Feasibility and acceptability of a physical activity behavioural modification tele-coaching intervention in lung transplant recipients.

BACKGROUND: Despite improvements in pulmonary function following lung transplantation (LTx), physical activity levels remain significantly lower than the general population. To date, there is little research investigating interventions to improve daily physical activity in LTx recipients. This study assessed the feasibility and acceptability of a novel, 12-weeks physical activity tele-coaching (TC) intervention in LTx recipients. METHODS: Lung transplant recipients within 2 months of hospital discharge were recruited and randomised (1:1) to TC or usual care (UC). TC consists of a pedometer and smartphone app, allowing transmission of activity data to a platform that provides feedback, activity goals, education, and contact with the researcher as required. Recruitment and retention, occurrence of adverse events, intervention acceptability and usage were used to assess feasibility. RESULTS: Key criteria for progressing to a larger study were met. Of the 15 patients eligible, 14 were recruited and randomised to TC or UC and 12 completed (67% male; mean ± SD age; 58 ± 7 years; COPD n = 4, ILD n = 6, CF n = 1, PH n = 1): TC (n = 7) and UC (n = 5). TC was well accepted by patients, with 86% indicating that they enjoyed taking part. Usage of the pedometer was excellent, with all patients wearing it for over 90% of days and rating the pedometer and telephone contact as the most vital aspects. There were no adverse events related to the intervention. After 12 weeks, only TC displayed improvements in accelerometry steps/day (by 3475 ± 3422; p = .036) and movement intensity (by 153 ± 166 VMU; p = .019), whereas both TC and UC groups exhibited clinically important changes in physical SF-36 scores (by 11 ± 14 and 7 ± 9 points, respectively). CONCLUSION: TC appears to be a feasible, safe, and well-accepted intervention in LTx.

Effect of interval compared to continuous exercise training on physiological responses in patients with chronic respiratory diseases: A systematic review and meta-analysis.

BackgroundCurrent evidence suggests that interval exercise training (IET) and continuous exercise training (CET) produce comparable benefits in exercise capacity, cardiorespiratory fitness and symptoms in patients with chronic obstructive pulmonary disease (COPD). However, the effects of these modalities have only been reviewed in patients with COPD. This meta-analysis compares the effectiveness of IET versus CET on exercise capacity, cardiorespiratory fitness and exertional symptoms in patients with chronic respiratory diseases (CRDs). Methods: PubMed, CINHAL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Nursing and Allied health were searched for randomised controlled trials from inception to September 2020. Eligible studies included the comparison between IET and CET, reporting measures of exercise capacity, cardiorespiratory fitness and symptoms in individuals with CRDs. Results: Thirteen randomised control trials (530 patients with CRDs) with fair to good quality on the PEDro scale were included. Eleven studies involved n = 446 patients with COPD, one involved n = 24 patients with cystic fibrosis (CF) and one n = 60 lung transplantation (LT) candidates. IET resulted in greater improvements in peak work rate (WRpeak) (2.40 W, 95% CI: 0.83 to 3.97 W; p = 0.003) and lower exercise-induced dyspnoea (-0.47, 95% CI: -0.86 to 0.09; p = 0.02) compared to CET; however, these improvements did not exceed the minimal important difference for these outcomes. No significant differences in peak values for oxygen uptake (VO2peak), heart rate (HRpeak), minute ventilation (VEpeak), lactate threshold (LAT) and leg discomfort were found between the interventions. Conclusions: IET is superior to CET in improving exercise capacity and exercise-induced dyspnoea sensations in patients with CRDs; however, the extent of the clinical benefit is not considered clinically meaningful.

Exercise training for lung transplant candidates and recipients: a systematic review.

Exercise intolerance and impaired quality of life (QoL) are characteristic of lung transplant candidates and recipients. This review investigated the effects of exercise training on exercise capacity, QoL and clinical outcomes in pre- and post-operative lung transplant patients.A systematic literature search of PubMed, Nursing and Allied Health, Cochrane (CENTRAL), Scopus and CINAHL databases was conducted from inception until February, 2020. The inclusion criteria were assessment of the impact of exercise training before or after lung transplantation on exercise capacity, QoL or clinical outcomes.21 studies met the inclusion criteria, comprising 1488 lung transplant candidates and 1108 recipients. Studies consisted of five RCTs, two quasi-experimental and 14 single-arm cohort or pilot studies. Exercise training improved or at least maintained exercise capacity and QoL before and after lung transplantation. The impact on clinical outcomes was less clear but suggested a survival benefit. The quality of evidence ranged from fair to excellent.Exercise training appears to be beneficial for patients before and after lung transplantation; however, the evidence for direct causation is limited by the lack of controlled trials. Well-designed RCTs are needed, as well as further research into the effect of exercise training on important post-transplant clinical outcomes, such as time to discharge, rejection, infection, survival and re-hospitalisation.

Effect of time on biomechanics during exercise on the functional re-adaptive exercise device.

Mechanistic studies of the Functional Re-adaptive Exercise Device (FRED) have shown it automatically recruits Lumbar Multifidus (LM) and Transversus Abdominis (TrA) - two deep-spinal muscles that are atrophied and show altered motor control in low back pain (LBP). No studies have investigated the time required to familiarise to FRED exercise, which is required to inform future FRED based clinical trial protocols. This study therefore determined the effect of time, during FRED exercise, on biomechanical outcome measures, to establish the familiarisation period, and assess for loss of technique throughout a ten minute trial. A cohort comparison study of 148 participants, 70 experiencing low back pain, had lumbopelvic kinematics, exercise frequency and movement variability measured during a 10 minute trial. Magnitude-based inference was used to assess for familiarisation, using plots of variation over time with familiarised reference ranges. The no pain group took 170 seconds, and the back pain group took 150 seconds, to familiarise. A familiarisation period of at least 170 seconds (2.8 minutes) is recommended. This justifies, and provides a familiarisation time for use of the FRED as a motor control intervention.

Measurement error of 3D kinematic and kinetic measures during overground endurance running in recreational runners between two test sessions separated by 48 h.

OBJECTIVE: The purpose of this study was to quantify the measurement error of 3D kinematic and kinetic measures during overground endurance running between two sessions separated by 48 h. APPROACH: Thirteen recreational runners were assessed on two occasions while running overground, over embedded force plates and through an array of 3D cameras. MAIN RESULTS: In the sagittal, frontal and transverse planes, over the entire stance phase, the typical error of kinematic variables ranged from 1.33°-6.16° for the hip, 1.38°-6.01° for the knee and 0.48°-7.36° for the ankle. Over the same time period and planes typical error of peak-joint moments ranged from 0.04-0.54 Nm · Kg-1 for the hip, 0.06-0.37 Nm · Kg-1 for the knee and 0.01-0.15 Nm · Kg-1 for the ankle. SIGNIFICANCE: Results suggest 3D kinematic and kinetic measures of the stance phase in overground-endurance running are reliable between sessions separated by 48 h. The measurement error reported here could inform sample-size estimates for future studies and provide smallest-detectable changes for the interpretation of interventions performed over a similar time scale.

Systematic review of countermeasures to minimise physiological changes and risk of injury to the lumbopelvic area following long-term microgravity.

BACKGROUND: No studies have been published on an astronaut population to assess the effectiveness of countermeasures for limiting physiological changes in the lumbopelvic region caused by microgravity exposure during spaceflight. However, several studies in this area have been done using spaceflight simulation via bed-rest. The purpose of this systematic review was to evaluate the effectiveness of countermeasures designed to limit physiological changes to the lumbopelvic region caused by spaceflight simulation by means of bed-rest. METHODS: Electronic databases were searched from the start of their records to November 2014. Studies were assessed with PEDro, Cochrane Risk of Bias and a bed-rest study quality tool. Magnitude based inferences were used to assess countermeasure effectiveness. RESULTS: Seven studies were included. There was a lack of consistency across studies in reporting of outcome measures. Some countermeasures were found to be successful in preventing some lumbopelvic musculoskeletal changes, but not others. For example, resistive vibration exercise prevented muscle changes, but showed the potential to worsen loss of lumbar lordosis and intervertebral disc height. CONCLUSION: Future studies investigating countermeasures should report consistent outcomes, and also use an actual microgravity environment. Additional research with patient reported quality of life and functional outcome measures is advocated.

Testing the null hypothesis: the forgotten legacy of Karl Popper?

Testing of the null hypothesis is a fundamental aspect of the scientific method and has its basis in the falsification theory of Karl Popper. Null hypothesis testing makes use of deductive reasoning to ensure that the truth of conclusions is irrefutable. In contrast, attempting to demonstrate the new facts on the basis of testing the experimental or research hypothesis makes use of inductive reasoning and is prone to the problem of the Uniformity of Nature assumption described by David Hume in the eighteenth century. Despite this issue and the well documented solution provided by Popper's falsification theory, the majority of publications are still written such that they suggest the research hypothesis is being tested. This is contrary to accepted scientific convention and possibly highlights a poor understanding of the application of conventional significance-based data analysis approaches. Our work should remain driven by conjecture and attempted falsification such that it is always the null hypothesis that is tested. The write up of our studies should make it clear that we are indeed testing the null hypothesis and conforming to the established and accepted philosophical conventions of the scientific method.

Simple anthropometric and physical performance tests to predict maximal box-lifting ability.

Box-lifting ability is an important characteristic of military personnel. The purpose of this paper was to determine the usefulness of the upright row free weight exercise and simple anthropometric tests to predict maximal box-lifting performance that simulates the loading of military supply vehicles. Two groups of adults performed maximal box lifts to 1.4 m (study 1) and 1.7 m (study 2), respectively. All subjects were also tested for upright row 1 repetition maximum (1RM) strength, body mass, height, and body composition. In study 1, a remarkably good prediction of maximal box-lift performance to 1.4 m (42 +/- 12 kg) was obtained from a regression equation including the variables body mass, body composition, and upright row 1RM. Approximately 95% of the variation in 1.4-m box-lifting performance could be accounted for. In contrast, in study 2, only 80% of the variation in 1.7-m box-lifting performance (51 +/- 15 kg) could be accounted for by the best predictor equation. Upright row 1RM strength appears to be a useful tool in the prediction of box-lifting ability to approximately chest height for most adults, probably due to a close match between the muscle groups and contraction modes required during both tasks. Military or other organizations could use the data reported here to substitute simple anthropometry and a 1RM test of strength and for the direct assessment of 1.4-m box-lifting performance.