If you measure it, it matters!: a survey of factors influencing implementation of physical activity promotion in cardiac and pulmonary rehabilitation in Australia.

OBJECTIVE: To identify factors related to the frequency of physical activity (PA) promotion by health professionals working in cardiac and/or pulmonary rehabilitation. METHODS: A cross-sectional online survey of health professionals working in cardiac and/or pulmonary rehabilitation in Australia was conducted between July and November 2022. RESULTS: A total of 71 health professionals from four disciplines (physiotherapy, nursing, exercise physiology, occupational therapy) completed the survey. The majority agreed that PA promotion was part of their role. Despite this, only half of the participants encouraged ≥ 10 patients per month to be more physically active. In logistic regression modelling, health professionals that measured patients' PA levels (odds ratio 8.04, 95% confidence level 1.45-44.19) and prioritised PA promotion regardless of other patient problems (odds ratio 3.3, 95% confidence level 0.74-14.82) were much more likely to frequently promote PA to patients. CONCLUSION: Measurement of patients' PA levels within cardiac and pulmonary rehabilitation and making PA promotion a priority may impact the implementation of PA promotion within these programs. PRACTICAL IMPLICATIONS: Physical activity measurement as a key performance indicator in cardiac and pulmonary rehabilitation is indicated. This may be an important strategy to increase physical activity promotion by cardiac and pulmonary rehabilitation health professionals.

Entrustable Professional Activities Developed for Allied Health Entry-Level Programs Across a National Level Training Standards Framework in Singapore.

BACKGROUND: Singapore reviewed its national allied health professions (AHP) training framework, aiming to link educational objectives with entrustment and provide clearer transition to entry-level practice. Entrustable Professional Activities (EPAs) were chosen. METHODS: A participatory, iterative, four-phased approach was used to develop the EPAs within and across each AHP's Working Committee (WC). For a harmonized conceptualization of EPAs across the national framework, two steps anchor key considerations: defining EPA phenotypes along the training continuum and identifying competency domains of professional practice for subsequent mapping to EPAs. WC members were purposefully selected from diverse backgrounds and healthcare settings to achieve content validity. RESULTS: Thirty-one allied health EPAs, 5 national AHP competency domains, and 11 subcompetencies were developed altogether for undergraduate diagnostic radiography, dietetics and nutrition, occupational therapy, physiotherapy, radiation therapy and speech and language therapy (SLT) and SLT graduate-entry master's programs in two universities. Core EPAs demonstrated elements of clinical practice common in student training and entry-level work: assessment, planning, implementing intervention and discharging/transferring of care. The entrustment level to be attained in most EPAs by end of program is indirect supervision. CONCLUSION: An aligned national EPA framework for AHP students' training into entry-level may facilitate clearer signposts through entrustment levels.

Taekwondo Poomsae practise in slow motion and the balance of healthy older adults: A Pre-Experimental Study.

BACKGROUND AND PURPOSE: Poor balance confidence and functional balance can lead to falls in community-dwelling older adults. Exercises utilising slow movements have been shown to improve balance in this population. It is hypothesised that by superimposing the use of slow movements onto Taekwondo Poomsae, there could be similar benefits in improving balance confidence and functional balance in older adults. METHODS: This was a pre - experimental study. Fifteen community-dwelling older adults received 11 weeks of Slow Poomsae (SP) training using a proposed 50-min protocol. Pre- and post-intervention scores of the Activities-Specific Balance Confidence Simplified Scale (ABC-S), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and 'Timed Up and Go' test (TUG) assessments were recorded and compared. RESULTS: Fifteen eligible participants with mean and standard deviation (SD) of age 73.8 (6.05) years completed the study. Significant improvements (p < 0.05) were seen in the pre-post differences between ABC-S, BBS, DGI, and TUG, with median score changes of 15 points (Z = -3.408), 3 points (Z = -3.306), 3 points (Z = -2.852), and 3.5 s (Z = -3.296) respectively. CONCLUSION: The preliminary findings support the efficacy of SP as a potential balance training programme that is safe for healthy older adults to improve their balance confidence and functional balance. More research is required on this topic that leans towards a large population blinded randomised controlled trial with a longer intervention period and inclusion of a follow-up to further elucidate the effects of long-term practice and novelty of SP.

Development of entrustable professional activities for a physiotherapy undergraduate programme in Singapore.

BACKGROUND: The concept of entrustable professional activities (EPAs) as an assessment framework is new to undergraduate physiotherapy training in Singapore. The physiotherapy community was tasked to develop EPAs to reflect the core professional activities of an entry-level physiotherapist for its undergraduate programme. METHODS: A qualitative participatory approach was used to develop entry-level EPAs for undergraduate physiotherapy students. Four phases occurred; (1) formation and training of the EPA writing workgroup from different sectors of the physiotherapy industry in Singapore; (2) conceptualization of the framework; (3) writing EPAs and; (4) iteration of EPAs through reflection, revision and consensus building. RESULTS: Five core activities were identified for undergraduate physiotherapy students to perform upon graduation and were developed into entry-level EPAs. These entry-level EPAs were subsequently termed as core EPAs to reflect the core practices expected at entry level across specialties and sectors in Singapore. These EPAs were mapped to five competency domains and 12 competency descriptors. The sources of information to support entrustment decisions were (1) short practice observation, (2) entrustment-based discussion and (3) case notes evaluation. Remote supervision was selected as the level of entrustment that physiotherapy students must attain at graduation. CONCLUSION: The development of EPAs utilized a ground-up and cross-sector approach to define entry-level EPAs as core physiotherapy activities expected to be performed and assessed during clinical training by undergraduate physiotherapy students. Future research is needed to validate the use of EPAs as an assessment framework for undergraduate physiotherapy education.

Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised crossover trial.

Exercise improves mucus clearance in people without lung disease and those with chronic bronchitis. No study has investigated exercise alone for mucus clearance in cystic fibrosis (CF). The aim of this study was to compare the effects of treadmill exercise to resting breathing and airway clearance with positive expiratory pressure (PEP) therapy on mucus clearance in adults with CF.This 3-day randomised, controlled, crossover trial included 14 adults with mild to severe CF lung disease (forced expiratory volume in 1 s % predicted 31-113%). Interventions were 20 min of resting breathing (control), treadmill exercise at 60% of the participant's peak oxygen consumption or PEP therapy (including huffing and coughing). Mucus clearance was measured using the radioaerosol technique and gamma camera imaging.Treadmill exercise improved whole lung mucus clearance compared to resting breathing (mean difference 3%, 95% CI 2-4); however, exercise alone was less effective than PEP therapy (mean difference -7%, 95% CI -6- -8). When comparing treadmill exercise to PEP therapy, there were no significant differences in mucus clearance from the intermediate and peripheral lung regions, but significantly less clearance from the central lung region (likely reflecting the huffing and coughing that was only in PEP therapy).It is recommended that huffing and coughing are included to maximise mucus clearance with exercise.

Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial.

BACKGROUND: Treadmill exercise and airway clearance with the Flutter® device have previously been shown to improve mucus clearance mechanisms in people with cystic fibrosis (CF) but have not been compared. It is therefore not known if treadmill exercise is an adequate form of airway clearance that could replace established airway clearance techniques, such as the Flutter®. The aim of this study was to evaluate respiratory flow, sputum properties and subjective responses of treadmill exercise and Flutter® therapy, compared to resting breathing (control). METHODS: Twenty-four adults with mild to severe CF lung disease (FEV1 28-86% predicted) completed a three-day randomised, controlled, cross-over study. Interventions consisted of 20 min of resting breathing (control), treadmill exercise at 60% of the participant's peak oxygen consumption and Flutter® therapy. Respiratory flow was measured during the interventions. Sputum properties (solids content and mechanical impedance) and subjective responses (ease of expectoration and sense of chest congestion) were measured before, immediately after the interventions and after 20 min of recovery. RESULTS: Treadmill exercise and Flutter® resulted in similar significant increases in peak expiratory flow, but only Flutter® created an expiratory airflow bias (i.e. peak expiratory flow was at least 10% higher than peak inspiratory flow). Treadmill exercise and Flutter® therapy resulted in similar significant reductions in sputum mechanical impedance, but only treadmill exercise caused a transient increase in sputum hydration. Treadmill exercise improved ease of expectoration and Flutter® therapy improved subjective sense of chest congestion. CONCLUSIONS: A single bout of treadmill exercise and Flutter® therapy were equally effective in augmenting mucus clearance mechanisms in adults with CF. Only longer term studies, however, will determine if exercise alone is an adequate form of airway clearance therapy that could replace other airway clearance techniques. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, Registration number # ACTRN12609000168257 , Retrospectively registered (Date submitted to registry 26/2/2009, First participant enrolled 27/2/2009, Date registered 6/4/2009).

A randomised, double-blinded clinical study on the efficacy of multimedia presentation using an iPad for patient education of postoperative hip surgery patients in a public hospital in Singapore.

INTRODUCTION: This study compared patient satisfaction and recall of physiotherapy patient education among patients who had undergone hip surgery, with information presented via an iPad versus a standard paper booklet. METHODS: Patients who had undergone hip surgery joined and completed this single-centre study, which utilised a randomised parallel group design. They were randomly allocated to either Group A (received information on hip surgery physiotherapy via an iPad) or Group B (received the same information via a paper booklet). The participants were blinded to the intervention received by the other group and the testers were blinded to the intervention received by the participants. The interventions were carried out during the patients' first four postoperative physiotherapy sessions. The outcome measures were recorded using pre-validated questionnaires. RESULTS: A total of 42 participants (mean age 70 ± 12 years) were recruited. After the intervention, patients in both groups had improved recall of the information presented during patient education. However, the patients in Group A had a significantly better recall score than those in Group B (4.0 points higher, p < 0.001). The level of patient satisfaction was also significantly higher in Group A than in Group B (8.5 points higher, p < 0.001). CONCLUSION: While the use of an iPad and a paper booklet both had positive outcomes for patient recall and satisfaction, the use of an iPad was found to be more effective at improving patient satisfaction and recall of physiotherapy patient education in the present study.

Prescribing Cycle Exercise Intensity Using Moderate Symptom Levels in Chronic Obstructive Pulmonary Disease.

PURPOSE: Laboratory-based cardiopulmonary exercise testing from which to prescribe cycle training intensity in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD) is not readily available in clinical practice. Alternative methods of prescribing cycle exercise intensity, such as patient symptoms of dyspnea or rating of perceived exertion (RPE), have been used, but it is unknown whether cycle intensity based on such symptoms elicits an exercise intensity appropriate for achieving physiological training responses. The aim of the study was to determine the exercise intensity elicited when continuous cycle exercise was prescribed at symptoms of moderate dyspnea or RPE in people with COPD. METHODS: Participants with diagnosed COPD performed lung function tests and an incremental cycle test to peak work capacity. On a subsequent day, participants performed 10 minutes of cycle exercise based on moderate symptoms (CycleSYMP) of either dyspnea or RPE, depending on which symptom limited the incremental cycle test. Oxygen uptake ((Equation is included in full-text article.)O2) was measured during all exercise using a portable metabolic system (Cosmed K4b). RESULTS: Thirty participants, mean age of 70 ± 9 years and FEV1 60 ± 12% predicted, completed the study. The mean intensity achieved during CycleSYMP was 78 ± 12%(Equation is included in full-text article.)O2peak and 71 ± 18 % (Equation is included in full-text article.)O2Reserve. Steady-state (Equation is included in full-text article.)O2 was achieved by the sixth minute of CycleSYMP. CONCLUSIONS: Using symptoms of moderate dyspnea or RPE as a method of prescribing cycle exercise elicited a high training intensity at which steady-state was achieved in people with mild to moderate COPD.

Prescription of walking exercise intensity from the 6-minute walk test in people with chronic obstructive pulmonary disease.

PURPOSE: The 6-minute walk test (6MWT) is widely used in clinical practice, particularly to assess functional exercise capacity and to prescribe walking training intensity in people with chronic obstructive pulmonary disease (COPD). However, the actual walking intensity prescribed from the 6MWT, in terms of percent peak oxygen uptake (%(Equation is included in full-text article.)O2peak) and percent (Equation is included in full-text article.)O2 reserve (%(Equation is included in full-text article.)O2R), has not been previously reported. This study aims to examine the exercise intensity when walking training is prescribed at 80% average 6MWT speed. METHODS: Patients with COPD (N = 45) were recruited. Peak (Equation is included in full-text article.)O2 from an incremental cycle test and 6MWT and (Equation is included in full-text article.)O2 from a 10-minute walking exercise (Walk-10) were measured by a portable metabolic system (Cosmed K4b; Cosmed, Rome, Italy). Walk-10 was done on the same oval course as the 6MWT. Participants were asked to walk at 80% average 6MWT speed for 10 minutes continuously. RESULTS: Four participants could not complete Walk-10 and 2 did not perform Walk-10 due to low 6MWT distance. The remaining 39 participants with mean (SD) forced expiratory volume in 1 minute of 58 (19)% predicted completed Walk-10. The mean intensity of Walk-10 was 69 (17)% (Equation is included in full-text article.)O2R or 77 (13)% (Equation is included in full-text article.)O2peak. Steady-state (Equation is included in full-text article.)O2 was achieved within the first 4 minutes of Walk-10. CONCLUSION: Walking exercise prescribed at 80% average 6MWT speed resulted in a high but tolerable exercise intensity that is likely to result in training benefits in most people with COPD.

Prescription of walking exercise intensity from the incremental shuttle walk test in people with chronic obstructive pulmonary disease.

OBJECTIVE: This study determined the intensity of walking exercise prescribed from 70% of peak speed achieved during the incremental shuttle walk test (ISWT) in people with chronic obstructive pulmonary disease and whether a steady-state response was achieved when exercising at this intensity. DESIGN: Each participant performed lung function tests, an incremental cycle test, two ISWTs, and a 10-min continuous walking exercise at 70% peak ISWT speed. Oxygen consumption (V(O2)) was collected using a portable system (Cosmed K4b(2), Rome, Italy). The V(O2) from the 10-min walking exercise was compared with V(O2)peak from the better ISWT as a measure of walking exercise intensity. RESULTS: Thirty-four participants completed the study. The mean intensity achieved during the 10-min walking exercise was 76% (11%) V(O2)peak. Steady-state V(O2) was achieved by minute 5 in the 10-min walking exercise. CONCLUSIONS: Prescription of walking exercise at 70% of the peak ISWT speed provided an intensity appropriate for achieving physiologic training responses.

Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease.

BACKGROUND: Intensity of exercise is considered a key determinant of training response, however, no systematic review has investigated the effects of different levels of training intensity on exercise capacity, functional exercise capacity and health-related quality of life (HRQoL) in people with chronic obstructive pulmonary disease (COPD). As type of training (continuous or interval) may also affect training response, the effects of the type of training in COPD also require investigation. OBJECTIVES: To determine the effects of training intensity (higher versus lower) or type (continuous versus interval training) on primary outcomes in exercise capacity and secondary outcomes in symptoms and HRQoL for people with COPD. SEARCH METHODS: We searched for studies in any language from the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and PubMed. Searches were current as of June 2011. SELECTION CRITERIA: We included randomised controlled trials comparing higher training intensity to lower training intensity or comparing continuous training to interval training in people with COPD. We excluded studies that compared exercise training with no exercise training. DATA COLLECTION AND ANALYSIS: We pooled results of comparable groups of studies and calculated the treatment effect and 95% confidence intervals (CI) using a random-effects model. We made two separate comparisons of effects between: 1) higher and lower training intensity; 2) continuous and interval training. We contacted authors of missing data. MAIN RESULTS: We analysed three included studies (231 participants) for comparisons between higher and lower-intensity training and eight included studies (367 participants) for comparisons between continuous and interval training. Primary outcomes were outcomes at peak exercise (peak work rate, peak oxygen consumption, peak minute ventilation and lactate threshold), at isowork or isotime, endurance time on a constant work rate test and functional exercise capacity (six-minute walk distance). When comparing higher versus lower-intensity training, the pooled primary outcomes were endurance time and six-minute walk distance. There were no significant differences in endurance time improvement (mean difference (MD) 1.07 minutes; 95% CI -1.53 to 3.67) and six-minute walk distance improvement (MD 2.8 metres; 95% CI -10.1 to 15.6) following higher or lower-intensity training. However, heterogeneity of the endurance time results between studies was significant. When comparing continuous and interval training, there were no significant differences in any of the primary outcomes, except for oxygen consumption at isotime (MD 0.08; 95% CI 0.01 to 0.16) but the treatment effect was not considered clinically important. According to the GRADE system, studies were of low to moderate quality. AUTHORS' CONCLUSIONS: Comparisons between the higher and lower training intensity were limited due to the small number of included studies and participants. Consequently, there are insufficient data to draw any conclusions on exercise capacity, symptoms and HRQoL for this comparison. For comparisons between continuous and interval training, both appear to be equally effective in improving exercise capacity, symptoms and HRQoL.