Effects of Combined Endurance and Resistance Eccentric Training on Muscle Function and Functional Performance in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial.

OBJECTIVE: To evaluate the adherence to treatment and efficacy of an eccentric-based training (ECC) program on peripheral muscle function and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Prospective, assessor-blinded, randomized controlled trial. SETTING: The cardiopulmonary rehabilitation unit of a tertiary subacute referral center. PARTICIPANTS: Thirty (N=30) stable inpatients (mean age 68±8 years; FEV1 44±18% of predicted) with COPD were included in the study. INTERVENTIONS: Inpatients were randomly assigned to 4 weeks of a combined endurance and resistance ECC (n=15) or conventional training (CON; n=15). MAIN OUTCOME MEASURES: Quadriceps peak torque (PT) was the primary outcome measure for muscle function. Rate of force development (RFD), muscle activation and quality (quadriceps PT/leg lean mass), 6-min walk distance (6MWD), 4-meter gait speed (4mGS), 10-meter gait speed, 5-repetition sit-to-stand (5STS), dyspnea rate, and mortality risk were the secondary outcomes. Evaluations were performed at baseline and repeated after 4 weeks and 3 months of follow-up. RESULTS: Quadriceps PT, RFD, and muscle quality improved by 17±23% (P<.001), 19±24%, and 16±20% (both P<.05) within the ECC group. Besides, a significant between-group difference for RFD (56±94 Nm/s, P=.038) was found after training. Both groups showed clinically relevant improvements in 6MWD, 4mGS, dyspnea rate, and mortality risk, with no significant differences between groups. CONCLUSION: Combined endurance and resistance ECC improved lower limbs muscle function compared with CON in inpatients with COPD. In contrast, ECC did not further improve functional performance, dyspnea, and mortality risk. ECC may be of particular benefit to effect on skeletal muscle function in patients with COPD.

Respiratory rehabilitation for patients with COVID-19 infection and chronic respiratory failure: a real-life retrospective study by a Lombard network.

The Lombardy region has been one of the areas most affected by the COVID-19 pandemic since the first months of 2020, providing real-life experiences in the acute phase. It is unclear how the respiratory rehabilitation network responded to this emergency. The aims of this retrospective study were: i) to analyze clinical, functional, and disability data at admission; ii) describe assessment tools and rehabilitative programs; iii) evaluate improvement after rehabilitation. The study was conducted on data collected from ten pulmonary rehabilitation centers in Lombardy, between the period of March 1st 2020 to March 1st 2021, in patients with respiratory failure recovering from COVID-19 both at admission and discharge. The study included demographics, comorbidities, nutritional status, risk of falls, disability status (Barthel index; Short Physical Performance Battery (SPPB); 6 minutes walking test (6MWT), symptoms (dyspnoea with Barthel Dyspnoea and MRC Dyspnoea Scale), length of stay, discharge destination, need for mechanical ventilation, respiratory function, assessment/outcomes indices, and prescribed rehabilitative programs. 413 patients were analyzed. Length of stay in acute and rehabilitative units was less than 30 days. Fifty % of patients used non-invasive ventilation during their stay. Functional status was mildly compromised for forced volumes and oxygenation, while severely compromised for diffusion capacity. Independency was low while physical performance status very low.  At discharge, 318 (77%) patients were sent home, 83 (20.1%) were transferred to an acute unit and 12 (2.9%) passed away. Barthel Index and 6MWT were the most used, while MRC score was the least used outcome parameter. The 5 main rehabilitative activities were walking (90.8 %), transfer from bed to armchair (77.5%), limb mobilization in bed (76%), balance (71.2%), and cycle-ergometer or treadmill (43.1%). A huge difference was found in admission, discharge, and delta change among different rehabilitative centers. When available, all outcomes showed a significant improvement. With the limitation of a retrospective study with a clear amount of missing data, COVID-19 subjects admitted to rehabilitative centers presented a reduced physical performance, symptoms of dyspnoea, and severe disability. The 6MWT and Barthel index were the most used measurement.

The Association Between the Probability of Sarcopenia and Functional Outcomes in Older Patients Undergoing In-Hospital Rehabilitation.

OBJECTIVE: Sarcopenia is a geriatric syndrome with a prevalence ranging from 5% to 50% in community-dwelling adults. It is associated with adverse outcomes including worse functional status, falls, and mortality. A paucity of studies have included an assessment of sarcopenia among older adults receiving in-hospital rehabilitation. This is, at least partially, due to the lack of simple assessment methods to reliably measure muscle mass. The objective of this study was to evaluate the probability of sarcopenia using a validated simple method and examine the association between sarcopenia and functional outcomes at discharge. SETTING: One in-hospital rehabilitation setting. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 280 patients 65 years and older who were admitted to in-hospital rehabilitation. MEASUREMENTS: The probability of sarcopenia was determined using a validated method that includes 3 variables: age, grip strength, and calf circumference. Two multivariable linear regression models were used to analyze the association between the probability of sarcopenia and the following functional outcome measures: (1) total Barthel index (BI) score; and (2) BI walking mobility subitem. Each analysis adjusted for the following covariates: age, gender, admission diagnoses, body mass index, comorbidity, C-reactive protein, number of medications on admission, Mini- Mental State Examination total score, and change in the functional outcome measure from admission to discharge. RESULTS: Patients were mainly female (66%) with a mean age of 82 ± 7 years. The mean probability of sarcopenia overall was 60%. About one-half of the patients had a probability of sarcopenia ≥75% (N = 140). The remaining patients were distributed as follows: probability of sarcopenia <25% (N = 79); 25%-49% (N = 26); and 50%-74% (N = 34). The probability of sarcopenia was significantly associated with an overall worse functional status at discharge based on total BI score (point estimate -8.5; standard error 17.1; P < .0001) and ability to walk at discharge as measured with the BI walking mobility subitem (point estimate -1.3; standard error 0.5; P = .02) after adjusting for relevant covariates. CONCLUSIONS: These findings support the use of a simple screening tool for probable sarcopenia among older adults receiving in-hospital rehabilitation to increase the ability of clinicians to initiate early interventions to improve functional outcomes at discharge.