Effect of rehabilitation program on endocrinological parameters in patients with COPD and in healthy subjects.

BACKGROUND: Skeletal muscle wasting commonly occurs in patients with chronic obstructive pulmonary disease (COPD) and has been associated with the presence of systemic inflammation and endocrinological disturbance. The aim of this study is to analyze the effect of rehabilitation program on the balance of anabolic versus catabolic hormone in patients with COPD and in healthy subjects. METHODS: Nineteen patients with COPD and 16 age-matched healthy subjects undertooked exercise training 3 days/week for 8 weeks. Before and after the training program the concentration of growth hormone (GH), Insulin-Like Growth Factor-1 (IGF-1), Insulin-like Growth Factor-Binding Protein 3 (IGF-BP3), testosterone and cortisol in serum were determined. The exercise measurements included a 6-Minute Walking Test (6MWT). RESULTS: After 8 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. Growth hormone, Insulin-like Growth Factor-1 and Insulin-like Growth Factor-Binding Protein 3 increased significantly after rehabilitation training (p < 0.01). The rehabilitation program improves the testosterone/cortisol ratio (T/C ratio) in both groups. There is a significant improvement in the 6-Minute Walking distance (6MWD) in both groups (p < 0.01). Dyspnea and heart rate at rest and at the peak of the 6-Minute Walking Test (6MWT) decreased significantly after training program (p < 0.01). CONCLUSION: Pulmonary rehabilitation induces an improvement of the anabolic process and reduces proteine distruction by the modifications in endocrinological factors regulating skeletal muscle in patients with COPD.

Morning-evening differences of short-term maximal performance and psychological variables in female athletes.

The aim of this study was to examine the effect of time of day on short-term maximal performance and psychological variables in young females. Fifteen active women participated in the study (age: 22 ± 3 years) and completed Hooper and the POMS-F questionnaires subsequently. In a randomized order, they performed a maximum of 30 s cycling exercise at two different times of day: in the morning at 07:00 h and in the afternoon at 16:00 h with a recovery period of 48 h. The digit cancellation test, countermovement jump (CMJ), squat jump (SJ) test, and the lower quarter Y balance test were performed at the beginning and at the end of each session. Our results showed that only peak power and mean power (p < 0.01) during the maximum 30 s cycling, reaching distances during the Y-balance (p < 0.05), Jump height in CMJ and SJ (p < 0.01) as well as attention, vigor, and stress scores (all p < 0.01) were higher in the afternoon than in the morning. Our results indicated a daily diurnal variation in short-term maximal performance and mood states in young athletic women with better performance observed during the afternoon.

Specific balance training included in an endurance-resistance exercise program improves postural balance in elderly patients undergoing haemodialysis.

PURPOSE: The purpose of this study was to evaluate the effects of 6 months of specific balance training included in endurance-resistance program on postural balance in haemodialysis (HD) patients. METHODS: Forty-nine male patients undergoing HD were randomly assigned to an intervention group (balance training included in an endurance-resistance training, n = 26) or a control group (resistance-endurance training only, n = 23). Postural control was assessed using six clinical tests; Timed Up and Go test, Tinetti Mobility Test, Berg Balance Scale, Unipodal Stance test, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scale. RESULTS: All balance measures increased significantly after the period of rehabilitation training in the intervention group. Only the Timed Up and Go, Berg Balance Scale, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scores were improved in the control group. The ranges of change in these tests were greater in the balance training group. CONCLUSIONS: In HD patients, specific balance training included in a usual endurance-resistance training program improves static and dynamic balance better than endurance-resistance training only. Implications for rehabilitation Rehabilitation using exercise in haemodialysis patients improved global mobility and functional abilities. Specific balance training included in usual endurance resistance training program could lead to improved static and dynamic balance.

Minimal Detectable Change for Balance Measurements in Patients With COPD.

PURPOSE: The purpose of this study was to determine the reliability and minimal detectable change (MDC) of various outcome measures that are potentially suitable for evaluating postural control in individuals with chronic obstructive pulmonary disease (COPD). METHODS: This was a test-retest reliability study. Participants with COPD were asked to complete 5 balance assessments, separated by 1 week. The assessments included Timed Up and Go (TUG) Test, Unipodal Stance Test (UST), Tinetti Test, Berg Balance Scale (BBS), and the Activities Balance Confidence (ABC) scale. Test-retest reliability using intraclass correlation coefficients and MDC values were calculated for each assessment. RESULTS: All 5 outcome measures were found to have excellent test-retest reliability (r > 0.90). The MDC95 values were 3.01 seconds and 4.03 seconds for the TUG Test and the UST, respectively; 3.23 points and 3.46 points for the Tinetti Test and the BBS, respectively; and 8.25% for the ABC scale. CONCLUSION: The TUG, UST, BBS, the Tinetti Test, and the ABC scale are reliable outcome measures for use with people with COPD, recognizing that individual variability of performance is high. Minimal detectable change scores at the 95% CI can be used to assess change in performance over time and the impact of interventions in this population.

The Effect of Interdialytic Combined Resistance and Aerobic Exercise Training on Health Related Outcomes in Chronic Hemodialysis Patients: The Tunisian Randomized Controlled Study.

Background: Tunisia has the highest prevalence of hemodialysis patients compared to the other countries in North Africa. Dialysis centers rarely offer an exercise program to prevent physiological and psychological dialysis therapy-related alterations in chronic hemodialysis patients. Aim: To examine the effect of combined endurance-resistance training program on physiological and psychological outcomes in patients undergoing hemodialysis. Methods: We designed a single blinded, randomized, controlled study for a period of 4 months. Patients were randomized to intervention group or control group. Intervention group patients received 4 training sessions per week, held on non-hemodialysis days for a period of 4 months, whereas control group patients continued their regular lifestyle practice without direct intervention from the personnel of this investigation. Patients were evaluated at baseline (initial assessment) and after the four-month study period (final assessment) by the same investigator blinded to treatment group assignment using physical, physiological, and psychological measurements. Results: Compared with control group, intervention group showed significant improvement in physical performance during the sit-to-stand-to-sit tests (STS-10: -16.2%, ES = -1.65; STS-60: +23.43%, ES = 1.18), handgrip force task (+23.54%, ES = 1.16), timed up and go test (-13.86%, ES = -1.13), and 6-min walk test (+15.94%, ES = 2.09). Likewise, mini nutritional assessment long form scores after intervention period were significantly higher in the intervention group compared to the control group (ES = 1.43). Physical and mental component scores of SF-36 questionnaire increased significantly in the intervention group (ES = 1.10 and ES = 2.06, respectively), whereas hospital anxiety and depression scale scores decreased significantly (ES = -1.65 and ES = -2.72, respectively). Regarding biological parameters, intervention group displayed improvement in systolic and diastolic blood pressures (ES = -2.77 and ES = -0.87, respectively), HDL-cholesterol, LDL-cholesterol, and triglycerides systematic levels (ES = 1.15, ES = -0.98, and ES = -1.01, respectively); however no significant effect of intervention period was observed on C-reactive protein, hemoglobin, albumin, and total cholesterol levels (P > 0.05). Conclusion: The current study showed that combined endurance-resistance training program had a beneficial effect on physical capacity and quality of life in chronic hemodialysis patients.

Effects of listening to Holy Qur'an recitation and physical training on dialysis efficacy, functional capacity, and psychosocial outcomes in elderly patients undergoing haemodialysis.

The purpose of this study was to determine whether listening to Holy Qur'an recitation would augment the beneficial effects of physical exercise on physiological and psychological measures in elderly patients undergoing haemodialysis. Fifty-three male haemodialysis patients were randomly assigned to an intervention group (listening to Holy Qur'an recitation in combination with endurance-resistance training, n = 28) or a control group (endurance-resistance training only, n = 25). Functional capacity was assessed using the Timed Up and Go test (TUG) and the Six-Minute Walk Test (6MWT). Psychosocial outcomes were assessed using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). Dialysis adequacy (Kt/V) was calculated for all patients. After intervention, a significant Group × Period interaction effect was observed for all measured parameters (p < 0.05), except for 6MWT performance (p > 0.05). All measured parameters were significantly improved over baseline in both groups, except for Kt/V in the control group (p > 0.05). Moreover, final measurements were significantly higher in the intervention group than in the control group for all measured parameters, except for 6MWT performance and the physical component summary of the SF-36 (p > 0.05). In conclusion, the present study showed that listening to a recitation of the Holy Qur'an in combination with interdialytic endurance-resistance training induced an improvement in physical condition and quality of life and a large reduction in anxiety among patients undergoing haemodialysis.

Effect of 6 Months of Balance Training During Pulmonary Rehabilitation in Patients With COPD.

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 between-group 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.

Balance Training in Pulmonary Rehabilitation: EFFECTS ON PSYCHOSOCIAL OUTCOMES.

PURPOSE: Balance impairment in chronic obstructive pulmonary disease (COPD) is associated with a worsening of quality of life (QOL) as related with fatigue perception, depression, and anxiety. The aim of this study was to examine the effect of balance training included in pulmonary rehabilitation (PR) on QOL, fatigue perception, depression, and anxiety in patients with COPD. METHODS: Patients were assigned randomly to an intervention or PR-only group. The intervention group underwent balance training 3 times a week for 6 months concurrently with PR. The PR-only group received 6 months of the standard PR program. Quality of life was assessed at the beginning and at the end of the program using the St. George's Respiratory Questionnaire, fatigue using the Multidimensional Fatigue Inventory, and anxiety and depression using the Hospital Anxiety and Depression Scale. Exercise tolerance was determined from the 6-minute walk test. RESULTS: After the 6 months of the intervention or PR-only, both the intervention (n = 32) and PR-only (n = 30) groups improved their QOL (activity, impact, and total) with a significant intergroup difference (P < .05) after PR. General fatigue, physical fatigue, and reduced activity decreased in both groups with an intergroup difference (P < .05). Anxiety decreased significantly in both groups with a greater change in the intervention group (P < .01). Only the intervention group had an improved depression score at the end of 6 months. CONCLUSIONS: Balance training added to PR improved health-related QOL, fatigue, and mental health in patients with COPD.