High-flow nasal cannula improves respiratory impedance evaluated by impulse oscillometry in chronic obstructive pulmonary disease patients: a randomised controlled trial.

Non-pharmacological treatment with high-flow nasal cannula (HFNC) may play a vital role in treatment of patients with chronic obstructive pulmonary disease (COPD). To evaluate the efficacy of HFNC, impulse oscillation system (IOS) is a new noninvasive technique in measuring the impedance of different portions of lungs. It shows higher sensitivity in contrast to conventional pulmonary function tests (PFT). However, whether IOS is an appropriate technique to evaluate the efficacy of HFNC in improving the impedance of small airways or peripheral lung in patients with COPD is still unclear. We enrolled 26 stable COPD participants randomised into two groups receiving HFNC or nasal cannula (NC) for 10 min followed by a 4-week washout period and crossover alternatively. IOS was used to detect the difference of respiratory impedance after HFNC or NC interventions. IOS parameters, PFT results, transcutaneous partial pressure of carbon dioxide, peripheral oxygen saturation, body temperature, respiratory rate, pulse rate, and blood pressure at the time of pre-HFNC, post-HFNC, pre-NC, and post-NC, were collected and analysed using SPSS (version 25.0, IBM, Armonk, NY, USA). The IOS measurement indicated that HFNC significantly improved R5, R5% predicted, R5-R20, X5-predicted, and Fres compared with NC, whereas no significant difference was observed through the PFT measurement. The beneficial effect of HFNC in improving small airway resistance and peripheral lung reactance compared with that of NC in patients with stable COPD was confirmed through IOS measurement.Trial registration: ClinicalTrials.gov NCT05130112 22/11/2021.

Efficacy of a home-based exercise program for orthotopic heart transplant recipients.

BACKGROUND: A hospital-based cardiac rehabilitation program can significantly improve the cardiopulmonary endurance and quality of life (QOL) in patients after orthotopic heart transplantation (OHT). Home-based programs for these patients have advantages of low cost and high accessibility, but little is known about their efficacy. This prospective study was designed to evaluate the effect of an 8-week home-based exercise program on muscular strength and endurance of lower limbs, aerobic capacity and QOL in OHT recipients. METHODS: Thirty-seven OHT recipients were randomized into exercise (n = 14) or control (n = 23) groups. Exercise group subjects were to exercise at least 3 times a week for 8 weeks. Each subject was evaluated by Cybex testing of right quadriceps strength and endurance, 1-min sit-to-stand test, a symptom-limited maximal exercise test and QOL assessment before and after 8 weeks. RESULTS: Subjects in the exercise group improved significantly in sit-to-stand test, fatigue index of the right quadriceps, maximal workload achieved and physical domain of QOL compared to controls after 8 weeks, regardless of older age and lower value for sit-to-stand test at baseline. CONCLUSIONS: OHT recipients can significantly improve their muscular endurance, sit-to-stand test scores and QOL after a medically directed home-based exercise program.

Home-based exercise increases exercise capacity but not quality of life in people with chronic heart failure: a systematic review.

QUESTIONS: Does home-based exercise improve exercise capacity and quality of life in people with chronic heart failure? Is it safe? DESIGN: Systematic review with meta-analysis. PARTICIPANTS: Adults with heart failure > 3 months duration. INTERVENTION: Home-based aerobic exercise with or without resistance exercise. OUTCOME MEASURES: Exercise capacity (measured at the impairment level by peak VO2 and at the activity level by 6-min Walk Test), quality of life (measured by disease-specific scales), and adverse events (measured as death, hospitalisation). RESULTS: 10 randomised controlled trials with 648 participants of New York Heart Association Class II or III were included. Most participants were male > or = 50 years old with an ejection fraction < or = 40%. The exercise programs ranged from 6 weeks to 9 months at low to moderate intensity (40-70% of maximum heart rate or heart rate at 70% peak VO2. Home-based exercise increased 6-min walking distance by 41 m (WMD, 95% CI 19 to 63) and peak VO2 by 2.71 ml/kg/min (WMD, 95% CI 0.67 to 4.74) more than usual activity. It did not improve scores on the Minnesota Heart Failure Questionnaire (WMD 0.5 points out of 105, 95% CI -4.4 to 5.4) or increase the odds of hospitalisation (OR 0.75, 95% CI 0.19 to 2.92) more than usual activity. CONCLUSIONS: Home-based exercise increased exercise capacity safely but did not improve quality of life in patients with chronic heart failure. It could therefore be used to improve the management of people with chronic heart failure who do not have access to hospital-based exercise.

Gender differences in myocardial perfusion defect in asymptomatic postmenopausal women and men with and without diabetes mellitus.

BACKGROUND: To compare the results of myocardial perfusion imaging (MPI) of asymptomatic postmenopausal women and age-matched men and to investigate the effect of diabetes mellitus (DM) on gender differences and the risk estimation of coronary heart disease (CHD). METHODS: Sixty-seven postmenopausal women and 27 men low in Framingham Global Risk Score (FGRS) were recruited from year 2008 to 2009 in northern Taiwan. Each subject underwent blood tests, a cardiopulmonary exercise test, an electrocardiograph (ECG), and MPI. RESULTS: Women had similar percentages of predicted oxygen consumption and ECG changes at peak exercise, but lower oxygen pulse and rate-pressure product. They also had significantly higher summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) than men, despite showing much lower scores for the FGRS than men. Women with DM had a lower 10-year risk of CHD assessed by the United Kingdom Prospective Diabetes Study (UKPDS) risk engine, but significantly higher SSS and SDS than men. In the subjects with abnormal MPI, the extent of ischemia was small to moderate in men, whereas in 50% of the women, the extent of ischemia was large. CONCLUSION: The results of this preliminary study suggest that asymptomatic postmenopausal women had more abnormalities in MPI and those with DM had a higher SSS and SDS than age-matched men. The risk of CAD may still be underestimated by the UKPDS.

Home-based exercise improves the quality of life and physical function but not the psychological status of people with chronic heart failure: a randomised trial.

QUESTIONS: Are anxiety and depression correlated with physical function, disability, and quality of life in people with chronic heart failure? Does 8 weeks of home-based exercise improve anxiety, depression, physical function, disability, and quality of life in these patients? Do the changes in these outcomes correlate? DESIGN: Randomised trial. PARTICIPANTS: 51 people with clinically stable chronic heart failure were randomised into an experimental group (n=24) or a control group (n=27). INTERVENTION: The experimental group undertook an individualised home-based exercise program, 30 minutes per session, 3 sessions per week for 8 weeks, with regular telephone follow-up and consultations. The control group maintained their usual activity during this period. OUTCOME MEASURES: The Hospital Anxiety and Depression Scale, six-minute walk test, Groningen Activity Restriction Scale, and Minnesota Living with Heart Failure Questionnaire were administered at baseline and 8 weeks. RESULTS: At baseline, anxiety and depression were inversely moderately correlated with walking distance, activity, and quality of life. Compared with controls, the experimental group improved significantly more in their walking distance (by 21m, 95% CI 7 to 36) and their quality of life (by 7 points on the 105-point Minnesota score, 95% CI 1 to 12). In the experimental group, the changes in quality of life correlated moderately strongly with changes in anxiety (r=0.539, p=0.01). CONCLUSIONS: Anxiety and depression were associated with physical function, disability, and quality of life in people with chronic heart failure. Home-based exercise improved quality of life and physical function significantly but not psychological status in these patients.

Myocardial perfusion image in asymptomatic postmenopausal women with physical inactivity and overweight.

OBJECTIVE: This study aimed to investigate whether physical inactivity and overweight deteriorate myocardial perfusion and cardiac function in asymptomatic postmenopausal women. METHODS: A prospective cross-sectional study design was used. Postmenopausal women recruited in this study were categorized into groups based on activity level and BMI: physically active, normal-weight group (PANw, n = 15, 60.9 ± 6.0 years), physically inactive, normal-weight group (PIANw, n = 13, 57.2 ± 5.0 years) and physically inactive, overweight group (PIAO, n = 26, 58.5 ± 5.8 years). Each subject took cardiopulmonary function tests and ECG-gated exercise (201)Tl myocardial perfusion imaging (MPI). Perfusion abnormalities, cardiac function indices, and (201)Tl lung-to- heart ratio (LHR) were derived. RESULTS: The PIANw women had lower exercise capacity than PANw women. More subjects in PIANw (46%) or PIAO (48%) groups had worsening in left ventricular ejection fraction (LVEF) by exercise than subjects in PANw (7%) group. The PIAO women exhibited significantly lower exercise capacity and higher rest LHR than PANw women (LHR 0.41 ± 0.05 vs. 0.36 ± 0.06; p = 0.014). Abnormal MPI tended to increase in PIANw (38%) and PIAO (46%) women when compared with the PANw (27%) group. CONCLUSIONS: Physically inactive, overweight postmenopausal women had higher rest (201)Tl lung uptake and worsening LVEF by exercise and tended to have higher prevalence of inducible ischemia, suggesting higher cardiovascular risks although asymptomatic.

Resistance training increases 6-minute walk distance in people with chronic heart failure: a systematic review.

QUESTION: Does resistance training, either alone or as an adjunct to aerobic training, improve cardiac function, exercise capacity and quality of life in people with chronic heart failure? DESIGN: Systematic review with meta-analysis of randomised trials. PARTICIPANTS: Adults with stable chronic heart failure. INTERVENTION: Progressive resistance exercise training, alone or as an adjunct to aerobic training. OUTCOME MEASURES: Cardiac function, exercise capacity and quality of life. RESULTS: 241 participants from eight trials performed 2 to 6 months of moderate-intensity resistance training (50-75% of 1RM). Most programs consisted of 5 to 6 exercises for large limb and trunk muscles with two sets of 8 to 12 repetitions, three times a week. Resistance training significantly increased 6-minute walk distance (WMD 52 m, 95% CI 19 to 85) but not peak oxygen consumption (WMD 1.4 ml/kg/min, 95% CI -0.3 to 3.1). When used as an adjunct to aerobic training, resistance training did not significantly alter left ventricular ejection fraction (WMD -0.5%, 95% CI -4.3 to 3.3), peak oxygen consumption (WMD -0.7 ml/kg/min, 95% CI -2.3 to 1.0), or Minnesota Living with Heart Failure Questionnaire scores (WMD -0.9, 95% CI -5.4 to 3.7), compared with aerobic training alone. CONCLUSION: Resistance training increased 6-minute walk distance compared to no training, but had no other benefits on cardiac function, exercise capacity, or quality of life if used alone or as an adjunct to aerobic training in people with chronic heart failure. However, further high quality, large scale, randomised trials are needed.