Effectiveness of a community-based exercise training programme to increase physical activity level in patients with chronic obstructive pulmonary disease: A randomized controlled trial.

BACKGROUND AND PURPOSE: The exercise training included in pulmonary rehabilitation (PR) programmes improves exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD). Nevertheless, the duration of these effects is limited, and the implementation of PR is still insufficient. Moreover, the physical activity level of COPD patients is low, and it is not modified with the classic PR programmes. The purpose of this study was to assess the effects of a community-based PR programme designed to increase physical activity in COPD patients. METHODS: Stable COPD patients were assigned to either an experimental group (EG, n = 17) who followed a community-based 8-week programme consisting of exercise training through walking and a plan to increase activity, using a pedometer for feedback; or a control group (n = 16), who followed general recommendations to walk more every day. The following were evaluated postintervention, after 3 months, and after 12 months: exercise capacity (endurance shuttle test [EST]), physical activity (steps/day and modified Baecke questionnaire), quality of life (St. George's Respiratory Questionnaire [SGRQ]), dyspnoea (modified Medical Research Council scale), and exacerbations. RESULTS: Postintervention, the EG showed significant improvements in EST times (7.6 min [4.4, 10.7]), distance (549 m [282, 815]; p < 0.01, both), number of steps (3,361 [1,553, 5,118]), and Baecke scores (1.6 [0.2, 3.1], p < 0.01). SGRQ scores decreased (-5.4 [-8.6, -2.4], p < 0.01). These results remained evident after 3 and 12 months (p < 0.01). There were no differences between the groups nor in the exacerbations or dyspnoea. A significant association was found between increase in physical activity level, improvement in exercise capacity, and quality of life during the period monitored. CONCLUSIONS: A community-based programme of exercise training through walking and increased physical activity, using pedometers as feedback, produces short- and long-term improvements in exercise capacity, physical activity level, and quality of life in COPD patients.

Gait phenotypes in paediatric hereditary spastic paraplegia revealed by dynamic time warping analysis and random forests.

The Hereditary Spastic Paraplegias (HSP) are a group of heterogeneous disorders with a wide spectrum of underlying neural pathology, and hence HSP patients express a variety of gait abnormalities. Classification of these phenotypes may help in monitoring disease progression and personalizing therapies. This is currently managed by measuring values of some kinematic and spatio-temporal parameters at certain moments during the gait cycle, either in the doctor´s surgery room or after very precise measurements produced by instrumental gait analysis (IGA). These methods, however, do not provide information about the whole structure of the gait cycle. Classification of the similarities among time series of IGA measured values of sagittal joint positions throughout the whole gait cycle can be achieved by hierarchical clustering analysis based on multivariate dynamic time warping (DTW). Random forests can estimate which are the most important isolated parameters to predict the classification revealed by DTW, since clinicians need to refer to them in their daily practice. We acquired time series of pelvic, hip, knee, ankle and forefoot sagittal angular positions from 26 HSP and 33 healthy children with an optokinetic IGA system. DTW revealed six gait patterns with different degrees of impairment of walking speed, cadence and gait cycle distribution and related with patient's age, sex, GMFCS stage, concurrence of polyneuropathy and abnormal visual evoked potentials or corpus callosum. The most important parameters to differentiate patterns were mean pelvic tilt and hip flexion at initial contact. Longer time of support, decreased values of hip extension and increased knee flexion at initial contact can differentiate the mildest, near to normal HSP gait phenotype and the normal healthy one. Increased values of knee flexion at initial contact and delayed peak of knee flexion are important factors to distinguish GMFCS stages I from II-III and concurrence of polyneuropathy.