Возможности краткосрочной пульмореабилитации в предоперационной подготовке больных раком легкого на фоне ХОБЛ

Background: Lung cancer reduces lung function, muscle mass, and psychological well-being, which lowers exercise capacity and quality of life. Pulmonary rehabilitation, such as aerobic exercise, can improve exercise capacity and the quality of life (QoL) in lung cancer patients. This study aimed to investigate the influence of aerobic exercise on the six-minute walking test (6MWT) and the quality of life of lung cancer patients. Methods: A clinical trial with a quasi-experimental, pretest, and post-test design was conducted on stage ≥IVa adenocarcinoma lung cancer patients who were receiving outpatient targeted therapy at the pulmonary clinic of Dr. Moewardi General Hospital for ≥1 month starting from May 2023, until the required sample size was met. The 6MWT and Functional Assessment of Cancer Therapy-Lung (FACT-L) were measured at the baseline and eight weeks ±2 weeks after aerobic exercise by walking about 15-20 minutes and breathing exercises. Results: The study included fourteen patients in the control group and fifteen patients in the aerobic group. The mean difference of 6MWT between the control and the aerobic group was 38.33 m. Functional, lung cancer subscale (LCS), total, and TOI in FACT-L showed significant differences in the increment pre-test and post-test between the control and aerobic group (P<0.05), with significant differences in pre-test and post-test of most categories in both groups, except for social. Conclusion: Aerobic exercise, psychological support, and nutrition have significantly improved the 6MWT and quality of life in lung cancer patients.

Pulmonary rehabilitation (PR) improves health-related quality of life (HRQoL) and exercise capacity. Little is known about the impact of depression symptoms and exercise self-efficacy on improvements in these key PR outcomes. This study examined the impact of baseline depression status and change in depression symptoms (Beck Depression Inventory-II [BDI-II] score) over the course of PR on change in HRQoL assessed by the Chronic Respiratory Disease Questionnaire-Self Reported (CRQ-SR) and exercise capacity as measured by the 6-Minute Walk Test (6MWT). We also examined whether baseline exercise self-efficacy moderated the association between baseline depression symptoms and change in these key PR outcomes. We studied 112 US veterans (aged 70.38 ± 8.49 years) with chronic obstructive pulmonary disease (COPD) who completed PR consisting of twice-weekly 2-hour classes for 18 sessions. Depressed (BDI-II >13) and nondepressed (BDI-II ≤13) patients at baseline demonstrated comparable and significant improvement in CRQ-SR total score, subscales, and 6MWT. Greater reduction in depression over the course of treatment was significantly associated with greater improvement in CRQ-SR total score and the following subscales: fatigue, mastery, and emotional function. Change in depression did not predict change in 6MWT distance. Baseline exercise self-efficacy moderated the association between baseline depression symptoms and change in CRQ-SR fatigue. Specifically, when baseline exercise self-efficacy was <30.4, greater baseline depression was associated with less improvement in CRQ-SR fatigue. When baseline self-efficacy was >152.0, greater baseline depression was associated with greater improvement in CRQ-SR fatigue. PR programs should address mood and confidence to exercise given their impact on key PR outcomes.

Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: arandomised trial.

Pulmonary rehabilitation (PR) is an effective intervention in the treatment of patients with chronic obstructive pulmonary disease (COPD). Unfortunately some patients offered this treatment either fail to take up the offer or fail to complete the course. Studies have indicated a number of factors influencing uptake and completion rates. We describe the introduction of an intervention, the group opt-in session (GOIS), prior to individualised baseline assessment and entry to the PR course, with the intention being to improve uptake and completion rates. A 1.5-hour-long GOIS was offered as the first face-to-face contact to all patients referred for PR. Drop-out rates at all stages of the pathway from referral to graduation were collected on 200 patients prior to the introduction of the GOIS (non-GOIS group) and compared to the first 400 patients following introduction (the GOIS group). Possible independent predictors of course uptake and completion were examined in the GOIS group. The proportion of referred patients taking up the offer of individualised baseline assessment or a GOIS was similar (75% vs. 72.2%, p value not significant [ns]). However, since in the GOIS group the opt-in session preceded the individualised baseline assessment and some patients opted-out, a smaller proportion of referred patients underwent this assessment than in the non-GOIS group (58.7% vs. 75%, p < 0.001). In addition, dropouts following individualised baseline assessments were also reduced (7% vs. 22%, p < 0.001). Both of these factors reduced 'wasted' assessments. Similar proportions of patients referred began the PR course in both groups (53% vs. 51.7%, ns), but a higher proportion of patients graduated in the GOIS group (87.9% vs. 76.4%, p < 0.05). Drop-out rates due to illness were similar in both groups (8.5% pre vs. 6.8% post, ns). However, drop-out rates not due to illness were much higher in the non-GOIS group (15.1% vs. 5.3%, p < 0.001). In the GOIS group, patients who did not attend the GOIS were, on average, younger (64.6 years vs. 69.7 years, p < 0.001) and had a higher mean percent predicted Forced Expiratory Volume (50.6% vs. 43.8%, p < 0.05) than those that did attend. A greater proportion of patients who opted in to the GOIS and attended the PR course lived less than 25 minutes from the PR centre than either those who did not attend the GOIS or who attended and then opted out (77.4% vs. 63%, p<0.005). The GOIS improved the graduation rates at The North Bristol Lung Centre PR Course and reduced wasted assessments. There was no effect on initial uptake. Analysis of the behaviour of patients invited to a GOIS suggested that age, lung function and travel distance were important factors influencing patient choice.

Background: It is well established that anxiety is a highly prevalent psychological comorbidity in patients with COPD and as a negative affective trait it has detrimental effects on pulmonary rehabilitation (PR) outcomes. Moreover, disease-specific fears could play an even more important role. However, disease-specific fear is a multifaceted concept and relations of its specific components to PR outcomes are widely unexplored. Therefore, we examined how different disease-specific fears relate to diverse outcomes over the course of PR. Methods: Patients with COPD (N=102) underwent a 3-week inpatient PR program. At the start and end patients performed a 6-min walking test to assess functional exercise capacity. The COPD-Anxiety-Questionnaire and Fear Avoidance Questionnaire COPD were used to measure disease-specific fears. General anxiety, depression, health-related quality of life, dyspnea-related disability, and activity-related dyspnea were measured. Results: Multiple regression analyses demonstrated that at PR start, higher levels of disease specific fears were associated with worse PR outcomes, even after controlling for potential effects of age, sex, lung function, smoking status, and general anxiety. In addition, more favorable changes in disease-specific fears over the course of PR were associated with more favorable changes in these outcomes. Discussion: This study demonstrates that disease-specific fears are negatively related to PR outcomes beyond the effects of general anxiety. Moreover, improvements in these fears could have a positive impact on PR outcomes. Therefore, different disease-specific fears should be assessed and treated in order to improve PR in patients with COPD.

Objective: To compare the long-term effects of two community-based exercise programs on fall risk factors, such as balance, postural control, mobility and leg strength, in community-dwelling older men. Design: Single-blinded randomized controlled trial, comparing three groups, with follow-ups at eight, 16, 24 and 32 weeks. Setting: Older men independent-living residing in Maia city, Portugal. Participants: A total of 66 older men (aged 69.0 ±4.9 years) were randomly assigned to an aerobic exercise group (n = 22), a combined aerobic and resistance exercise group (n = 22) or a control group (n = 22). Interventions: Both community-based exercise programs consisted of three sessions each week for 32 consecutive weeks and were planned for moderate-to-vigorous intensity. The control group had no exercise intervention. Measurements: Main outcomes were measured by the Timed Up and Go Test, functional reach test, 30-second chair stand test and 6-minute walk test, on five different occasions. Results: Repeated measures of analysis of covariance revealed significant main effects between time × group interaction in all outcomes over time (Timed Up and Go Test: p < 0.001; functional reach test: p = 0.002; 30–second chair stand: p = 0.001; 6-minute walk test: p < 0.001). Both exercise groups reported improvements; however, better performance was identified in the combined aerobic and resistance exercise group compared with the aerobic exercise group (–20.3% vs. –9.1% on the Timed Up and Go Test, +27.5% vs. +10.9% on the functional reach test, +20.8% vs. +7.3% on 30-second chair stand, +10.9% vs. +3.5% on 6-minute walk test). Conclusions: Adding resistance exercise to aerobic exercise improves factors associated with an increased risk of falls. However, both exercise regimes, combined or aerobic alone, are more effective than no exercise in the reduction of fall risk factors. ClinicalTrials.org #NCT01874132

Resistance Exercise and Knee Osteoarthritis

The aim of this study was twofold: (a) to determine whether Theory of Planned Behavior (TPB) variables and implicit attitudes toward physical activity and sedentary behavior would change during a 5-week pulmonary rehabilitation (PR) program, and (b) to investigate the relationships between behavioral intentions, implicit attitudes, physical activity, and sedentary behavior in postrehabilitation. Out of 142 patients with respiratory disease included in this study, 119 completed 2 questionnaires measuring TPB variables with regard to physical activity and sedentary behavior, and an Implicit Association Test (IAT) measuring implicit attitudes toward physical activity in contrast to sedentary behavior. The TPB questionnaires and the IAT were administered at the beginning (Time 1) and the end of the program (Time 2). Six months after the program (Time 3), 62 patients provided self-reported measures of their recreational physical activity and screen-based, leisure-time sedentary behavior. Over the course of pulmonary rehabilitation, perceived behavioral control and intentions toward physical activity increased, as did social norms and perceived behavioral control toward sedentary behavior; implicit attitudes were also more positive toward physical activity. Implicit attitudes at the end of PR (Time 2) were significantly associated with postrehabilitation physical activity (Time 3). TPB variables toward physical activity and sedentary behavior as well as implicit attitudes were enhanced during PR. At 6 months, implicit attitudes were significantly associated with physical activity. These results suggest that motivation, particularly implicit attitudes, should be targeted in future behavioral interventions in order to optimize the effects of rehabilitation on physical activity maintenance. (PsycINFO Database Record

Background: Chronic obstructive pulmonary disease (COPD) patients are at high risk for COVID-19 infection and severe pulmonary complications. Exercise-based pulmonary rehabilitation (PR) in outpatient settings is essential for COVID-19 survivors with COPD comorbidities, providing the most critical patient benefits, but it is challenging during the pandemic.Case: A sixty-four-year-old man with COPD since 2 years ago, a history of COVID-19 one month ago, and Pulmonary Tuberculosis since 1 year ago presented with chief complaints of tiredness, cough, and breathlessness after walking for more than 100 meters. We performed PR, including breathing retraining exercise, chest mobility exercise, active cycle breathing technique (ACBT), posture correction, and aerobic exercise with static ergo-cycle for 8 weeks.Discussion: After 8 weeks of PR, there was a 3% increase in the O2 saturation level from 94-95% room air to 98%, an increase of single breath counting test (SBCT) from 20 to 38 counts, improvement of peak cough flow from 100-110-100 to 420-435-425 L/minute, and peak flow meter from 140-150-145 to 380-400-400 L/minute. Before PR the patient could not perform the sit-to-stand test (STS) and a 6-minute walking test (6MWT), but after 8 weeks of PR, STS was 5 times in 30 seconds, and 6MWT maximum distance was 248 meters. COPD assessment test (CAT) score improved from 23 to 9, and the Modified Medical Research Council (mMRC) dyspnea scale improved from 3 to 2.Conclusion: Eight weeks of pulmonary rehabilitation showed benefits for the patient in reducing dyspnea and improving exercise tolerance and quality of life, especially in hospital-based settings.

To assess the clinical utility of 5 physical therapy (PT) outcome measures in quantifying functional changes in pediatric lower extremity chronic pain treated at a hospital-based interdisciplinary rehabilitation center. This was a cross-sectional study with retrospective review of 173 individuals, 8 to 18 years old, treated from June 2008 to 2013. The measures used were the Timed Up and Go, Timed Up and Down Stairs, Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, 6-minute walk test, and Lower Extremity Functional Scale. Participant performance was correlated with demographic characteristics, the Functional Disability Index, Multidimensional Anxiety Scale for Children, Child Depression Inventory, and Canadian Occupational Performance Measure. Scores from all 5 PT measures showed significant improvement following treatment. Functional Disability Index correlated to every PT measure except the 6-minute walk test. This study supports the clinical use of these PT measures to track functional progress after rehabilitative treatment of lower extremity chronic pain-related disability.

BackgroundRegular exercise is important in the management of COPD. Pulmonary rehabilitation (PR) facilitates a more physically active lifestyle through exercise participation, ideally without compromising non-exercise physical activity (PA). During PR patients are advised to perform exercise defined by duration and intensity. The extent to which PR attendees participate in unsupervised exercise bouts and their adherence to the exercise prescription provided during PR is unclear. Commercially available devices have the potential to support patients to exercise at their individually prescribed intensity. Study aims were to (1) assess how adherent patients are to their prescribed walking intensity; (2) examine the pattern of overall PA and walking exercise during the course of PR; (3) determine the feasibility of prescribing exercise to PR attendees using an activity monitor; and (4) explore the relationship between exercise and non-exercise PA with routine PR outcome measures.Methods19 patients wore an activity monitor during routine walking tests and 6 weeks of PR, recording in a diary when they exercised. Exercise intensity (cadence) was prescribed from the Endurance Shuttle Walk Test. Patients completed questionnaires, walking tests and a lower limb strength test before and after PR. Repeated ANOVA compared changes in outcomes between weeks 1–6.ResultsPatients wore the monitor every day during PR (median 42 days). Exercise steps increased by 56% (Δ332 [95% CI 54–611] steps/day, p = 0.009) between weeks 1 and 6, with no significant change in non-exercise steps (Δ79 [95% CI − 22 to − 179] steps/day, p = 0.13). Patients reported exercising on 70% of days. Adherence to prescribed cadence was achieved 55% of time spent exercising, and did not change across the 6 weeks (p = 0.907). Change in total daily steps was associated with improved dyspnea (p = 0.027), Chronic Respiratory Questionnaire (CRQ) Dyspnea domain (p = 0.019), CRQ Emotional Functioning domain (p = 0.001) and CRQ Mastery domain scores (p = 0.001) but not with exercise capacity or lower limb muscle strength.ConclusionsImprovements in exercise participation, not at the expense of non-exercise PA, throughout a PR course was observed in attendees provided with a commercially available activity monitor. Wearable technology may be able to support effective remote walking exercise prescription and participation during PR.Trial registration (retrospectively registered): http://www.isrctn.com/ISRCTN15892972.

Rehabilitation of Covid19 survivors is the next pandemic challenge. Recently ERS task force stated that data on safety and efficacy is still lacking. The goal of this case series is to present data related to pulmonary rehabilitation (PR) in post Covid19 subjects submitted to mechanical ventilation (MV), that developed pulmonary fibrosis, lung restrictive disorders, mild hypoxemia, loss of muscle mass, and exertion intolerance. From the November of 2020 up to April 2021 we screened 9 patients with history of prolonged MV, chest CT scan showing ground-glass opacities, lung restriction confirmed by body plethysmography. The subjects underwent inpatient PR according to the ERS/ATS statement at CASA DI CURA VILLA SERENA, Piossasco, Italy. All individuals followed an assessment protocol with a 6-minute walk test, lung function tests, and blood gas analysis. Rehabilitation protocol comprised aerobic and strength exercise training, respiratory physiotherapy, and pharmacologic treatment with cortisone and bronchodilators. Subjects were normoxemic and normocapnic in O2-therapy with mixed pulmonary disorder (moderate lung restriction, severe CO diffusion reduction). After PR patients improved functional status peripheric saturation during exertion and dyspnea (table 1). Data demonstrated that PR in post Covid19 patients with pulmonary fibrosis and lung restriction, improve exercise tolerance, oxygen saturation and dyspnea.

ObjectiveTo investigate the benefits of pulmonary rehabilitation (PR) in older adults with stable chronic obstructive pulmonary disease (COPD) and analyze its influencing factors.MethodsFrom January 2023 to April 2024, convenience sampling was adopted to collect 254 stable patients with COPD who met the inclusion and exclusion criteria in a Classiii hospital in Nantong City as the research objects. Among them, 196 patients completed the PR course and were finally included in the study. According to the PR benefit criteria, they were divided into the benefit group and the non-benefit group, and the incidence of benefit and influencing factors were analyzed. The generalized estimating equations (GEE) were used to plot the trend profiles of physical capacity and quality of life before rehabilitation and at 3, 6, and 9 weeks after rehabilitation.ResultsA total of 196 patients completed the PR course, 107 patients achieved PR benefit, benefit at a rate of 54.59%. Logistic regression analysis showed that, Chronic pain (OR = 0.43, 95%Cl:0.22 ~ 0.83, p = 0.011), baseline 6MWD (OR = 0.98, 95%Cl:0.96 ~ 0.99, p < 0.001), sarcopenia (OR = 0.50, 95%Cl:0.27 ~ 0.95, p = 0.035), better economic situation (OR = 1.96, 95%Cl:1.03 ~ 3.71, p = 0.039), and good family care index (OR = 2.11, 95%Cl:1.08 ~ 4.11, p = 0.029) were the influencing factors of pulmonary rehabilitation benefits in older adults with stable COPD.ConclusionThe PR benefit rate of patients with clinically stable COPD is low, which is mainly affected by the baseline 6MWD, chronic pain, sarcopenia, economic situation, and family care index. Clinical medical staff should consider the influencing factors when they perform PR for patients.

Eficacia de las intervenciones fisioterápicas sobre la musculatura respiratoria mediante técnicas de entrenamiento respiratorio en el postoperatorio de trasplantados pulmonares: una revisión sistemática

Introduction: Corona Virus Infection Disease (COVID-19) refers to the infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Most of COVID-19 survivors have residual symptoms after being discharged from the hospital, it then leads to the decreased lung function and quality of life (QoL). Pulmonary rehabilitation is essential because it can reduce the impact of these sequelae. This study aimed to determine the effectiveness of pulmonary rehabilitation in improving lung function among adult patients of COVID-19 survivors.Methods: This study was conducted using 5 databases, namely: CINAHL, PubMed, SAGE, Science Direct, and Scopus from 1 April 2020 to 30 September 2021. The combination of keywords used was: "Pulmonary Rehabilitation", “Pulmonary Function", and "Post-COVID-19". In assessing the bias and methodological quality of the articles obtained, this study used the Joanna Briggs Institute (JBI) critical appraisal checklist tools.Results: From 678 articles, 11 research articles met the criteria. Pulmonary rehabilitation performed in post-COVID-19 patients included the provision of aerobic exercise, breathing exercises, strength training, balance exercises, relaxation, occupational therapy, psychological support, and nutrition consultation. Lung rehabilitation mainly was performed two sessions a week for 3-8 weeks with different proportions for each patient according to clinical conditions and ability limits. Spirometry and the 6-minute walk test (6MWT) revealed that patients who completed the pulmonary rehabilitation program experienced improvements in their lung function.Conclusion: Comprehensive pulmonary rehabilitation programs under supervision and psychotherapists are the right choice in improving lung function among COVID-19 survivor adult patients.