacity, self-efficacy, and health-related quality of life (HRQoL), and (ii) explore whether the effects vary across lung diseases. Methods: this retrospective pre–post study analyzed data from the Winnipeg Regional Health Authority PR program between 2016 and 2019. Results: 682 patients completed the full PR program. Pooled analyses found significant improvements in the patients’ exercise capacity (six-minute walk test (6MWT) (13.6%), fatigue (10.3%), and dyspnea (6.4%)), Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD6) (11.6%), and HRQoL (Clinical COPD Questionnaire (CCQ) (18.5%) and St George’s Respiratory Questionnaire (SGRQ) (10.9%)). The analyses conducted on sub-groups of patients with chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, interstitial lung diseases (ILDs), other restrictive lung diseases (e.g., obesity, pleural effusion, etc.), lung cancer, and pulmonary hypertension (PH) indicated that, except for patients with PH, all the patients improved in the 6MWT. Fatigue decreased in patients with COPD, ILDs, and other restrictive lung diseases. Dyspnea decreased in patients with COPD, asthma, and lung cancer. SEMCD6 scores increased in COPD, ILDs and PH patients. CCQ scores decreased in all lung diseases, except lung cancer and PH. SGRQ scores only decreased in patients with COPD. Conclusion: PR services had a significant impact on patients with different lung diseases. Therefore, publicly funded PR should be available as a critical component in the management of patients with these diseases. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

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8 pages, 255 KiB

Open AccessArticle

Physical Tests Are Poorly Related to Patient-Reported Outcome Measures during Severe Acute Exacerbations of COPD

by Kirsten Quadflieg, Ana Machado, Sarah Haesevoets, Marc Daenen, Michiel Thomeer, David Ruttens, Martijn A. Spruit and Chris Burtin

J. Clin. Med. 2022, 11(1), 150; https://doi.org/10.3390/jcm11010150 - 28 Dec 2021

Cited by 3 | Viewed by 2457

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative impact on patients’ health status, including physical function and patient-reported outcomes. We aimed to explore the associations between physical tests and patient-reported outcome measures (PROMs) in hospitalised patients for an AECOPD. Patients [...] Read more.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative impact on patients’ health status, including physical function and patient-reported outcomes. We aimed to explore the associations between physical tests and patient-reported outcome measures (PROMs) in hospitalised patients for an AECOPD. Patients were assessed on the day of discharge. Quadriceps force, handgrip strength, short physical performance battery (SPPB), five-repetition sit-to-stand test (5STS), four-meter gait speed test (4MGS), balance test, six-minute walk test (6MWT), COPD Assessment Test (CAT), London Chest Activity of Daily Living scale (LCADL), modified Medical Research Council (mMRC) dyspnea scale, Checklist of Individual Strength (CIS)-fatigue subscale, and Patient Health Questionnaire (PHQ-9) were collected. Sixty-nine patients with an AECOPD were included (54% female; age 69 ± 9 years; FEV₁ 39.2 (28.6–49.1%) predicted). Six-minute walk distance was strongly correlated with mMRC (ρ: −0.64, p < 0.0001) and moderately correlated with LCADL total score, subscales self-care and household activities (ρ ranging from −0.40 to −0.58, p < 0.01). Moreover, 4MGS was moderately correlated with mMRC (ρ: −0.49, p < 0.0001). Other correlations were weak or non-significant. During a severe AECOPD, physical tests are generally poorly related to PROMs. Therefore, a comprehensive assessment combining both physical tests and PROMs needs to be conducted in these patients to understand their health status. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

14 pages, 945 KiB

Open AccessArticle

What Motivates Patients with COPD to Be Physically Active? A Cross-Sectional Study

by Sara Pimenta, Cândida G. Silva, Sofia Flora, Nádia Hipólito, Chris Burtin, Ana Oliveira, Nuno Morais, Marcelo Brites-Pereira, Bruno P. Carreira, Filipa Januário, Lília Andrade, Vitória Martins, Fátima Rodrigues, Dina Brooks, Alda Marques and Joana Cruz

J. Clin. Med. 2021, 10(23), 5631; https://doi.org/10.3390/jcm10235631 - 29 Nov 2021

Cited by 2 | Viewed by 3016

Abstract

Motivation can be broadly defined as what moves people to act. Low motivation is a frequently reported factor for the reduced physical activity (PA) levels observed in patients with chronic obstructive pulmonary disease (COPD). This study assessed patients’ motives to be physically active, [...] Read more.

Motivation can be broadly defined as what moves people to act. Low motivation is a frequently reported factor for the reduced physical activity (PA) levels observed in patients with chronic obstructive pulmonary disease (COPD). This study assessed patients’ motives to be physically active, according to three pulmonary rehabilitation (PR) participation groups (Never PR, Previous PR and Current PR) and explored whether these motives were related to the PA levels and clinical characteristics. The motives to be physically active were assessed with the Exercise Motivation Inventory-2 (EMI-2, 14 motivational factors, five dimensions) and PA with accelerometry (PA groups: <5000 steps/day vs. ≥5000 steps/day). The clinical variables included symptoms, impact of the disease, exercise capacity and comorbidities. Ninety-two patients (67.4 ± 8.1 years, 82.6% male, forced expiratory volume in 1s (FEV₁) 48.3 ± 18.9% predicted; 30.4% Never PR, 51% Previous PR and 18.5% Current PR) participated. The motivational dimensions related to health/fitness presented the highest scores (3.8 ± 1.1; 3.4 ± 1.3). The motives to be active were not significantly different between PA groups (p > 0.05) but having less symptoms and ≥two comorbidities were associated with higher scores in psychological/health and body-related motives, respectively (p < 0.05). The findings may encourage health professionals to actively explore with patients their motives to be physically active to individualise PA promotion. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

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11 pages, 1526 KiB

Open AccessArticle

Effect of Automated Oxygen Titration during Walking on Dyspnea and Endurance in Chronic Hypoxemic Patients with COPD: A Randomized Crossover Trial

by Linette Marie Kofod, Elisabeth Westerdahl, Morten Tange Kristensen, Barbara Cristina Brocki, Thomas Ringbæk and Ejvind Frausing Hansen

J. Clin. Med. 2021, 10(21), 4820; https://doi.org/10.3390/jcm10214820 - 20 Oct 2021

Cited by 9 | Viewed by 3795

Abstract

The need for oxygen increases with activity in patients with COPD and on long-term oxygen treatment (LTOT), leading to periods of hypoxemia, which may influence the patient’s performance. This study aimed to evaluate the effect of automated oxygen titration compared to usual fixed-dose [...] Read more.

The need for oxygen increases with activity in patients with COPD and on long-term oxygen treatment (LTOT), leading to periods of hypoxemia, which may influence the patient’s performance. This study aimed to evaluate the effect of automated oxygen titration compared to usual fixed-dose oxygen treatment during walking on dyspnea and endurance in patients with COPD and on LTOT. In a double-blinded randomised crossover trial, 33 patients were assigned to use either automated oxygen titration or the usual fixed-dose in a random order in two walking tests. A closed-loop device, O2matic delivered a variable oxygen dose set with a target saturation of 90–94%. The patients had a home oxygen flow of (mean ± SD) 1.6 ± 0.9 L/min. At the last corresponding isotime in the endurance shuttle walk test, the patients reported dyspnea equal to median (IQR) 4 (3–6) when using automated oxygen titration and 8 (5–9) when using fixed doses, p < 0.001. The patients walked 10.9 (6.5–14.9) min with automated oxygen compared to 5.5 (3.3–7.9) min with fixed-dose, p < 0.001. Walking with automated oxygen titration had a statistically significant and clinically important effect on dyspnea. Furthermore, the patients walked for a 98% longer time when hypoxemia was reduced with a more well-matched, personalised oxygen treatment. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

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12 pages, 442 KiB

Open AccessArticle

Effectiveness of a Primary Care Telerehabilitation Program for Post-COVID-19 Patients: A Feasibility Study

by Marcelo Dalbosco-Salas, Rodrigo Torres-Castro, Andrés Rojas Leyton, Franco Morales Zapata, Elisabeth Henríquez Salazar, Gabriel Espinoza Bastías, María Elizabeth Beltrán Díaz, Kris Tapia Allers, Daniela Mornhinweg Fonseca and Jordi Vilaró

J. Clin. Med. 2021, 10(19), 4428; https://doi.org/10.3390/jcm10194428 - 27 Sep 2021

Cited by 48 | Viewed by 6594

Abstract

In many health systems, it is difficult to carry out traditional rehabilitation programs as the systems are stressed. We evaluate the effectiveness of a telerehabilitation program conducted in primary care in post-COVID-19 patients. An observational, prospective study was conducted in seven primary care [...] Read more.

In many health systems, it is difficult to carry out traditional rehabilitation programs as the systems are stressed. We evaluate the effectiveness of a telerehabilitation program conducted in primary care in post-COVID-19 patients. An observational, prospective study was conducted in seven primary care centers in Chile. We included adult patients (>18 years) with a previous SARS-CoV-2 infection. The telerehabilitation program consisted of 24 sessions of supervised home-based exercise training. The efficacy was measured by the 1-min sit-to-stand test (1-min STST), the 36-Item Short Form Health Survey (SF-36), fatigue, and dyspnea symptoms before and after intervention. We included 115 patients (55.4% female) with a mean age of 55.6 ± 12.7 years. Fifty-seven patients (50%) had antecedents of hospitalization, and 35 (30.4%) were admitted to the ICU. The 1-min STST was improved after the intervention from 20.5 ± 10.2 (53.1 ± 25.0%predicted) to 29.4 ± 11.9 (78.2 ± 28.0%predicted) repetitions (p < 0.001). The SF-36 global score improved significantly from 39.6 ± 17.6 to 58.9 ± 20.5. Fatigue and dyspnea improved significantly after the intervention. Although limited by the absence of a control group, this report showed that a telerehabilitation program applied in primary health care is feasible and was effective in improving physical capacity, quality of life and symptoms in adult survivors of COVID-19. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

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9 pages, 419 KiB

Open AccessArticle

Early Intervention of Pulmonary Rehabilitation for Fibrotic Interstitial Lung Disease Is a Favorable Factor for Short-Term Improvement in Health-Related Quality of Life

by Satoshi Matsuo, Masaki Okamoto, Tomoyuki Ikeuchi, Yoshiaki Zaizen, Atsushi Inomoto, Remi Haraguchi, Shunichiro Mori, Retsu Sasaki, Takashi Nouno, Tomohiro Tanaka, Tomoaki Hoshino and Toru Tsuda

J. Clin. Med. 2021, 10(14), 3153; https://doi.org/10.3390/jcm10143153 - 16 Jul 2021

Cited by 10 | Viewed by 2423

Abstract

Patients with fibrosing interstitial lung disease (FILD) have poor health-related quality of life (HRQOL). We analyzed predictors of short-term improvement of HRQOL after starting pulmonary rehabilitation (PR) in moderate to severe FILD patients. This study involved 28 consecutive patients with FILD (20 males, [...] Read more.

Patients with fibrosing interstitial lung disease (FILD) have poor health-related quality of life (HRQOL). We analyzed predictors of short-term improvement of HRQOL after starting pulmonary rehabilitation (PR) in moderate to severe FILD patients. This study involved 28 consecutive patients with FILD (20 males, median age of 77.5 years), who participated in PR program of our hospital for >6 weeks. The St. George’s Respiratory Questionnaire (SGRQ) score and the 6-min walk distance (6MWD) were evaluated before and after PR, and the predictors of efficacy of PR were analyzed. The duration from diagnosis of FILD to start of PR showed a positive correlation with the increase in the SGRQ score, and the baseline SGRQ score showed a negative correlation with increase in the 6MWD. The FILD subtype, modified Medical Research Council score, and treatment history were not associated with the endpoints. According to the receiver operating characteristic curve (ROC) analyses, starting PR within 514 days after diagnosis of FILD was a significant favorable predictor of improvement in the SGRQ total score more than a minimal clinically important difference of 4. In this study, early intervention of PR and lower SGRQ score were associated with the favorable response to PR. PR for FILD should be initiated early before the disease becomes severe. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

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12 pages, 1081 KiB

Open AccessArticle

Exacerbations and Changes in Physical Activity and Sedentary Behaviour in Patients with Bronchiectasis after 1 Year

by Victoria Alcaraz-Serrano, Ane Arbillaga-Etxarri, Patricia Oscanoa, Laia Fernández-Barat, Leticia Bueno, Rosanel Amaro, Elena Gimeno-Santos and Antoni Torres

J. Clin. Med. 2021, 10(6), 1190; https://doi.org/10.3390/jcm10061190 - 12 Mar 2021

Cited by 4 | Viewed by 2203

Abstract

Background: Low physical activity and high sedentary behaviour in patients with bronchiectasis are associated with hospitalisation over one year. However, the factors associated with longitudinal changes in physical activity and sedentary behaviour have not been explored. We aimed to identify clinical and sociodemographic [...] Read more.

Background: Low physical activity and high sedentary behaviour in patients with bronchiectasis are associated with hospitalisation over one year. However, the factors associated with longitudinal changes in physical activity and sedentary behaviour have not been explored. We aimed to identify clinical and sociodemographic characteristics related to a change in physical activity and sedentary behaviour in patients with bronchiectasis after one year. Methods: This was a prospective observational study during which physical activity measurements were recorded using a SenseWear Armband for one week at baseline and at one year. At each assessment point, patients were classified as active or inactive (measured as steps per day) and as sedentary or not sedentary (measured as sedentary time). Results: 53 patients with bronchiectasis were analysed, and after one year, 18 (34%) had worse activity and sedentary levels. Specifically, 10 patients became inactive and sedentary. Multivariable analysis showed that the number of exacerbations during the follow-up period was the only outcome independently associated with change to higher inactivity and sedentary behaviour (odds ratio (OR), 2.19; 95% CI, 1.12 to 4.28). Conclusions: The number of exacerbations in patients with bronchiectasis was associated with changes in physical activity and sedentary behaviour. Exacerbation prevention may appear as a key factor in relation to physical activity and sedentary behaviour in patients with bronchiectasis. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

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13 pages, 683 KiB

Open AccessArticle

High-Intensity Interval Training Is Effective at Increasing Exercise Endurance Capacity and Is Well Tolerated by Adults with Cystic Fibrosis

by Abbey Sawyer, Vinicius Cavalheri, Sue Jenkins, Jamie Wood, Nola Cecins, Natasha Bear, Bhajan Singh, Daniel Gucciardi and Kylie Hill

J. Clin. Med. 2020, 9(10), 3098; https://doi.org/10.3390/jcm9103098 - 25 Sep 2020

Cited by 11 | Viewed by 3803

Abstract

Background: To optimize outcomes in people with cystic fibrosis (CF), guidelines recommend 30 to 60 min of moderate-intensity aerobic exercise on most days. Accumulating this volume of exercise contributes importantly to the substantial treatment burden associated with CF. Therefore, the main aim of [...] Read more.

Background: To optimize outcomes in people with cystic fibrosis (CF), guidelines recommend 30 to 60 min of moderate-intensity aerobic exercise on most days. Accumulating this volume of exercise contributes importantly to the substantial treatment burden associated with CF. Therefore, the main aim of this study was to investigate the effects of low-volume high-intensity interval training (HIIT) on exercise capacity in people with CF. Methods: This randomized controlled trial included people with CF aged ≥15 years, who were allocated to either eight weeks of thrice-weekly 10-min sessions of HIIT (experimental group) or eight weeks of weekly contact (control group). Before and after the intervention period, participants completed measurements of time to symptom limitation (T_lim) during a constant work rate cycle ergometry test (primary outcome), and maximal work rate (W_max) during a ramp-based cycle ergometry test and health-related quality of life (HRQoL). Results: Fourteen participants (median (IQR) age 31 (28, 35) years, forced expiratory volume in 1 second (FEV₁) 61 (45, 80) % predicted) were included (seven in each group). Compared to the control group, participants in the experimental group demonstrated a greater magnitude of change in T_lim, W_max (p = 0.017 for both) and in the physical function domain of HRQoL (p = 0.03). No other between-group differences were demonstrated. Mild post-exercise muscle soreness was reported on a single occasion by four participants. Overall, participants attended 93% of all HIIT sessions. Discussion: Eight weeks of low-volume (i.e., 30-min/week) HIIT produced gains in exercise capacity and self-reported physical function and was well tolerated by people with CF. Full article

(This article belongs to the Special Issue Recent Research in Pulmonary Rehabilitation)

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