Online resources as a source of information for exercise and physical activity in solid organ transplant recipients.

Introduction: Exercise training post-transplant has been shown to improve physical function and quality of life in solid organ transplant (SOT) recipients. Online resources in the form of websites and videos are commonly used to provide education and instruction on exercise and physical activity in SOT; however, the content and quality of these online resources has not been evaluated. Methods: The first 200 websites and videos identified on Google and YouTube using the English search term "exercise and physical activity in solid organ transplantation" were analyzed. Website and video content was evaluated based on 25 key components of exercise and physical activity in SOT as described in established exercise program recommendations. Website and video quality was determined using DISCERN, Global Quality Scale (GQS), and Patient Education Materials and Assessment Tool (PEMAT; threshold for which material is deemed understandable or actionable is >70%). Parametric and non-parametric tests were used to assess website and video characteristics, content, and quality metrics. Results: Forty-nine unique SOT websites (n = 15) and videos (n = 34) were identified, with the two most common categories being foundation/advocacy organizations and scientific resources. The average reading grade level of websites was 13 ± 3. Website and video content scores varied significantly (websites 11.3 ± 6.4; videos 8.4 ± 5.3). DISCERN total score and GQS score were low (median range for DISCERN 2.5-3.0; median for GQS 2.0 for both websites and videos, out of 5). PEMAT understandability and actionability scores were also low across websites and videos (mean range 57%-67% and 47%-65%, respectively). Foundation/advocacy websites had higher content and quality scores compared to scientific organizations and news/media articles. Conclusions: To our knowledge, this is the first comprehensive assessment of online content and quality of website and video resources on physical activity and exercise in adult SOT recipients. There were a limited number of online English patient-directed resources related to physical activity in SOT, most of which only partly captured items outlined in consensus exercise program recommendations and were of low quality and understandability and actionability. This work provides important insight to the English-speaking transplant community on the current state of online exercise health information and provides future direction for resource development.

Exercise Effects on Maternal Vascular Health and Blood Pressure during Pregnancy and Postpartum: A Systematic Review and Meta-Analysis.

AIM: This systematic review aimed to assess the effects of exercise training during pregnancy and the postpartum period on maternal vascular health and blood pressure (BP). METHODS: The outcome of interest were pulse wave velocity (PWV), flow-mediated dilation (FMD), and BP from pregnancy until 1-year postpartum. Five databases, including Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library, were systematically searched from inception to August 2023. Studies of randomized controlled trials (RCTs) comparing the effects of prenatal or postpartum exercise to a non-exercise control group were included. The risk of bias and the certainty of evidence were assessed. Random-effects meta-analyses and sensitivity analyses were conducted. RESULTS: In total, 20 RCTs involving 1,221 women were included. Exercise training, initiated from week 8 during gestation or between 6-14 weeks after delivery, with the program lasting for a minimum of 4 weeks up to 6 months, showed no significant impact on PWV and FMD. However, it resulted in a significant reduction in systolic BP (SBP) (MD: -4.37 mmHg; 95% CI: -7.48 to -1.26; p = 0.006) and diastolic BP (DBP) (MD: -2.94 mmHg; 95% CI: -5.17 to -0.71; p = 0.01) with very low certainty. Subgroup analyses revealed consistent trends across different gestational stages, types of exercise, weekly exercise times, and training periods. CONCLUSION: Exercise training during pregnancy and the postpartum period demonstrates a favorable effect on reducing maternal BP. However, further investigations with rigorous methodologies and larger sample sizes are needed to strengthen these conclusions.

This systematic review of the literature demonstrates that exercise training during pregnancy and postpartum can reduce blood pressure in women. Key findings: Exercise training significantly decreased both systolic and diastolic blood pressure values in pregnant and postpartum women.The positive exercise effects on maternal blood pressure were consistently observed regardless of the specific stage of pregnancy, type of exercise, frequency of weekly exercise sessions, or duration of the training programs.

Virtual Physical Prehabilitation in Lung Transplant Candidates: A Proof-of-Concept Study.

This study aimed to preliminary test the effectiveness of 12-week virtual physical prehabilitation program followed by a maintenance phase. The main objective was to estimate the extent to which it affects exercise capacity, frailty, lower limb strength and health-related quality of life (HRQOL) in lung transplant candidates. The program offered supervised strengthening exercises, independent aerobic exercises and weekly phone calls (maintenance phase). Primary outcome was the six-minute walk distance (6MWD). Secondary outcomes: the Short Physical Performance Battery (SPPB), five-times sit-to-stand test (5STS), the St George's Respiratory Questionnaire (SGRQ) for HRQOL. Twenty patients were included (mean age 57.9; 6 women/14 men); fourteen completed the prehabilitation program and 5 completed the maintenance phase. There was no statistically significant improvement in 6MWD, SPPB or SGRQ after the 12-week program. Most patients either maintained or improved the 6MWT and SPPB scores. There was a significant improvement in the 5STS. After the maintenance phase, most patients either improved or maintained their scores in all outcomes except for the sub-score of symptoms in the SGRQ. A 12-week virtual physical prehabilitation program with a 12-week maintenance phase can help lung transplant candidates improve or maintain their physical function while waiting for transplantation.

KEeP ACTIVe Club Study: Kidney Transplant Recipients' Experiences of a Physical Activity and Social Interaction Virtual Group.

Background: It can be difficult for kidney transplant recipients (KTRs) to be physically active after their transplantation. Physical inactivity is a risk factor for cardiovascular disease, one of the leading cause of death among KTRs. To help KTRs start and maintain a physical activity routine, we developed the KEeP ACTIVe Club, a 6-month online intervention with access to a kinesiologist, a patient partner, and a private support group with an online platform (Facebook). Objective: The objective of this study was to capture the participants' experiences of the KEeP ACTIVe Club. Design: Individual interviews. Setting: The Center hospitalier de l'Université de Montréal (CHUM) and the McGill University Health Center (MUHC) kidney transplant programs. Participants: Kidney transplant recipients who participated in the KEeP ACTIVe Club. Methods: Between October and December 2021, we conducted 11 individual semi-directed interviews with KTRs from 2 urban kidney transplant programs who participated in the KEeP ACTIVe Club. The interviews were digitally recorded and transcribed. Thematic analysis was conducted. Results: Participants' principal motivation to participate in the KEeP ACTIVe Club was to improve their physical fitness following their transplant in a pandemic period. One of the main benefits of the KEeP ACTIVe Club was the improvement of participant's self-confidence and the knowledge gained regarding exercises adapted to their reality as KTRs. However, the small number of participants and the schedules of classes offered were viewed as a pitfall of the current intervention. Finally, the peer mentoring and support gained by other participants were important and viewed as highly impactful aspects of the KEeP ACTIVe Club. Limitations: Only 11 of the 18 patients who participated in the KEeP ACTIVe Club took part in the interviews. Conclusion: Participants reported a positive experience with the KEeP ACTIVe Club. Peer mentoring and support gained from other participants seem to be essential aspects of the experience within the KEeP ACTIVe Club. This program is a good avenue to offer in post-transplant care to help KTRs to be more active and to connect with other patients.

Contexte: Il peut être difficile pour les receveurs d'une greffe de rein d'être actifs physiquement après la transplantation. L'inactivité est un facteur de risque de maladie cardiovasculaire, une des principales causes de décès chez les greffés du rein. Afin d'aider ces patients à entreprendre une routine d'activité physique et à la maintenir, nous avons développé le KEeP ACTIVe Club, une intervention en ligne d'une durée de six mois qui donne accès à un kinésiologue, à un patient partenaire et à un groupe privé de soutien par le biais d'une plateforme en ligne (Facebook). Objectifs: Connaître l'expérience des participants au KEeP ACTIVe Club. Conception: Entretiens individuels. Cadre: Les programme de transplantation rénale du Center hospitalier de l'Université de Montréal (CHUM) et du Centre universitaire de santé McGill (CUSM). Participants: Des receveurs d'une greffe de rein ayant participé au KEeP ACTIVe Club. Méthodologie: Entre octobre et décembre 2021, nous avons mené 11 entretiens individuels semi-dirigés avec des receveurs d'une greffe rénale qui ont participé au KEeP ACTIVe Club dans deux programmes de transplantation en center urbain. Les entretiens ont été enregistrés en mode numérique, transcrits, puis une analyze thématique a été réalisée. Résultats: La principale motivation des receveurs à participer au KEeP ACTIVe Club était d'améliorer leur condition physique après la greffe, en période pandémique. Les principaux avantages d'avoir participé au KEeP ACTIVe Club ont été l'augmentation de la confiance en soi et l'acquisition de connaissances sur des exercices adaptés à leur réalité de greffés du rein. Le faible nombre de participants et l'horaire des cours proposés ont été perçus comme des faiblesses de l'intervention. Enfin, le mentorat par les pairs et le soutien reçu des autres participants ont été jugés importants et perçus comme des aspects très positifs du KEeP ACTIVe Club. Limites: Sur les dix-huit patients inscrits au KEeP ACTIVe Club, seuls onze ont participé aux entrevues. Conclusion: Les participants ont déclaré avoir eu une expérience positive avec le KEeP ACTIVe Club. Le mentorat par les pairs et le soutien reçu des autres participants semblent être des aspects essentiels de l'expérience positive vécue au sein du KEeP ACTIVe Club. Ce programme est une bonne avenue à proposer dans les soins post-transplantation pour aider les greffés du rein à être plus actifs physiquement et à échanger avec d'autres patients.

Experimental mmWave WiGig-based backhaul network dataset.

The wireless backhaul has emerged as an attractive alternative to traditional fiber backhaul for 5G technology, offering greater flexibility and cost-effectiveness thanks to the availability of high bandwidths capable of achieving fiber-like data rates. However, the millimeter-wave-based (mmWave) protocols, namely IEEE 802.11ad and later IEEE 802.11ay, suffer from a high susceptibility to obstruction, which only allows correct operation under Line-of-Sight conditions (LOS). Any sudden obstructions can significantly reduce the maximum achievable throughput, leading to delays exceeding acceptable limits for critical applications, and may even culminate in link failure in certain circumstances. Therefore, it is essential to assess how different types and durations of obstructions impact different network OSI layers to determine the feasibility of mmWave. WiGig-based technologies for wireless backhaul scenarios. This article describes a dataset collected from an experimental IEEE 802.11ad backhaul network, mmWave-based mesh network at 60 GHz, deployed in an outdoor environment. The data contains multi-layer information, including MAC, PHY, and network data, which provides valuable insights into the WiGig network behavior under three distinct scenarios. These scenarios include normal operation, long-term blocked scenario, and short-term blocked scenario, based on the type and duration of the blockage event crossing the LOS path. The dataset presents an extensive PHY, MAC and transport layer measurement campaign for an outdoor WiGig network, and thus it is a valuable resource for researchers and professionals interested in understanding the behavior and performance of real-life mmWave-based WiGig networks aimed for 5G backhauling.

Enrollment and dropout rates of individuals with chronic obstructive pulmonary disease approached for telehealth interventions: A systematic review and meta-regression analysis.

Introduction: Telehealth interventions have the potential of improving health outcomes for individuals with chronic obstructive pulmonary disease (COPD). However, the precise impact of telehealth on exacerbation and hospital readmissions remains inconclusive. This lack of knowledge on the effectiveness of telehealth for COPD care might be due to lack of clarity regarding which variables are most strongly associated with enrolment and dropout rates. Objectives: Among individuals with COPD in telehealth studies, we aimed to: (1) estimate the extent to which trial-related variables are associated with enrolment and dropout rates, and identify reasons for dropouts; (2) estimate the extent to which patients-related and intervention-related variables are associated with dropout rates; (3) estimate the effect of enrolment rate and dropout rate on effect size; (4) estimate the effect of trial-related, patient-related, and intervention-related variables on effect size. Methods: A systematic literature search was conducted using four electronic databases. Two independent reviewers screened all retrieved titles, abstracts and full texts according to the inclusion criteria and extracted the data. A random-effect meta-regression analysis was conducted to estimate the overall enrolment and dropout rates, and estimated the different variables' effects on the enrolment rate, dropout rate, and effect sizes in the studies included in the review. Results: A total of 56 studies comprising 7530 participants were identified. The estimated enrolment and dropout rates were 50.3 % and 14.9 %, respectively. Trial-related variables influence enrollment and dropout rates, including RCT designs and the recruitments. The patient-related variables, including age and severity of the disease, and intervention-related variables, including the components of the intervention and mode of delivery, influence dropout rates. Studies with low dropout rates had a bigger effect size by 0.23. The main reported reasons for dropping out of the intervention were related to death (21 %) followed by lost to follow-up (14 %). Conclusion: Trial, patient, and intervention-related variables were found to influence the enrolment and dropout rates. This would help plan and develop a more appealing telehealth intervention that patients can easily accept and incorporate into their everyday lives. Registration information: International Prospective Register of Systematic Reviews (PROSPERO); ID: CRD42017078541.

Comparison of Zinc Oxide Nanoparticle Integration into Non-Woven Fabrics Using Different Functionalisation Methods for Prospective Application as Active Facemasks.

The development of advanced facemasks stands out as a paramount priority in enhancing healthcare preparedness. In this work, different polypropylene non-woven fabrics (NWF) were characterised regarding their structural, physicochemical and comfort-related properties. The selected NWF for the intermediate layer was functionalised with zinc oxide nanoparticles (ZnO NPs) 0.3 and 1.2wt% using three different methods: electrospinning, dip-pad-dry and exhaustion. After the confirmation of ZnO NP content and distribution within the textile fibres by morphological and chemical analysis, the samples were evaluated regarding their antimicrobial properties. The functionalised fabrics obtained via dip-pad-dry unveiled the most promising data, with 0.017 ± 0.013wt% ZnO NPs being mostly located at the fibre's surface and capable of total eradication of Staphylococcus aureus and Escherichia coli colonies within the tested 24 h (ISO 22196 standard), as well as significantly contributing (**** p < 0.0001) to the growth inhibition of the bacteriophage MS2, a surrogate of the SARS-CoV-2 virus (ISO 18184 standard). A three-layered structure was assembled and thermoformed to obtain facemasks combining the previously chosen NWF, and its resulting antimicrobial capacity, filtration efficiency and breathability (NP EN ISO 149) were assessed. The developed three-layered and multiscaled fibrous structures with antimicrobial capacities hold immense potential as active individual protection facemasks.

European Society of Organ Transplantation (ESOT) Consensus Statement on Prehabilitation for Solid Organ Transplantation Candidates.

There is increasingly growing evidence and awareness that prehabilitation in waitlisted solid organ transplant candidates may benefit clinical transplant outcomes and improve the patient's overall health and quality of life. Lifestyle changes, consisting of physical training, dietary management, and psychosocial interventions, aim to optimize the patient's physical and mental health before undergoing surgery, so as to enhance their ability to overcome procedure-associated stress, reduce complications, and accelerate post-operative recovery. Clinical data are promising but few, and evidence-based recommendations are scarce. To address the need for clinical guidelines, The European Society of Organ Transplantation (ESOT) convened a dedicated Working Group "Prehabilitation in Solid Organ Transplant Candidates," comprising experts in physical exercise, nutrition and psychosocial interventions, to review the literature on prehabilitation in this population, and develop recommendations. These were discussed and voted upon during the Consensus Conference in Prague, 13-15 November 2022. A high degree of consensus existed amongst all stakeholders including transplant recipients and their representatives. Ten recommendations were formulated that are a balanced representation of current published evidence and real-world practice. The findings and recommendations of the Working Group on Prehabilitation for solid organ transplant candidates are presented in this article.

Changes in Functional Outcomes After an Inpatient Rehabilitation Program for Solid-Organ Transplant Recipients.

Introduction: Outpatient exercise training has been shown to be beneficial for solid organ transplant recipients. Little is known about the effects of inpatient rehabilitation programs for recipients with a more complicated postoperative course. Research Question: This study was designed to (1) describe the changes in functional outcomes after an inpatient rehabilitation program, and (2) determine whether the changes in lower body strength and quadriceps strength are associated with changes in functional exercise capacity. Design: This was a single-arm prospective longitudinal study. The recipients participated in an inpatient rehabilitation program twice a day, 7 days a week for 3 to 4 weeks. Outcome Measures Included: 2-Minute Walking Test, Timed Up and Go, Berg Balance Scale, 30-Second Sit to Stand, biceps and quadriceps strength, Functional Independence Measure, SF-36, and Canadian Occupational Performance Measure. Results: Twenty-eight patients (54% female, mean age = 55 [11]) completed the study. Participants were mostly liver (42%) and lung recipients (35%). There were statistically significant improvements in all outcomes after the intervention. There was no relationship between changes in functional exercise capacity and quadriceps strength or lower body strength. Conclusion: An inpatient rehabilitation program may improve several functional outcomes and health-related quality of life in transplant recipients with a complicated postoperative course.

Implementation and maintenance of an enhanced pulmonary rehabilitation program in a single centre: An implementation study.

BACKGROUND: Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre. METHODS: Pre-post implementation study consisted of two evaluation periods: immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included: Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS: Reach: 70-75% of referred patients agreed to a PR program (n = 26). Effectiveness: Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. Adoption: All healthcare professionals (HCPs) involved in PR (n = 8) participated. Implementation: Fidelity for the group education sessions ranged from 76 to 95% (first evaluation) and from 82 to 88% (second evaluation). Maintenance: The program was sustained over 18 months with minor changes. Patients and HCPs were highly satisfied with the program. CONCLUSIONS: The enhanced PR program was accepted by patients and HCPs and was implemented and maintained at a single expert center with good implementation fidelity.

A novel gluten knowledge base of potential biomedical and health-related interactions extracted from the literature: Using machine learning and graph analysis methodologies to reconstruct the bibliome.

BACKGROUND: In return for their nutritional properties and broad availability, cereal crops have been associated with different alimentary disorders and symptoms, with the majority of the responsibility being attributed to gluten. Therefore, the research of gluten-related literature data continues to be produced at ever-growing rates, driven in part by the recent exploratory studies that link gluten to non-traditional diseases and the popularity of gluten-free diets, making it increasingly difficult to access and analyse practical and structured information. In this sense, the accelerated discovery of novel advances in diagnosis and treatment, as well as exploratory studies, produce a favourable scenario for disinformation and misinformation. OBJECTIVES: Aligned with, the European Union strategy "Delivering on EU Food Safety and Nutrition in 2050″ which emphasizes the inextricable links between imbalanced diets, the increased exposure to unreliable sources of information and misleading information, and the increased dependency on reliable sources of information; this paper presents GlutKNOIS, a public and interactive literature-based database that reconstructs and represents the experimental biomedical knowledge extracted from the gluten-related literature. The developed platform includes different external database knowledge, bibliometrics statistics and social media discussion to propose a novel and enhanced way to search, visualise and analyse potential biomedical and health-related interactions in relation to the gluten domain. METHODS: For this purpose, the presented study applies a semi-supervised curation workflow that combines natural language processing techniques, machine learning algorithms, ontology-based normalization and integration approaches, named entity recognition methods, and graph knowledge reconstruction methodologies to process, classify, represent and analyse the experimental findings contained in the literature, which is also complemented by data from the social discussion. RESULTS AND CONCLUSIONS: In this sense, 5814 documents were manually annotated and 7424 were fully automatically processed to reconstruct the first online gluten-related knowledge database of evidenced health-related interactions that produce health or metabolic changes based on the literature. In addition, the automatic processing of the literature combined with the knowledge representation methodologies proposed has the potential to assist in the revision and analysis of years of gluten research. The reconstructed knowledge base is public and accessible at https://sing-group.org/glutknois/.

Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies.

OBJECTIVES: Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms. METHODS: This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built. RESULTS: According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression. CONCLUSION: At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

Evaluation of parent bonding style and traumatic experiences in patients with schizophrenia and bipolar disorder: A case-control study.

BACKGROUND: There is no consensus about the etiology of schizophrenia (SQZ) and bipolar disorder (BD). Both hereditary and environmental factors are recognized, but the importance of variables like the role of parental attachment and trauma is still under research. AIMS: Evaluate and compare the patient-parent bonding and the frequency and severity of various types of trauma in patients with SQZ, BD, and a control group from Primary Health Care. METHOD: This study included 50 patients with SQZ and 50 with BD followed at a psychiatric hospital, through a convenience sample. Each participant of the clinical sample was paired with a control with no psychiatric background of the same gender and similar age, from a primary health center. Two scales were applied - Parental Bonding Instrument (PBI) and Childhood Trauma Questionnaire - Short Form (CTQ-SF). RESULTS: Regarding PBI, there was a higher frequency of the most dysfunctional attachment style (affectionless control), in patients with SQZ and BD, with p < .001 (always), both for the father and the mother. In addition, ideal parenting style (optimal parenting) was significantly more common in control samples, with p = .002 or <.001, both for the father and for the mother. Trauma was more frequent and severe in SQZ and BD than controls, in all evaluated dimensions. Again, differences between groups are obvious, with p = .012 or <.001. Parental bonding style and scores in the care and overprotection dimensions were also correlated. The only parental bonding style in which correlations were found was in affectionless control. Correlations were more common in cases of neglect compared to abuse. CONCLUSIONS: In this research we found important differences in terms of parental attachment and childhood trauma between patients with SQZ and BD, compared with controls of the same gender and age.

Identifying Outcome Domains for Clinical Trials of Physical Rehabilitation Among Adults Undergoing Solid Organ Transplantation Using a Delphi Approach.

Introduction: A core outcome set (COS) improves the quality of reporting in clinical trials; however, this has not been developed for clinical trials of exercise training among adults undergoing solid organ transplant. Research Question: To explore the perspectives of transplant patients and healthcare professionals on the key outcomes domains that are relevant for clinical trials of exercise in all recipients of transplanted organs. Methods: A Delphi approach was employed with 2 rounds of online questionnaires. Participants rated the importance of outcome domains using a 9-point Likert scale ranging from "not important" to "very important". A score of 7 to 9 (very important) by 70% or more participants and a score of 1 to 3 (not important) by less than 15% participants were required to keep an outcome domain from the first to the second round. Results: Thirty-six participants completed 2 rounds of questionnaires (90% response rate). After Round 1, 8 outcome domains were considered very important in the pretransplant phase; 16 in the early posttransplant; and 17 in the late posttransplant. Only 1 outcome domain, organ rejection in the early posttransplant phase, met the criteria to be considered very important after Round 2. Conclusion: Although consensus was not reached on the core outcome domains, this study provides preliminary information on which domains are higher priority for patients and professionals. Future work should consider a meeting with key stakeholders to allow for deeper discussion to reach consensus on a core outcome set.

Physical Activity and Symptom Burden in COPD: The Canadian Obstructive Lung Disease Study.

Background: The relationship between symptom burden and physical activity (PA) in chronic obstructive pulmonary disease (COPD) remains poorly understood with limited data on undiagnosed individuals and those with mild to moderate disease. Objective: The primary objective was to evaluate the relationship between symptom burden and moderate-to-vigorous intensity PA (MVPA) in individuals from a random population-based sampling mirroring the population at large. Methods: Baseline participants of the Canadian Cohort Obstructive Lung Disease (n=1558) were selected for this cross-sectional sub-study. Participants with mild COPD (n=406) and moderate COPD (n=331), healthy individuals (n=347), and those at risk of developing COPD (n=474) were included. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire was used to estimate MVPA in terms of energy expenditure. High symptom burden was classified using the COPD Assessment Test ([CAT] ≥10). Results: Significant associations were demonstrated between high symptom burden and lower MVPA levels in the overall COPD sample (ß=-717.09; 95% confidence interval [CI]=-1079.78, -354.40; p<0.001) and in the moderate COPD subgroup (ß=-694.1; 95% CI=-1206.54, -181.66; p=0.006). A total of 72% of the participants with COPD were previously undiagnosed. The undiagnosed participants had significantly higher MVPA than those with physician diagnosed COPD (ß=-592.41 95% CI=-953.11, -231.71; p=0.001). Conclusion: MVPA was found to be inversely related to symptom burden in a large general population sample that included newly diagnosed individuals, most with mild to moderate COPD. Assessment of symptom burden may help identify patients with lower MVPA, especially for moderate COPD and for relatively inactive individuals with mild COPD.

A Qualitative Study of the Perspectives of Healthcare Professionals on Features of Digital Health Interventions to Support Physical Activity in Solid Organ Transplant Recipients.

Introduction: Digital health interventions may support physical activity among solid organ transplant recipients. These interventions should be designed with users in mind, including healthcare professionals who counsel transplant recipients on physical activity to ensure acceptance and to promote an optimal user experience. The purpose of this study was to explore the perspectives of health care providers on the features of digital health interventions that would be useful in the promotion, implementation, and maintenance of physical activity among solid organ transplant recipients. Methods: This qualitative, cross-sectional study used semistructured interviews that were conducted remotely, via videoconferencing software, with providers who worked with transplant recipients. Interviews were transcribed, and an iterative-inductive, thematic analysis was used to identify common themes. Data were coded using NVivo software. Findings: Thirteen providers participated in this study. Four main themes were identified: (a) physical activity and exercise features (eg, physical activity guidelines, and exercise instructions); (b) credibility; (c) self-management; and (d) user engagement. Potential barriers to using digital health interventions included staffing requirements, professional regulatory issues, cost, perceived low patient motivation to use, and lack of technological literacy or access. Discussion: Digital health interventions were perceived to be a potential adjunct to current physical activity counseling practices, and part of an innovative strategy to address identified barriers to physical activity participation in solid organ transplant recipients.

Relationship of Exercise Capacity, Physical Function, and Frailty Measures With Clinical Outcomes and Healthcare Utilization in Lung Transplantation: A Scoping Review.

Measures of exercise capacity, frailty, and physical function are commonly used in lung transplant candidates and recipients to evaluate their physical limitations and the effects of exercise training and to select candidates for transplantation. It is unclear how these measures are related to clinical outcomes and healthcare utilization before and after lung transplantation. The purpose of this scoping review was to describe how measures of exercise capacity, physical function, and frailty are related to pre- and posttransplant outcomes. Methods: We considered studies of any design that included performance-based tests of exercise capacity, physical function, and frailty in adult lung transplant candidates or recipients. Outcomes of interest were clinical outcomes (eg, mortality, quality of life) and healthcare utilization. Results: Seventy-two articles met the inclusion criteria. The 6-min walk test (6MWT) was shown to be related to mortality on the waiting list with different distance values as cutoffs points. There were inconsistent results regarding the relationship of the 6MWT with other clinical outcomes. Few studies have examined the relationship between the cardiopulmonary exercise test or the short physical performance battery and clinical outcomes, although some studies have shown relationship with survival posttransplant and quality of life. Few studies examined the relationship between the tests of interest and healthcare utilization' and the results were inconsistent. Conclusions: Except for the relationship between the 6MWT and mortality on the waiting list, there is limited evidence regarding the relationship of performance-based measures of exercise capacity, frailty, and physical function with clinical outcomes or healthcare utilization.

Cardiorespiratory and metabolic demand of the 6-minute pegboard and ring test in healthy young adults.

OBJECTIVE: To determine the cardiorespiratory and metabolic demand of the Six-Minute Pegboard and Ring Test (6PBRT) in healthy young adults and its association with maximal arm cycle ergometer test (arm CET). METHODS: Volunteers were randomized to performed the 6PBRT test or arm CET. The second test was performed after 48 h. Oxygen consumption (VO2), heart rate (HR), dyspnea and upper limb fatigue were assessed during the tests. Demographic data, body composition, level of physical activity, arm strength and endurance were also evaluated. RESULTS: During 6PBRT, VO2 values increased from 5.8 to 11.1 mL kg-1.min-1 (p < 0.001). VO2peak, HR Mean and HRmax at 6PBRT were 47.2% and close to 65% respectively of those achieved during the arm CET. There was a positive correlation between the score on 6PBRT and VO2mean and VO2peak achieved at arm CET (r = 0.268; p = 0.003 and r = 0.247; p = 0.046 respectively). No correlation was found between the HRmean, HRpeak, level of physical activity or strength with 6PBRT (p > 0.05). Handgrip endurance had a positive correlation with score on 6PBRT (r = 0.237; p = 0.054). Body Mass Index, body fat and fat mass were negatively correlated with the score on 6PBRT (r = 0.301; p = 0.014, 0.329; p = 0.007 and r = 0.427; p = 0.001). CONCLUSIONS: The 6PBRT test showed a moderate cardiorespiratory and metabolic demand in healthy individuals in comparison of arm CET. BMI, body fat and fat mass correlated with the score on 6PBRT.