1. Respirology. 2015 Mar 20. doi: 10.1111/resp.12510.
Heart rate recovery after the 6-min walk test is related to 6-min walk distance and
percutaneous oxygen saturation recovery in patients with COPD.
Shiroishi R1, Kitagawa C, Miyamoto N, Kakuno N, Koyanagi H, Rikitomi N, Senjyu H.
Author information: 1Department of Rehabilitation Medicine, Nagasaki Pulmonary
Rehabilitation Clinic, Nagasaki, Japan.
Abstract: Heart rate recovery (HRR) after maximal load exercise affects mortality in
chronic obstructive pulmonary disease (COPD). However, the associations of clinical
characteristics with HRR after the 6-min walk test (6MWT), which is defined as a
submaximal load test, remain unclear. We showed that HRR in patients with COPD
after 6MWT was related to 6-min walk distance and percutaneous oxygen saturation
recovery. HRR after the 6MWT may be useful to assess exercise capacity in COPD.
2. J Cardiopulm Rehabil Prev. 2015 Mar 11.
Effect of 6 Months of Balance Training During Pulmonary Rehabilitation in Patients
With COPD.
Mkacher W1, Mekki M, Tabka Z, Trabelsi Y.
Author information: 1Department of Physiology and Lung Function Testing (UR12
ES06), Sousse Faculty of Medicine, University of Sousse, Sousse, Tunisia.
PURPOSE: Balance impairment is recognized as an important issue for patients with
chronic obstructive pulmonary disease (COPD). The aim of this study was to examine
the effect of balance training as part of pulmonary rehabilitation (PR) on balance in
COPD patients. METHODS: Patients were randomly assigned to an intervention or
usual care group. The intervention group underwent balance training 3 times a week
for 6 months in addition to the standard PR. The control group received 6 months of
the standard PR program only. Balance was assessed by the Timed Up and Go (TUG),
Tinetti, Berg Balance Scale (BBS), and the Unipodal Stance (UST) tests. Balance
confidence was rated using the ABC scale. Exercise tolerance was determined using a
6-Minute Walk Test. RESULTS: Following the completion of PR, the intervention group
showed improvement in all balance measures. Only TUG, ABC, and UST scores were
improved in the usual care group (P < .05). Results demonstrated significant betweengroup differences in TUG, Tinetti, BBS, and ABC scores (P < .01) and UST score (P < .05).
CONCLUSIONS: Balance training incorporated into a standard PR program significantly
improves scores on balance tests in COPD patients.
3. Chron Respir Dis. 2015 Mar 10. pii: 1479972315575717.
Physiological responses during downhill walking: A new exercise modality for
subjects with chronic obstructive pulmonary disease?
Camillo CA1, Burtin C2, Hornikx M1, Demeyer H1, De Bent K3, van Remoortel
H1, Osadnik CR4, Janssens W3, Troosters T5.
Author information: 1KU Leuven, Department of Rehabilitation Sciences, Leuven,
Belgium. 2KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
Hasselt University, Rehabilitation Research Centre, Biomedical Research Institute,
Faculty of Medicine and Life Sciences, Diepenbeek, Belgium. 3University Hospital
Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium. 4KU Leuven,
Department of Rehabilitation Sciences, Leuven, Belgium Monash University,
Department of Physiotherapy, Victoria, Australia Institute for Breathing and Sleep,
Victoria, Australia. 5KU Leuven, Department of Rehabilitation Sciences, Leuven,
Belgium University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven,
Belgium thierry.troosters@med.kuleuven.be.
Abstract: Skeletal muscle quadriceps low-frequency fatigue (LFF) during exercise
promotes improvements in exercise capacity with exercise training. In healthy
subjects, eccentric muscle work induced by downhill walking (DW) generates higher
muscular stress, whilst metabolic cost is lower compared to level walking (LW). We
investigated quadriceps LFF and metabolic cost of DW in patients with chronic
obstructive pulmonary disease. Ten participants (67 ± 7 years, FEV 1 51 ± 15%
predicted) performed DW, DW carrying a load (DWL) of 10% body weight via vest
and LW, in random order. Quadriceps potentiated twitch force (TWqpot) was
assessed before and after each walk, and muscle damage was assessed before and
24 hours after each walk via serum creatine kinase (CK) levels. Ventilation (VE) and
oxygen consumption (VO2) were measured via breath-by-breath analysis during
each walk. DW and DWL resulted in a greater decrease in TWqpot (-30 ± 14 N in DW,
p < 0.05; and -22 ± 16 N in DWL, p < 0.05) compared to LW (-3 ± 21 N, p > 0.05). CK
levels only increased 24 hours following DW and DWL (p < 0.05). DW and DWL
showed lower VE and VO2 than LW (p < 0.05). DW is associated with enhanced
quadriceps LFF and lower cardiorespiratory costs than LW. The addition of a chest
load to DW does not seem to enhance these effects.
4. Am J Respir Crit Care Med. 2015 Mar 31.
Pulmonary Gas Exchange Abnormalities in Mild COPD: Implications for Dyspnea
and Exercise Intolerance.
Elbehairy AF1, Ciavaglia CE, Webb KA, Guenette JA, Jensen D, Mourad SM, Neder
JA, O'Donnell DE; Canadian Respiratory Research Network..
Author information: 1Queen's University and Kingston General Hospital,
Medicine, Kingston, Ontario, Canada, Alexandria University, Department of Chest
Diseases,
Faculty
of
Medicine,
Alexandria,
Egypt;
dr.amanyelbehairy@yahoo.com.
BACKGROUND: Several studies in mild COPD have shown higher than normal
ventilatory equivalent for carbon dioxide (VE/VCO2) during exercise. Our
objective was to examine pulmonary gas exchange abnormalities and the
mechanisms of high VE/VCO2 in mild COPD and its impact on dyspnea and
exercise intolerance.
METHODS: Twenty-two subjects (11 GOLD grade-1B COPD patients, 11 agematched healthy controls) undertook physiological testing and a symptomlimited incremental cycle exercise test with arterial blood gas collection.
RESULTS: Patients (post-bronchodilator FEV1: 94±10 %predicted; mean±SD) had
evidence of peripheral airway dysfunction and reduced peak oxygen uptake
compared to controls (80±18 versus 113±24 %predicted; p<0.05). Arterial blood
gases were within the normal range and effective alveolar ventilation was not
significantly different from controls throughout exercise. The alveolar-arterial O2
gradient was elevated at rest and throughout exercise in COPD (p<0.05). VE/VCO2,
dead space-to-tidal volume ratio (VD/VT), and arterial-to-end tidal CO2
difference were all higher (p<0.05) in COPD than controls during exercise. In
COPD versus controls, there was significant dynamic hyperinflation and greater
tidal volume constraints (p<0.05). Standardized dyspnea intensity ratings were
also higher (p<0.05) in COPD versus controls in association with higher ventilatory
requirements. Within all subjects, VD/VT correlated with the VE/VCO2 ratio
during submaximal exercise (r=0.780, p<0.001). CONCLUSION: High VD/VT was
the most consistent gas exchange abnormality in smokers with only mild
spirometric abnormalities. Compensatory increases in minute ventilation during
exercise maintained alveolar ventilation and arterial blood gas homeostasis but
at the expense of earlier dynamic mechanical constraints, greater dyspnea and
exercise intolerance in mild COPD.
5. Chest. 2015 Mar 26. doi: 10.1378/chest.14-1466.
An Internet-Mediated Pedometer-Based Program Improves Health-Related
Quality of Life Domains and Daily Step Counts in COPD: A Randomized Controlled
Trial.
Moy ML, Collins RJ, Martinez CH, Kadri R, Roman P, Holleman RG, Kim
HM, Nguyen HQ, Cohen MD, Goodrich DE, Giardino ND, Richardson CR.
Background: Low levels of physical activity (PA) are associated with poor
outcomes in persons with COPD. Interventions to increase PA could improve
outcomes. Methods: We tested the efficacy of a novel Internet-mediated,
pedometer-based exercise intervention. Veterans with COPD (n=239) were
randomized in a 2:1 ratio to: (1) intervention group (Omron HJ-720 ITC
pedometer and Internet-mediated program) or (2) wait-list control group
(pedometer). The primary outcome was health-related quality of life (HRQL),
assessed by the St. George's Respiratory Questionnaire (SGRQ), at 4 months. We
examined the SGRQ Total Score (SGRQ-TS) and three domain scores: Symptoms,
Activities, and Impact. The secondary outcome was daily step counts. Linear
regression models assessed the effect of intervention on outcomes. Results:
Participants had mean age 67±9 years and were 94% male. There was no
significant between-group difference in mean 4-month SGRQ-TS (2.3 units,
P=0.14). Nevertheless, a significantly greater proportion of intervention
participants than controls had at least a 4-unit improvement in SGRQ-TS, the
minimum clinically important difference, (53% versus 39% respectively, P=0.05).
For domain scores, the intervention group had a lower (reflecting better HRQL)
mean than the control group by 4.6 units for Symptoms (P=0.046) and by 3.3 units
for Impact (P=0.049). There was no significant difference in Activities score
between the two groups. Compared to the controls, intervention participants
walked 779 more steps per day at 4 months (P=0.005). Conclusions: An Internetmediated, pedometer-based walking program can improve domains of HRQL and
daily step counts at 4 months in persons with COPD.
6.
6. Chron Respir Dis. 2015 Mar 9. pii: 1479972315575201.
Six-minute walk distance in patients with chronic obstructive pulmonary
disease: Which reference equations should we use?
Andrianopoulos V1, Holland AE2, Singh SJ3, Franssen FM4 , Pennings
HJ5, Michels AJ6, Smeenk FW7, Vogiatzis I8, Wouters EF9, Spruit MA4. Author
information: 1Department of Research and Education, CIRO+, Centre of
Expertise for Chronic Organ Failure, Hornerheide, Horn, The Netherlands
vasilisandrianopoulos@ciro-horn.nl. 2Department of Physiotherapy, Alfred
Health and La Trobe University, Melbourne, Australia. 3Department of
Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield
Hospital of Leicester Headquarters, Leicester, UK. 4Department of Research
and Education, CIRO+, Centre of Expertise for Chronic Organ Failure,
Hornerheide, Horn, The Netherlands. 5Department of Respiratory Medicine,
Laurentius Hospital, Roermond, The Netherlands. 6Department of Respiratory
Medicine, St Anna Hospital, Geldrop, The Netherlands. 7Department of
Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands.
8Department of Physical Education and Sport Sciences, National and
Kapodistrian University of Athens, Athens, Greece. 9Department of Research
and Education, CIRO+, Centre of Expertise for Chronic Organ Failure,
Hornerheide, Horn, The Netherlands Department of Respiratory Medicine,
Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Abstract: The use of different 6-min walk distance (6MWD) reference
equations probably results in different predicted 6MWD reference values. We
wished to investigate the impact of several 6MWD reference equations for
adults in patients with chronic obstructive pulmonary disease (COPD) and
factors accountable for different 6MWD% predicted values. Twenty-two
6MWD reference equations were applied to a data set of 2757 patients with
COPD. The predicted 6MWD reference value of Troosters and colleagues was
used as the point of reference. Four out of 21 remaining equations resulted in
comparable 6MWD% predicted, 16 equations resulted in significantly higher
6MWD% predicted and 1 equation resulted in a significantly lower 6MWD%
predicted. Similar differences in 6MWD% predicted were observed after
stratification by sex. Body mass index and global initiative for chronic
obstructive lung disease (GOLD) stage classification demonstrated varying
results within and between the groups; 9 out of 21 equations resulted in
comparable 6MWD% predicted in underweight patients but only 1 equation
demonstrated comparable result in obese. Eight equations in GOLD I, whilst 5
out of 21 equations in GOLD IV resulted in comparable 6MWD% predicted.
Existing 6MWD reference equations will give varying results. The choice of
6MWD reference equation should consider the consistency of 6-min walk test
operating procedures and at least be specific for the country/region of origin.
7. COPD. 2015 Mar 16.
Patient Anxiety and Depression Moderate the Effects of Increased Selfmanagement Knowledge on Physical Activity: A Secondary Analysis of a
Randomised Controlled Trial on Health-Mentoring in COPD.
Schüz N1, Walters JA, Cameron-Tucker H, Scott J , Wood-Baker R, Walters
EH. Author information: 1School of Medicine, Faculty of Health, University
of Tasmania, Hobart , Australia.
OBJECTIVE: Anxiety and depression are common comorbidities in people
with chronic obstructive pulmonary disease (COPD). While these
comorbidities could potentially lead to a higher motivation to learn about
self-management, they could also inhibit patients from translating this
knowledge into appropriate self-management behaviours. This paper
explores the moderating effects of anxiety and depression on a healthmentoring intervention, focusing on mechanisms of change (mediation).
METHODS: 182 COPD patients participated in an RCT, with anxiety and
depression assessed by the Hospital Anxiety and Depression Scale (HADS),
self-management knowledge by the Partners in Health Scale, and
spontaneous physical activity using accelerometers, all measured at
baseline, 6 and 12 months. The moderated mediation model tested the
intervention's effect on physical activity, mediated via changes in selfmanagement knowledge, at different levels of anxiety and depression.
RESULTS: Knowledge mediated the effect of the intervention on changes in
physical activity only for participants reporting low levels of anxiety or
depression. Both acted as moderators: Increased knowledge led to more
physical activity among participants reporting low anxiety or depression
and to less activity among highly anxious or depressed participants.
CONCLUSION: Although health-mentoring interventions can be an effective
tool to increase knowledge and physical activity among COPD patients, it is
essential to take anxiety and depression into account, as increased
knowledge may have detrimental effects in highly anxious or depressed
participants. This suggests that patients with elevated anxiety or depression
may need to be treated appropriately before engaging in chronic disease
self-management interventions.
8. Chest. 2015 Mar 5. doi: 10.1378/chest.14-2240.
Chronic Bronchitis is Associated with Worse Symptoms and Quality of Life
than Chronic Airflow Obstruction.
Meek P, Petersen H, Washko GR, Diaz AA, Kim V, Sood A, Tesfaigzi Y.
Background: Chronic obstructive pulmonary disease (COPD) includes the
chronic bronchitis (CB) and emphysema phenotypes. While it is generally
assumed that emphysema or chronic airway obstruction (CAO) is
associated with worse quality of life than CB, this assumption has not been
tested. Methods: The present study, analyses from the Lovelace Smokers'
Cohort (LSC) were validated in the COPDGene Cohort. CB without CAO (CB
only) was defined by self-reported cough productive of phlegm for at least
3 months/year for 2 consecutive years and postbronchodilator
FEV1/FVC≥70%. CAO without CB (CAO only) was defined by a
postbronchodilator FEV1/FVC<70% with no evidence of CB. Quality of life
outcomes were obtained from the SGRQ and SF-36 questionnaires. A
Priori Covariates included age, sex, pack-years of smoking, current
smoking, and FEV1. Results: Smokers with CB without CAO (LSC n=341;
COPDGene=523) were younger, had a greater BMI, and less smoking
exposure than those with CAO only (LSC n=302; COPDGene=2208).
Compared to the latter group, quality of life scores were worse for those
with CB only. Despite similar SGRQ Activity and SF-36 Role physical and
physical functioning, SGRQ Symptoms and Impact scores and SF-36
Emotional and Social measures were worse in the CB only group, in both
cohorts. After adjustment for covariates, CB only group remained a
significant predictor for 'worse' symptoms, and emotional and social
measures. Conclusions: This analysis is the first study to suggest that
among subjects with COPD those with CB only present worse quality of
life, symptoms and mental well-being than those with CAO only.
9. Sleep Breath. 2015 Mar 4.
Frequent sputum production is associated with disturbed night's rest and
impaired sleep quality in patients with COPD.
Hartman JE1, Prinzen J, van Lummel RC, Ten Hacken NH. Author
information: 1Department of Pulmonary Diseases AA11, University of
Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB,
Groningen, The Netherlands, j.hartman@umcg.nl.
PURPOSE: In this study, we measured night's rest parameters measured
with an accelerometer and sleep quality in mild to very severe patients
with COPD. Furthermore, our aim was to investigate the association
between night's rest parameters and clinical variables and the association
between sleep quality and quality of life or health status. METHODS: Mild
to very severe COPD patients were recruited from general practitioners
and outpatient clinics of general hospitals to participate in a crosssectional study on physical activity in patients with COPD. A total of 103
patients (mean age 65 years, 67 % male) wore the accelerometer during
night's rest for at least four nights and were included in the analyses.
RESULTS: No significant associations were found between objectively
measured body movements during night's rest or subjective sleep quality
and lung function, dyspnoea severity, body composition and physical
activity during the day. Patients with frequent sputum production during
the day had a higher number of sitting transitions during the night (5.3 vs
4.3 sitting transitions) and more frequently got out of bed compared to
patients who hardly ever produced sputum during the day (1.0 vs 0.8 times
per night). Furthermore, these patients also reported worse sleep quality
(Pittsburgh sleep quality index (PSQI) score 4 vs 3). CONCLUSIONS: Our
results indicate that objectively measured body movements during night's
rest like body postures and transitions are not related to sleep quality in
patients with COPD. We did find an association between frequent sputum
production and disturbances during night's rest and sleep quality. Future
studies should investigate whether the treatment of mucus
hypersecretion leads to improved night's rest.