A High-Intensity versus Moderate-Intensity exercise training program in Alpha-1 antitrypsin deficiency-related COPD (IMAC): a randomized, controlled trial.

INTRODUCTION: Training-induced adaptations of the oxidative capacity have been shown to be blunted in alpha-1 antitrypsin deficiency (AATD)-related chronic obstructive pulmonary disease (COPD). To improve training outcomes in AATD, this study was aimed to compare the effects of two exercise training programs with different training intensities. METHODS: 30 patients with AATD (genotype PiZZ) and COPD III-IV were randomly assigned either to high-intensity (HIT) or moderate-intensity training (MIT), each consisting of endurance, strength and a squat training for a duration of 3 weeks. 6-minute walk distance (6MWD) was used as the primary outcome. RESULTS: 25 subjects augmented with alpha-1 antitrypsin (HIT: n=12, FEV1 41.3±17.4%pred., MIT: n=13, FEV1 45.9±15.5%pred.) completed the study. In HIT and MIT, 6MWD (+37±43m vs. +32±28m, p=0.741), 1-minute sit-to-stand test (5.6±4.9 repetitions vs. 5.6±4.5 repetitions, p=0.766), exercise-induced BORG dyspnoea (-1.4±1.7pts vs. -1.5±2.4pts, p=0.952) and all CRQ domains have improved after training without between-group differences. When considering only subgroups of (probably) anxious or depressive patients (Hospital Anxiety and Depression Scale [HADS] ≥ 8 pts), only HIT induced a significant reduction of anxiety (-4.8 pts, 95% CI [2.1 to 7.5]) or depression symptoms (-5.0 pts, 95% CI [2.8 to 7.3]). CONCLUSION: Although HIT and MIT were equally effective by improving exercise capacity, quality of life and dyspnoea in homozygous AATD, HIT may show advantages over MIT, if anxiety or depression symptoms were present. The goal should be personalized training based on the patient's personal preference in order to achieve long-term adherence.

[Overview on pulmonary rehabilitation]. / Übersicht zur pneumologischen Rehabilitation.

Pulmonary rehabilitation (PR) is an evidence-based multidisciplinary treatment for patients with chronic respiratory diseases. The indications for PR prescription are given if there is a rehabilitation capability, a need for rehabilitation and a beneficial rehabilitation prognosis. The aims of PR are to reduce symptoms and to improve the quality of life and the patients' physical capacity. The effectiveness of PR is well-proven for patients with chronic obstructive pulmonary disease (COPD) at the highest level of evidence and for non-COPD patients with an increasing level of evidence based on randomized controlled trials and meta-analyses. The treatment content of PR is individually adapted to the patients' needs by a multimodal and multidisciplinary treatment team. To maintain the rehabilitation benefits of PR there is the possibility to participate in outpatient follow-up programs as well as to use digital technologies.

[S1 Guideline Post-COVID/Long-COVID]. / S1-Leitlinie Post-COVID/Long-COVID.

The German Society of Pneumology initiated the AWMFS1 guideline Post-COVID/Long-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendation describes current post-COVID/long-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an expilcit practical claim and will be continuously developed and adapted by the author team based on the current increase in knowledge.

[Smoking Cessation and Prescription of Ambulatory Exercise Training as Part of Pulmonary Rehabilitation in Germany]. / Tabakentwöhnung und Verordnung von ambulantem Lungensport im Rahmen der pneumologischen Rehabilitation in Deutschland.

PURPOSE: This survey was conducted on behalf of the German Respiratory Society (DGP) section 12. The aim was to assess the means of achieving tobacco cessation and prescription of exercise training on an outpatient basis after discharge from pulmonary rehabilitation clinic as part of aftercare of pulmonary rehabilitation programs in Germany. METHODS: We contacted all pulmonary rehabilitation clinics in Germany. Of the 67 clinics we identified, 62 fulfilled the inclusion criteria; 39 clinics (62.9 %) agreed to participate and returned the completed questionnaires. RESULTS: Each clinic rated ambulatory exercise training sessions as effective aftercare. In each case, slightly above 50 % of the sample informed their patients via standardized talks or information brochures. In 38.5 % of the clinics, ambulatory exercise in groups was provided as aftercare. The number of patients who received prescription for aftercare at the end of the rehabilitation program ranged between 0 % and 100 %. Only a quarter of the clinics had ever been asked by the funding organizations regarding the success rate of the exercise program. All clinics assessed the smoking status of their patients and explained the importance of tobacco abstinence to them. The percentage of smokers was estimated to be 33 %; 69.7 % of the clinics stated that the rehabilitation program included standardized talks regarding tobacco cessation and 61.5 % reported having therapeutic group meetings on a regular basis. Further treatment options included psychological counselling (89.7 %), nicotine replacement therapy (61.5 %), or varenicline (15.4 %). Aftercare was offered only in 10.3 % of the clinics. On average, the percentage of smokers who achieved tobacco abstinence during the rehabilitation program was 32 %. Only one clinic (2.6 %) had ever been asked by the funding organization regarding the success rate of the tobacco cessation program. CONCLUSION: This survey emphasizes that most of the pulmonary rehabilitation clinics in Germany have already achieved a good standard regarding tobacco cessation and exercise training programs for their inpatients; however, there are still areas of improvement as far as providing care after discharge from a rehabilitation clinic is concerned with regard to smoking cessation and prescription of ambulatory exercise training.

[Rehabilitation in pneumology]. / Rehabilitation in der Pneumologie.

Pulmonary rehabilitation (PR) is an evidence-based multidisciplinary treatment for patients with chronic respiratory diseases. The indications for applying for PR are given if there is an appropriate rehabilitation capability, need for rehabilitation and favorable rehabilitation prognosis. The aims of PR are the reduction of symptoms and improvement of the quality of life and physical resilience. The efficiency of PR is well proven for patients with chronic obstructive pulmonary disease (COPD) with the highest evidence grade and for non-COPD patients with an increasing level of evidence based on randomized controlled trials and meta-analyses. The treatment content of PR is individually adapted to the patients' needs by a multidisciplinary treatment team. In order to sustainably maintain the success of PR there is the possibility to participate in outpatient aftercare programs (e.g. breathing exercises) and to utilize digital technologies as supporting measures.

Effects of Vibration Training in Interstitial Lung Diseases: A Randomized Controlled Trial.

BACKGROUND: Numerous studies have reported positive effects of exercise training in patients with interstitial lung disease (ILD) on physical capacity and quality of life. However, evidence is rare on the effects of specific forms of training and further pathophysiological mechanisms in these patients. OBJECTIVES: In this multicenter study we aimed to explore the clinical effects of whole-body vibration training (WBVT) in patients with ILD on various outcome measures, including proinflammatory cytokines and myostatin. METHODS: We randomly assigned 26 patients with different forms of multidisciplinary confirmed fibrotic ILDs either to the WBVT group (n = 11; 55% male, 61 ± 14 years old, forced vital capacity 83.2 ± 29.3% predicted, 6-min walking distance [6MWD] 478 ± 79 m) performing 3 months of a standardized training (3 times per week), or to a control training group (CTG, n = 15; 60% male, 63 ± 9 years old, FVC 74.6 ± 20.5% predicted, 6MWD 455 ± 85 m) performing sham WBV training. Training in the two groups was performed on a GalileoTM vibration plate (6-20 vs. 5 Hz). The functional assessments before and after the intervention period included pulmonary function, 6MWD test, chair rise test, ultrasonographic measurement of quadriceps muscle thickness (cross-sectional area), quality of life questionnaires, and serum samples. RESULTS: We observed a significant increase in 6MWD (∆Training = 30 m [12-67], p = 0.024) and a decrease of myostatin (∆Training = -465 pg/mL [-713 to -166], p = 0.008) in the WBVT group. In contrast, no significant differences were observed in the CTG. CONCLUSIONS: The present study demonstrates that WBVT is able to significantly increase 6MWD and decrease myostatin in patients with fibrotic ILDs. Therefore, WBVT seems to be a beneficial and feasible training modality in ILD patients. Clinical Trial Registry: German Clinical Trials Registry (DRKS00012930).

[Pulmonary Rehabilitation after Acute Exacerbation of COPD Reduces the Rate of Reexacerbations]. / Eine pneumologische Rehabilitation nach akuter Exazerbation der COPD senkt die Rate erneuter Exazerbationen.

Objective Acute exacerbation of COPD (AECOPD) provides for patients a significant hazard and is crucial for the prognosis. Data on the effects of pulmonary rehabilitation (PR) on the frequency of reexacerbations after AECOPD are inconsistent. A prospective, case-control study was conducted with the aim of measuring the impact of PR on the frequency of reexacerbations after AECOPD. Patients and Methods A PR was performed in 57 patients with COPD after AECOPD. 30 participants were followed-up after one year and compared to 32 Control-Group (KG = hospitalized for AECOPD without PR). The rate of reexacerbations was both retrospectively in the year preceding the AECOPD, and prospectively in the year after AECOPD analyzed within groups and between groups. Results In the intra group comparison the exacerbation rate was significantly lower in the PR-group in the year after rehabilitation (0.97 ±â€Š2.67 vs. 1.52 ±â€Š1.12; p < 0.001). The intergroup comparison also showed a significantly lower number of exacerbations for the PR-group (0.97 ±â€Š1.52 vs 2.16 ±â€Š1.25; p < 0.001). Conclusion It was shown that the exacerbation rate after an AECOPD could be significantly reduced in the PR-group in comparison to the KG-group during the investigation period of one year by PR. More prospective studies are required to define the value of PR in the context of AECOPD.

Inspiratory muscle training protocol for patients with chronic obstructive pulmonary disease (IMTCO study): a multicentre randomised controlled trial.

INTRODUCTION: Inspiratory muscle training (IMT) has been applied during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear if the addition of IMT to a general exercise training programme leads to additional clinically relevant improvements in patients with COPD. In this study, we will investigate whether the addition of IMT to a general exercise training programme improves 6 min walking distance, health-related quality of life, daily physical activity and inspiratory muscle function in patients with COPD with inspiratory muscle weakness. METHODS AND ANALYSIS: Patients with COPD (n=170) with inspiratory muscle weakness (Pi,max <60 cm H2O or <50%pred) will be recruited to a multicentre randomised placebo controlled trial of IMT and allocated into one of the two groups. Patients in both groups will follow a 3 month general exercise training programme, in combination with home-based IMT. IMT will be performed with a recently developed device (POWERbreathe KH1). This device applies an inspiratory load that is provided by an electronically controlled valve (variable flow resistive load). The intervention group (n=85) will undertake an IMT programme at a high intensity (≥50% of their Pi,max), whereas the placebo group (n=85) will undertake IMT at a low training intensity (≤10% of Pi,max). Total daily IMT time for both groups will be 21 min (6 cycles of 30 breaths). Improvement in the 6 min walking distance will be the primary outcome. Inspiratory muscle function, health-related quality of life and daily physical activity will be assessed as secondary outcomes. ETHICS AND DISSEMINATION: Ethics approval has been obtained from relevant centre committees and the study has been registered in a publicly accessible clinical trial database. The results will be easily interpretable and should immediately be communicated to healthcare providers, patients and the general public. RESULTS: This can be incorporated into evidence-based treatment recommendations for clinical practice. CLINICALTRIALSGOV: NCT01397396.