Analysis of time-domain indices, frequency domain measures of heart rate variability derived from ECG waveform and pulse-wave-related HRV among overweight individuals: an observational study.

Background: Research on the compatibility of time domain indices, frequency domain measurements of heart rate variability obtained from electrocardiogram (ECG) waveforms, and pulse wave signal (pulse rate variability; PRV) features is ongoing. The promising marker of cardiac autonomic function is heart rate variability. Recent research has looked at various other physiological markers, leading to the emergence of pulse rate variability. The pulse wave signal can be studied for variations to understand better changes in arterial stiffness and compliance, which are key indicators of cardiovascular health. Methods: 35 healthy overweight people were included. The Lead II electrocardiogram (ECG) signal was transmitted through an analog-to-digital converter (PowerLab 8/35 software, AD Instruments Pty. Ltd., New South Wales, Australia). This signal was utilized to compute Heart Rate Variability (HRV) and was sampled at a rate of 1024 Hz. The same AD equipment was also used to capture a pulse signal simultaneously. The right index finger was used as the recording site for the pulse signal using photoplethysmography (PPG) technology. Results: The participants' demographic data show that the mean age was 23.14 + 5.27 years, the mean weight was 73.68 +  7.40 kg, the mean body fat percentage was 32.23   +  5.30, and the mean visceral fat percentage was 4.60   +  2.0. The findings revealed no noticeable difference between the median values of heart rate variability (HRV) and PRV. Additionally, a strong correlation was observed between HRV and PRV. However, poor agreement was observed in the measurement of PRV and HRV. Conclusion: All indices of HRV showed a greater correlation with PRV. However, the level of agreement between HRV and PRV measurement was poor. Hence, HRV cannot be replaced with PRV and vice-versa.

Influence of home-based pulmonary rehabilitation program among people with interstitial lung disease: A pre-post study.

INTRODUCTION: Access to interstitial lung disease programs may not be available in rural settings. Home-based pulmonary rehabilitation (PR) programs have been proposed as an alternative to hospital-based programs. METHOD: Forty participants with ILD underwent a structured unsupervised home-based pulmonary rehabilitation program from September 2020 to September 2022. Quality of life was assessed using St. George Respiratory Questionnaire (SGRQ) and functional capacity using 6-minute walk test (6MWT). The outcome measures were assessed at baseline and 4 weeks post-unsupervised home-based PR program. RESULT: We recruited 40 participants with ILD. There was statistically significant improvement in the 6-minute walk distance (353.8 m and 368 m, effect size - 0.5, p ≤ .001) and quality of life using SGRQ total score (38.6 and 42.35, effect size - 2.5, p ≤ .001) between before and after receiving home-based PR among all 40 participants with ILD. CONCLUSION: Four weeks of home-based PR program, using minimal resources, deliver short-term improvements in functional exercise capacity and quality of life among ILD participants. Our home-based PR program resulted in a quarter percentage improvement in functional capacity, and we believe that if consistency is maintained, it will result in similar changes corresponding to the already established Minimal Clinically Important Difference (MCID) of 35 m.

Measurement properties of physical activity in adults with bronchiectasis: A systematic review protocol.

People with bronchiectasis reduce their physical activity (PA) due to muscle weakness, dyspnea, fatigue, reduced exercise capacity and frequent cough with expectoration. Patient-reported and objective physical assessment methods have been used to evaluate PA in people with bronchiectasis. In the literature, significant differences in the PA measured using patient-reported outcome measures when compared with the objective methods. Given the availability of many PA assessment tools, it is tedious for the clinician or researcher to choose an outcome measure for clinical practice or research. The evidence on validity and reliability in bronchiectasis are unclear. Objectives: To identify the PA assessment tools, describe and evaluate the literature on psychometric properties of instruments measuring and analyzing PA. Methods: The search will be conducted in PubMed/Medline, Cochrane Central Register of Controlled Studies, Scopus and EMBASE databases. The keywords, index terms and synonyms of the following words will be used: bronchiectasis, physical activity, and outcome measures. Published studies of adult with clinical and/ or radiologically diagnosed bronchiectasis, aged >18 years, any gender and studies that assessed PA and/or if there are reports on measurement properties of PA will be included in the review. Studies using qualitative research methods, narrative reviews, letters to editors and editorials will be excluded. The quality of the study will be assessed and data will be extracted. Any disagreement will be resolved in the presence of an author not involved in the screening or selecting studies. Discussion: By assessing the quality of studies on measurement properties, this review will help researchers choose the outcome measure to evaluate the effects of interventions on PA. This review will identify the suite of outcome measures of PA for people with bronchiectasis that can be used for research and clinical purpose.

Therapeutic approaches for the treatment of Interstitial Lung Disease: An exploratory review on molecular mechanisms.

BACKGROUND: Interstitial Lung Diseases (ILDs) are characterized by shortness of breath caused by alveolar wall inflammation and/or fibrosis. OBJECTIVE: Our review aims to study the depth of various variants of ILD, diagnostic procedures, pathophysiology, molecular dysfunction and regulation, subject and objective assessment techniques, pharmacological intervention, exercise training and various modes of delivery for rehabilitation. METHOD: Articles are reviewed from PubMed and Scopus and search engines. RESULTS: ILD is a rapidly progressing disease with a high mortality rate. Each variant has its own set of causal agents and expression patterns. Patients often find it challenging to self-manage due to persistent symptoms and a rapid rate of worsening. The present review elaborated on the pathophysiology, risk factors, molecular mechanisms, diagnostics, and therapeutic approaches for ILD will guide future requirements in the quest for innovative and tailored ILD therapies at the molecular and cellular levels. CONCLUSION: The review highlights the rationale for conventional and novel therapeutic approaches for better management of ILD.

Factors associated with physical activity participation among children: a systematic review protocol.

BACKGROUND: Reduced physical activity (PA) is one of the significant health concerns in adults and children alike. Despite the proven benefits of PA, most children, globally, do not meet the weekly criteria of enough PA to maintain health. The proposed systematic review is the review of the factors and will provide information on the factors associated with PA participation in children. METHODS: The proposed systematic review will be conducted based on the methodology from the Cochrane Handbook for Systematic Reviews of Interventions. We will include observational studies (cross-sectional, case-control, and cohort studies), randomized controlled trials (RCTs), and non-randomized study designs for information on factors associated with PA participation among children. Studies with participants in the age range of 5-18 years, indulging in physical activity of 60 min per day for a minimum of 3 days a week, will be included. Studies including differently abled children, children under medical treatment, and those taking medications for illnesses such as neurological, cardiac, and mental health conditions will be excluded from the review. We will search MEDLINE (via PubMed and Web of Science), Scopus, EMBASE, CINAHL, Cochrane CENTRAL, and PEDro for English language publications published from the inception till October 2022. For additional studies, we will search websites such as the Australian Association for Adolescent Health International Association for Adolescent Health and a reference list of the included publications. Selection of studies, data extraction, and quality assessment of the included studies will be performed in duplicate. Quality assessment of the included studies will be performed using the Cochrane Risk of Bias tool (ROB-II) for RCTs, New-Castle Ottawa, for observational studies, and ROBINS-I (Risk of Bias for Non-Randomized studies of Interventions) for non-randomized study designs. DISCUSSION: The proposed systematic review and meta-analysis will present a summary of the available evidence on factors associated with PA participation in children. The findings of this review will provide new insights into how exercise providers can improve PA participation among children and can also help healthcare workers, clinicians, researchers, and policymakers to plan long-term interventions targeting child health. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021270057.

Knowledge of Medical Imaging Professionals on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis.

Healthcare-associated infections (HCAIs) are a significant concern for both healthcare professionals and patients. With recent advances in imaging modalities, there is an increase in patients visiting the radiology department for diagnosis and therapeutic examination. The equipment used for the investigator is contaminated, which may result in HCAIs to the patients and healthcare professionals. Medical imaging professionals (MIPs) should have adequate knowledge to overcome the spread of infection in the radiology department. This systematic review aimed to examine the literature on the knowledge and precaution standard of MIPs on HCIAs. This study was performed with a relative keyword using PRISMA guidelines. The articles were retrieved from 2000 to 2022 using Scopus, PubMed, and ProQuest databases. The NICE public health guidance manual was used to assess the quality of the full-length article. The search yielded 262 articles, of which Scopus published 13 articles, PubMed published 179 articles, and ProQuest published 55 articles. In the present review, out of 262 articles, only 5 fulfilled the criteria that reported MIPs' knowledge of Jordan, Egypt, Sri Lanka, France, and Malawi populations. The present review reported that MIPs have moderate knowledge and precautionary standards regarding HCIAs in the radiology department. However, due to the limited studies published in the literature, the current review limits the application of the outcome in the vast MIPs population. This review recommended further studies to be conducted among the MIPs worldwide to know the actual knowledge and precaution standards regarding HCIAs.

Prevalence of sarcopenia in heart failure: A systematic review.

OBJECTIVE: Heart Failure (HF) is emerging as a crucial factor promoting muscle wasting and dysfunction contributing to sarcopenia. This modulates disease severity and reduces exercise capacity and leading to poorer outcomes. Therefore, we aimed to systematically investigate the overall prevalence of sarcopenia in HF. METHODS: An electronic search was carried out in selected databases until 21st January, 2021. Data was pooled from the included articles and represented as pooled prevalence of sarcopenia. Subgroup analysis was undertaken between methods of diagnosis of sarcopenia, gender, ejection fraction, median time point and geographical region. RESULTS: Amongst 32,643 citations imported from selected databases, 12 articles were included in final analysis. Analysis for prevalence of sarcopenia was 34%, with prevalence rates ranging from 10.1% to 68%. Subgroup analysis revealed strong associations between Dual-energy X-ray Absorptiometry (DXA) and Asian Working Group for Sarcopenia (AWGS) (chi square = 3.24; p < 0.001), with a good level of agreement (kappa = 0.76 [95% CI: 0.70-0.82]; p < 0.001). Gender wise analysis revealed higher prevalence of sarcopenia among males (66%) than females (34%). CONCLUSION: Sarcopenia is highly prevalent among those with HF (irrespective of type of HF) and is more commonly seen in males compared to females.

Prenatal Learning and Memory: Review on the Impact of Exposure.

BACKGROUND: Prenatal Learning is a topic still debated for its existence, although the concept is well known since ancient times. OBJECTIVE: The present review highlights the impact of various stimuli on learning and memory in prenatal and postnatal life. METHODS: For review, various articles from preclinical and clinical studies providing early pieces of evidence of prenatal learning to date were included based on the relevancy of the databases, namely, Scopus, Pubmed, and Google Scholar. RESULTS: Learning is the process of acquiring skills/ preferences/ habits from the experiences of the exposures of the past. These exposures are the stimuli, which help in categorizing learning into associated or nonassociated learning. The stimuli of adults related to auditory, gustatory, olfactory, visual, touch, etc. are also accessible to the prenatal life in utero either directly or indirectly through the mother. The effects of these stimuli are remarkable during prenatal life and can be seen clearly in infants. These stimuli play an important role in prenatal learning and contribute to neuronal development. The present review summarizes the pieces of evidence for each of these types of learning & their impact on the ex utero life, a futuristic view & the scope of understanding prenatal learning. The review also elucidates the factors affecting prenatal learning. CONCLUSION: Studies from clinical and preclinical studies reflected the impacts of several aspects of an infant's life and the memory created during prenatal life was found to be most likely carried on to postnatal life.

Effect of a home-based pulmonary rehabilitation program on functional capacity and health-related quality of life in people with interstitial lung disease - A randomized controlled trial protocol.

BACKGROUND: Centre-based pulmonary rehabilitation is an effective, non-pharmacological intervention in improving outcomes for people with interstitial lung disease (ILD). Home-based pulmonary rehabilitation (PR) is a lower-cost rehabilitation alternative for people with chronic respiratory diseases. The aims of this study are to evaluate the efficacy of home-based PR on functional capacity and health-related quality of life in people with ILD, as well as to assess changes in dyspnea and fatigue, muscle strength, activities of daily living, depression, and anxiety after completing a home-based PR program. METHODS: Ninety-six individuals with ILD will be randomly assigned to either an intervention group (home-based PR exercise training program) or a control group (usual care). An assessor blind to group allocation will measure the 6-min walk distance, peripheral muscular strength, health-related quality of life, dyspnoea, anxiety and depression, fatigue, activities of daily living, upper limb and lower limb endurance at baseline, at program completion one month, and three months after the intervention. DISCUSSION: If home-based PR programs are proven to be beneficial over time, they will address a critical gap by giving a readily accessible and viable choice of rehabilitation to people with ILD, enabling more people to participate in an exercise program.

Correlation between physical activity, cardiorespiratory fitness and heart rate variability among young overweight adults.

Objective: Cardiac autonomic function assessed by heart rate variability (HRV) is a non-invasive, quantitative, and reliable marker of measurement. An altered cardiac autonomic function among overweight individuals predisposes them to a greater risk of developing cardiovascular diseases. The present study aims to determine the correlation between physical activity, cardiorespiratory fitness and heart rate variability among young overweight adults. Methods: A total of 45 participants (23 men and 22 women) were enrolled in the cross-sectional study with inclusion criteria as follows: aged between 18-30 years, body mass index (kg/m2) between 25-29.9 kg/m2, and without any known or diagnosed medical condition. Physical activity level and cardiorespiratory fitness were measured using the Global Physical Activity Questionnaire and Bruce treadmill protocol test, respectively. Cardiac autonomic function was measured using a 5-min short-term heart rate variability recording. The time and frequency domain measures of HRV were used for analysis. Results: The mean age of study participants was 22.53 ± 1.58 years and mean body mass index was 27.38 ± 1.51 kg/m2. Among young overweight adults, cardiorespiratory fitness and physical activity were not correlated with Root mean square of successive RR interval differences, Percentage of successive RR intervals that differ by more than 50 ms, and Ratio of LF [ms2]/HF [ms2]. Conclusion: The study found no correlation between physical activity and cardiorespiratory fitness with heart rate variability among young overweight individuals.

Restorative Action of Vitamin D3 on Motor Dysfunction Through Enhancement of Neurotrophins and Antioxidant Expression in the Striatum.

A number of studies has explored a positive correlation between low levels of serum Vitamin D3 (VD; cholecalciferol) and development of neurodegenerative diseases including Huntington's disease (HD). In the present study, the prophylactic effect of VD on motor dysfunction was studied in an experimental model of HD. An HD-like syndrome was induced in male C57BL/6 mice through an intraperitoneal injection (i.p) of 3-NP for 3 consecutive doses at 12 h interval of time as described previously (Amende et al. 2005). This study investigated thein-vivotherapeutic potential of VD (500 IU/kg/day) supplementation on movement, motor coordination, motor activity and biochemical changes in this HD model. Mice were divided into four groups: Group I: Control (saline); Group II: 3-NP induced HD (HD); Group III: Vitamin D3 (VD) and Group IV: 3-NP induced + post Vitamin D3 injection (HD + VD). All groups of mice were tested for locomotion, gait analysis and rotarod performances over a span of 30-days. VD administration rescued locomotor dysfunction and neuromuscular impairment in HD mice with no change in gait dynamics. In addition, administration of VD to 3-NP treated mice led to a significant enhancement in the expression of key neurotrophic factors including brain-derived neurotrophic factor (BDNF) and nerve-growth factor (NGF), the Vitamin D receptor (VDR), and antioxidant markers (catalases [Cat] and glutathione peroxidase [GpX4]) in the striatum, suggesting a detoxification effect of VD. Altogether, our results show that VD supplementation induces survival signals, diminishes oxidative stress, and reduces movement and motor dysfunction in HD.

Effect of home-based pulmonary rehabilitation on functional capacity in people with idiopathic pulmonary fibrosis-a systematic review protocol.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is one of the common types of interstitial lung disease having high prevalence and mortality worldwide. As a result of patient-centred hindering factors of adherence to centre-based pulmonary rehabilitation (PR), home-based PR is an alternate mode of rehabilitating individuals with IPF. This systematic review will evaluate the effectiveness of unsupervised home-based PR on functional capacity and health-related quality of life (HRQoL) in individuals with IPF. METHODS: Clinically stable, high resolution computed tomography and physician diagnosed IPF participants having modified Medical Research Council score below 5 will be considered for the systematic review. Studies involving home-based PR as an intervention to treat individuals with IPF will be considered. Randomised controlled trials and quasi-randomised studies (with two groups followed up) are eligible to be included. Outcomes of our interest are functional capacity (6-min walk distance, shuttle walk test and incremental shuttle walk test) and secondary outcome measure would include assessment of quality of life and adverse effects of intervention. Electronic databases such as SCOPUS, Medline (PubMed and Web of Science), PEDRo and CINAHL will be searched using database specific terms. Additionally, forward and backward citations of included studies will be searched to identify potential records. Two review authors, independently, will conduct the screening, data extraction using a customised standard tool, and critical appraisal using Cochrane Risk of Bias 2 tool of included studies. If data permits, meta-analysis will be conducted. In case of substantial heterogeneity, we will do a narrative synthesis. Subgroup analysis will be undertaken based on various contextual and interventional factors. DISCUSSION: This review will provide comprehensive evidence on the effectiveness of unsupervised home-based PR to physiotherapists, policy makers and researchers who are interested in IPF management. Findings from this review may guide the development and evaluation of more robust evidence based home-based PR that aimed to improve functional capacity among people with IPF. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020213883.

Contrasting effects of three breathing techniques on pulmonary function, functional capacity and daily life functional tasks in patients following valve replacement surgery- A pilot randomized clinical trial.

BACKGROUND: Valve replacement surgeries affect the physiological mechanisms of patients leading to various postoperative pulmonary complications. Lung expansion therapy consisting of numerous techniques is routinely used for the prevention and treatment of these complications. OBJECTIVES: Our study aimed to compare the effects of diaphragmatic breathing (DB), flow (FS) and volume-oriented incentive spirometer (VS) in patients following valve replacement surgery. METHODS: 29 patients posted valve replacement surgeries were randomly assigned to VS, FS and DB groups. Patients underwent preoperative training and seven-day rehabilitation post-surgery. Pulmonary function tests were performed before surgery and for seven days afterward. On the seventh postoperative day, patients performed a six-minute walk test and completed a functional difficulties questionnaire (FDQ). RESULTS: Pulmonary function test values reduced in all three groups postoperatively when compared to the preoperative values but improved by the seventh postoperative day (p < 0.05). On comparing the seventh postoperative day values to the preoperative values, the VS group had no significant difference (p = 1.00) (Forced Vital Capacity- % change: DB-37.76, VS-1.59, FS-27.98), indicating that the value had nearly returned to the baseline. As compared to the DB and FS groups, FVC showed a greater improvement in the VS group (p = 0.01 and p = 0.06 respectively). No significant differences were observed between groups for distance walked (p > 0.05), however, FDQ scores demonstrated positive changes in favor of VS when contrasted with FS or DB (p < 0.05). CONCLUSION: Diaphragmatic breathing, flow or volume-oriented spirometer could improve pulmonary function in the postoperative period. The volume-oriented spirometer, however, was found to be the most beneficial among the three techniques in improving patients' pulmonary function and daily life functional tasks. Further research is warranted to confirm these findings.

Effects of three pulmonary ventilation regimes in patients undergoing coronary artery bypass graft surgery: a randomized clinical trial.

The aim was to compare the effect of diaphragmatic breathing exercise (DBE), flow- (FIS) and volume-oriented incentive spirometry (VIS) on pulmonary function- (PFT), functional capacity-6-Minute Walk Test (6 MWT) and Functional Difficulties Questionnaire (FDQ) in subjects undergoing Coronary Artery Bypass Graft surgery (CABG). The purpose of incorporating pulmonary ventilator regimes is to improve ventilation and avoid post-operative pulmonary complications. CABG patients (n = 72) were allocated to FIS, VIS and DBE groups (n = 24 each) by block randomization. Preoperative and postoperative values for PFT were taken until day 7 for all three groups. On 7th postoperative day, 6 MWT and FDQ was analyzed using ANOVA and post-hoc analysis. PFT values were found to be decreased on postoperative day 1(Forced Vital Capacity (FVC) = FIS group-65%, VIS group-47%, DBE group-68%) compared to preoperative day (p < 0.001). PFT values for all 3 groups recovered until postoperative day 7 (FVC = FIS group-67%, VIS group-95%, DBE group-59%) but was found to reach the baseline in VIS group (p < 0.001). When compared between 3 groups, statistically significant improvement was observed in VIS group (p < 0.001) in 6 MWT and FDQ assessment. In conclusion, VIS was proven to be more beneficial in improving the pulmonary function (FVC), functional capacity and FDQ when compared to FIS and DBE.

Coping strategies for obese individuals with obstructive sleep apnea during COVID-19 pandemic: A narrative review.

BACKGROUND: Patients infected with SARS-CoV-2- having pre-existing non-communicable diseases (NCDs)- are at a higher risk of complications. Obesity is one of the proven risk factors causing NCDs and can influence outcomes of COVID-19 patients. It is closely related to obstructive sleep apnea (OSA). The increased risk of COVID-19 and reduced access to treatment of non-COVID conditions during the pandemic may increase the stress in obese patients with OSA. This situation makes it necessary for them to cope with their condition by themselves. This review aimed at the effect of this pandemic on these patients and coping strategies for them. METHODS: Databases like PubMed and Scopus were searched using a combination of key words. Full-text articles meeting the inclusion criteria were selected. RESULTS: The search yielded eight studies, discussing about the potential interactions between the COVID-19, obesity and OSA, the impact of COVID-19 on them, and management of these patients. CONCLUSIONS: Increased prevalence of COVID-19 was found among obese patients with OSA. The fear of COVID-19 and shift of health care workers to manage COVID-19 patients has affected their regular visits to the hospital. However, there is lack of coping strategies for them, which should soon be established for these patients.

Altered patterns of abdominal muscle activation during forced exhalation following elective laparotomy: An experimental research.

BACKGROUND: Post-operative pulmonary complications are common after exploratory laparotomy. Good abdominal muscle functioning is essential for forced exhalation and effective coughing. However, the impact of a laparotomy on abdominal muscle activity remains uncertain. The study aimed to assess abdominal muscle activity during forced exhalation following elective laparotomy. MATERIALS AND METHODS: A was carried out on those undergoing (n = 30) their first elective laparotomy. Abdominal muscle activity, as percentage maximal voluntary contraction (%MVC), was assessed during forced exhalation using surface electromyography (EMG) for transverse abdominis (TrAb), external oblique (EO), and rectus abdominis (RA) pre-operatively and up to seven days post-operatively. Peak expiratory flow rate (PEFR) was assessed during the forced exhalation maneuver. Median %MVC was used to represent the trends and Z-scores to report the change from the baseline activity. Spearman's correlation was used for the correlation between %MVC and PEFR. RESULTS: Pre-operatively, we observed the %MVC of TrAb (75.58%) to be the highest followed by RA (66.28%) and EO (62.12%). Post-operatively, all the muscles demonstrated increased activity wherein EO (84.33%) was most active on post-op day1, and for the rest of the days TrAb was the most active. However, as observed from Z-scores of all the three muscles the activity of EO was raised significantly from the baseline. No correlation was observed between %MVC and PEFR. CONCLUSION: TrAb is the most active muscle that contributes to forced exhalation. Following an elective laparotomy, TrAb is no longer the most active muscle, rather it is the EO that primarily contributes to forced exhalation. This should be considered while providing post-operative respiratory care. However, more research is required in this area to better understand the role of expiratory muscle training for those undergoing elective laparotomies.

A Cross-Sectional Study on Balance Deficits and Gait Deviations in COPD Patients.

Background: The gait abnormalities were linked to the balance deficits in the previous studies. However, the deviations in the gait parameters in COPD are currently not known. The study aims to compare gait parameters, static and dynamic balance, and risk of falls in COPD with those in non-COPD individuals. Method: Fourty-two patients with COPD aged 45 years and gender-matched control subjects were included in the study. Gait parameters were assessed by Win-Track gait analyzer, the static balance was assessed by posturography, and the dynamic balance was assessed by the time up and go test. The fear of falls was assessed by Falls Efficacy Scale. Results: COPD individuals had decreased static and dynamic balance as assessed by posturography (p < 0.05) and TUG (p < 0.01), respectively. A significant difference in swing duration (p=0.004) and also increased risk of falls (p < 0.01) was observed in COPD patients as compared to non-COPD individuals. Conclusion: COPD individuals have increased swing duration, reduced static and dynamic balance, and increased fear of falls as compared to non-COPD individuals.

Barriers to pulmonary rehabilitation - A narrative review and perspectives from a few stakeholders.

Pulmonary Rehabilitation (PR) is an essential and comprehensive intervention recommended in the management of people with chronic respiratory diseases (CRD). Scientific evidence suggests significant health benefits with respect to repeated hospital admissions, exercise tolerance and Health Related Quality of Life (HRQoL). However, the uptake and completion of PR programs are globally low. In order to understand the factors contributing to underutilization of PR, it is important to review and recognize the barriers to PR program. A literature search was conducted on Medline (PubMed) database. After reviewing the title and abstracts, full text articles were scrutinized for their relevance. Twenty-two studies involving factors affecting the uptake, participation and completion of PR program were included in this review. Reported barriers to PR were healthcare system, healthcare professional and patient related factors. Primary factors related to healthcare system and healthcare professionals were fewer PR centers, accessibility inconvenience, lack of awareness of PR program, low knowledge of referral process and lack of interdisciplinary teamwork. Difficulties faced by patients to take up and/or to complete PR programs were lack of transportation, co-morbidities, lack of perceived benefits, socio-economic status and lack of funding facilities. Identified and reported barriers resulted into discontinuity between knowledge of health benefits and utilization of PR service for patients with CRDs. Addressing the barriers would accelerate the healthcare professionals' referral and patients to avail the health benefits of rehabilitation service.

Comparison of reaction time and functional balance in chronic obstructive pulmonary disease and healthy participants.

BACKGROUND: Reaction time is one of the components of functional balance and could contribute to balance impairment. Information regarding this relationship is scant among Chronic Obstructive Pulmonary Disease (COPD) participants. OBJECTIVES: To compare stepping reaction time between participants with COPD and age; gender-matched healthy individuals to find out whether reaction time in COPD population is affected. METHODS: This cross-sectional study included 41 COPD participants and 41 age and gender-matched healthy individuals. All the participants underwent measurements of stepping reaction time (SRT) and timed up and go test (TUG). RESULTS: SRT was significantly higher in COPD participants compared to healthy individuals [median of difference- 350 milliseconds (110, 830), p < 0.001]. TUG was significantly higher in COPD participants compared to healthy individuals [median of difference = 2.82 seconds (0.34 and 4.5), p < 0.001]. CONCLUSIONS: Participants with COPD exhibit marked increase in SRT and demonstrate a deficiency in functional balance compared to the healthy participants.

The initial steps in pulmonary rehabilitation: How it all began?

Pulmonary rehabilitation plays a vital role in improving symptom, thereby enhancing health-related quality of life in patients with chronic obstructive pulmonary disease. We here with review is highlighting the landmark changes and recommendation for pulmonary rehabilitation since inception to till date. We also discuss the utilization of oxygen therapy, various measures of exercise training, and adherence strategy recommendation for betterment of the patient performance in their activity of daily living life.