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1.
Medicine (Baltimore) ; 99(23): e20625, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32502040

RESUMEN

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common high-burden and highly disabling lung disease. The quality of life and exercise endurance of patients with COPD is often low because of atrophy of the respiratory and skeletal muscles. Although recommended by the global initiative for chronic obstructive lung disease guidelines, pulmonary rehabilitation (PR) has not been used widely because of its inherent limitations. Tuna-Hui-Chun-Gong (TNHCG) is a popular traditional exercise used to treat COPD in China. We aim to evaluate the safety and efficacy of TNHCG for PR of COPD. METHODS: The provided protocol is for a single-blind randomized controlled trial in which 120 COPD patients will be randomly and equally divided into the experimental or control group. The control group will be treated with standard COPD drugs while the experimental group will perform TNHCG exercises apart from standard drug treatment. The duration of treatment will be 24 weeks and a follow-up for 48 weeks. The primary outcome will be the 6-Minute Walk Test. The secondary outcomes will include the pulmonary function test, St George's respiratory questionnaire, COPD assessment test, modified medical research council dyspnea scale, Hospital Anxiety and Depression Scale, and exacerbation frequency. A safety assessment will also be performed during the trial. DISCUSSION: Our study will provide evidence to support TNHCG exercise as an additional measure for PR of COPD. TRIAL REGISTRATION: ChiCTR1900028332, Registered December 29, 2019. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Sichuan Traditional Chinese Medicine Regional Ethics Review Committee (No. 2019KL-050).


Asunto(s)
Tolerancia al Ejercicio , Ejercicio Físico , Medicina China Tradicional/métodos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Calidad de Vida , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Método Simple Ciego , Resultado del Tratamiento , Prueba de Paso
2.
JAMA ; 323(18): 1813-1823, 2020 05 12.
Artículo en Inglés | MEDLINE | ID: mdl-32396181

RESUMEN

Importance: Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive pulmonary disease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Current guidelines recommend that patients enroll in pulmonary rehabilitation after hospital discharge. Objective: To determine the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival. Design, Setting, and Patients: This retrospective, inception cohort study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015. Exposures: Initiation of pulmonary rehabilitation within 90 days of hospital discharge. Main Outcomes and Measures: The primary outcome was all-cause mortality at 1 year. Time from discharge to death was modeled using Cox regression with time-varying exposure to pulmonary rehabilitation, adjusting for mortality and for unbalanced characteristics and propensity to initiate pulmonary rehabilitation. Additional analyses evaluated the association between timing of pulmonary rehabilitation and mortality and between number of sessions completed and mortality. Results: Of 197 376 patients (mean age, 76.9 years; 115 690 [58.6%] women), 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge. A total of 38 302 (19.4%) died within 1 year of discharge, including 7.3% of patients who initiated pulmonary rehabilitation within 90 days and 19.6% of patients who initiated pulmonary rehabilitation after 90 days or not at all. Initiation within 90 days was significantly associated with lower risk of death over 1 year (absolute risk difference [ARD], -6.7% [95% CI, -7.9% to -5.6%]; hazard ratio [HR], 0.63 [95% CI, 0.57 to 0.69]; P < .001). Initiation of pulmonary rehabilitation was significantly associated with lower mortality across start dates ranging from 30 days or less (ARD, -4.6% [95% CI, -5.9% to -3.2%]; HR, 0.74 [95% CI, 0.67 to 0.82]; P < .001) to 61 to 90 days after discharge (ARD, -11.1% [95% CI, -13.2% to -8.4%]; HR, 0.40 [95% CI, 0.30 to 0.54]; P < .001). Every 3 additional sessions was significantly associated with lower risk of death (HR, 0.91 [95% CI, 0.85 to 0.98]; P = .01). Conclusions and Relevance: Among fee-for-service Medicare beneficiaries hospitalized for COPD, initiation of pulmonary rehabilitation within 3 months of discharge was significantly associated with lower risk of mortality at 1 year. These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Anciano , Estudios de Cohortes , Planes de Aranceles por Servicios , Femenino , Hospitalización , Humanos , Masculino , Medicare , Puntaje de Propensión , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Análisis de Regresión , Estudios Retrospectivos , Análisis de Supervivencia , Tiempo de Tratamiento , Estados Unidos
3.
Medicina (B Aires) ; 80(2): 143-149, 2020.
Artículo en Español | MEDLINE | ID: mdl-32282320

RESUMEN

Since 1996, the Hospital del Tórax Dr. Antonio A. Centrángolo conducts a pulmonary rehabilitation program that requires patients with chronic pulmonary disease to attend the hospital twice a week. In 2015 the home-based program (HBP) was developed for patients living more than either 10 km or 60 minutes away from the hospital, or with conflicting working schedules. A retrospective study was conducted to describe the adherence to the home-based program by patients with chronic pulmonary disease, and explore adherence-related factors. In 2017, 96 (75.6%) of 127 patients eligible for pulmonary rehabilitation were assigned to the home-based program; they were instructed to complete at least three exercise sessions a week -including aerobic and resistance, segmental strength of upper and lower limbs, and flexibility-; and attend hospital visits every 20 to 30 days; "adherence to the HBP" was determined for patients who attended their final assessment on the fifth visit. A 40.6% (n = 39) of the patients only attended the first visit; 23% (n = 22) adhered to the program. This latter group of patients had shown, at their first assessment, better FVCs (p = 0.013), lower dyspnea scores (p = 0.008), and less than two or more exacerbations during the previous 6 months (p = 0.032). Only one patient needed to take three or more different transportation services to reach the hospital (p = 0.006). The results suggest that adherence to the home-based program was associated to a better clinical status and better access to the hospital.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Femenino , Servicios de Atención de Salud a Domicilio , Servicios de Atención a Domicilio Provisto por Hospital , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Socioeconómicos
4.
Braz J Med Biol Res ; 53(3): e9391, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32077467

RESUMEN

The oxygen uptake (V˙O2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The V˙O2, heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (P<0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (P<0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (P<0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (P<0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P>0.05 in group vs load analysis). The ventilatory efficiency was related to MRT of V˙O2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.


Asunto(s)
Terapia por Ejercicio/métodos , Tolerancia al Ejercicio/fisiología , Ventilación Voluntaria Máxima/fisiología , Consumo de Oxígeno/fisiología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Recuperación de la Función/fisiología , Anciano , Humanos , Cinética , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología
5.
Fisioterapia (Madr., Ed. impr.) ; 42(1): 24-32, ene.-feb. 2020. tab
Artículo en Español | IBECS | ID: ibc-187812

RESUMEN

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC), se caracteriza por la limitación al flujo aéreo crónica que genera síntomas como disnea, tos y sibilancias. La GOLD 2018 plantea estrategias de tratamiento farmacológico. Sin embargo, la adherencia es baja. Las diferencias entre pacientes adherentes y no adherentes no están claramente establecidas, debido a que podría existir una relación inversa entre la adherencia y las exacerbaciones. Objetivo: Determinar las diferencias entre pacientes adherentes y no adherentes al tratamiento farmacológico propuesto por la GOLD 2018 en variables clínicas, índices CODEX, COTE y BODE. Métodos: Estudio de tipo transversal, se incluyeron 126 pacientes con diagnóstico de EPOC entre enero y septiembre de 2018. Divididos en dos grupos: adherentes (EPOC-A) y no adherentes (EPOC-NA) teniendo en cuenta el tratamiento farmacológico de la GOLD 2018. Resultados: Setenta y nueve pacientes (EPOC-NA) y 50 (EPOC-A), el 61% pertenecían al género masculino y el 39% restante al género femenino. La edad promedio fue de 70,62 ± (8,290), la evaluación de aspectos de la GOLD, la mayoría de los pacientes adherentes pertenecen al grupo D y los no adherentes al grupo B; obteniéndose un valor p=0,004. En cuanto a los días hospitalizados, los pacientes adherentes permanecieron más días hospitalizados con una media de 11,32 ± (13,39) respecto a los no adherentes que tenían menos días 7,68 ± (13,13); valor p=0,031. Conclusión: Los pacientes adherentes al tratamiento farmacológico de la GOLD 2018 visitan más urgencias y presentan mayor número de exacerbaciones, lo cual se refleja en un aumento en la probabilidad de muerte


Background: Chronic obstructive pulmonary disease (COPD) is characterized by the chronic limitation of airflow that generates symptoms such as dyspnoea, coughing, and wheezing. The GOLD 2018 proposes pharmacological treatment strategies. However, adherence is low. The differences between adherent and non-adherent patients are not clearly established, although there could be an inverse relationship between adherence and exacerbations. Objective: To determine the differences between adherent and non-adherent patients to the pharmacological treatment proposed by GOLD 2018 in clinical variables, as well as the CODEX, COTE, and BODE indices. Methods: Cross-sectional study was conducted on 126 patients diagnosed with COPD between January and September 2018. They were divided into two groups: adherent (COPD-A) and non-adherent (COPD-NA), taking into account the pharmacological treatment of GOLD 2018. Results: The groups included 79 patients inCOPD-NA, and 50 in COPD-A), of which 61% were males and 39% females. The mean age was 70.62 ± (8.29. The majority of adherent patients belonged to GOLD group D, and the non-adherent to GOLD group B (P=.004). As regards days hospitalised, the adherent patients spent more days in hospital, with a mean of 11.32 ± (13.39) days, compared to non-adherent patients with fewer days 7.68 ± (13.13); P =.031. Conclusion: Patients adhering to the pharmacological treatment of GOLD 2018 make more emergency department visits and present with a greater number of exacerbations, and is reflected in an increase in the probability of mortality


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Cumplimiento y Adherencia al Tratamiento , Actividad Motora , Comorbilidad , Prueba de Paso/métodos , Estudios Transversales , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Espirometría/métodos
6.
Int J Surg ; 73: 78-86, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31843677

RESUMEN

BACKGROUND: Increasing studies have shown that application of pulmonary rehabilitation may improve the quality of life of chronic obstructive pulmonary disease (COPD) patients. However, the results of some studies still remained controversial and sample size of them limited to small number of participants. A systematic review and meta-analysis was designed to evaluate the efficacy of pulmonary rehabilitation for improving the quality of life in patients with COPD. METHODS: We searched the Cochrane Library, PubMed, EMBASE and Web of Science up to March 29, 2019 to identify relevant randomized controlled trials (RCTs) analyzing and evaluating the efficacy of pulmonary rehabilitation (PR) in patients with COPD. Participants were randomly assigned to receive PR (intervention group) or usual care (controller group). We used St. George's Respiratory Questionnaire (SGRQ) scores as evaluating indicators of quality of life. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated to compare the outcomes of the groups. We also performed subgroup analysis for the pooled results of pulmonary rehabilitation effects in COPD patients. Besides, sensitivity analysis was performed to examine the stability of the combined results. Two reviewers assessed trial quality and extracted data independently. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2 and Stata 12.0. RESULTS: Nineteen randomized controlled trials (N = 1146 participants) were identified for the present analysis. Comparing pulmonary rehabilitation groups with usual care groups (control groups), statistically significant improvements were noted in total score of SGRQ, with MD of -6.53. In addition, life quality improvement of SGRQ scores was better than 5 units in symptoms score, impacts score and activity score, with MDs of -5.01, -7.23 and -6.08, respectively. CONCLUSIONS: Rehabilitation may constitute one of important components of the management of COPD and may be beneficial in improving the quality of life. Future research should focus on identifying which components of pulmonary rehabilitation are essential, its ideal length and location, the degree of supervision and intensity of training required and how long treatment effects persist.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Calidad de Vida , Terapia Respiratoria/psicología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Terapia Respiratoria/métodos , Resultado del Tratamiento
7.
Int J Chron Obstruct Pulmon Dis ; 14: 2461-2468, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31806955

RESUMEN

Purpose: Application of non-invasive ventilation (NIV) during exercise improves exercise tolerance in severe COPD patients; however, the underlying mechanism is only partially unraveled. As part of its known effect to unload the respiratory muscles, we looked for the influence of NIV on post-exercise quadriceps muscle endurance. Patients and methods: We included 25 severe COPD patients entering an outpatient pulmonary rehabilitation program. They performed, on successive days, three quadriceps endurance tests at 70% of the maximal strength (1RM) to task failure (TlimQ); 1) control condition; 2) following constant load cycling exercise to exhaustion without Inspiratory Pressure Support (TlimQ IPS-); 3) following the same cycling exercise with IPS (TlmQ IPS+). Results: Dyspnea Borg score was significantly reduced at the end of the constant load cycling exercise with IPS+ compared to IPS- (3.5±2.6 to 4.3±2.3, p<0.05). Compared to controlled condition, TlimQ was reduced from 78.9±22.7 s to 64.7±22.1 s (p<0.01) with IPS+ and to 48.9±13.7 s (p<0.001) with IPS-. Sensitive analysis revealed a positive effect of NIV on TlimQ in only 15 of the 25 included patients (60%) and was unpredictable from exercise tolerance or maximal quadriceps strength. Conclusion: Using a simple muscle endurance test, we showed the protective effect of NIV on the exercise-induced quadriceps dysfunction. This beneficial effect is inconstant in our small series of patients and could not be predicted by exercise capacity or endurance to exercise. However, measuring quadriceps muscle endurance following a session of exercise could determine in which patient NIV would improve the benefit of pulmonary rehabilitation.


Asunto(s)
Ciclismo , Terapia por Ejercicio/métodos , Tolerancia al Ejercicio , Pulmón/fisiopatología , Ventilación no Invasiva , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Músculo Cuádriceps/fisiopatología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Recuperación de la Función , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
8.
Int J Chron Obstruct Pulmon Dis ; 14: 2441-2449, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31802862

RESUMEN

Background: Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes. Methods: In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6 min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline. Results: Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups. Conclusion: Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Pulmón/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Determinantes Sociales de la Salud , Factores Socioeconómicos , Anciano , Tolerancia al Ejercicio , Femenino , Volumen Espiratorio Forzado , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Capacidad Vital
9.
Respir Res ; 20(1): 278, 2019 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-31806021

RESUMEN

Chronic obstructive pulmonary disease (COPD) is associated with exercise intolerance and limits the functional gains in response to exercise training in patients compared to sedentary healthy subjects (SHS). The blunted skeletal muscle angiogenesis previously observed in COPD patients has been linked to these limited functional improvements, but its underlying mechanisms, as well as the potential role of oxidative stress, remain poorly understood. Therefore, we compared ultrastructural indexes of angiogenic process and capillary remodelling by transmission electron microscopy in 9 COPD patients and 7 SHS after 6 weeks of individualized moderate-intensity endurance training. We also assessed oxidative stress by plasma-free and esterified isoprostane (F2-IsoP) levels in both groups. We observed a capillary basement membrane thickening in COPD patients only (p = 0.008) and abnormal variations of endothelial nucleus density in response to exercise training in these patients when compared to SHS (p = 0.042). COPD patients had significantly fewer occurrences of pericyte/endothelium interdigitations, a morphologic marker of capillary maturation, than SHS (p = 0.014), and significantly higher levels of F2-IsoP (p = 0.048). Last, the changes in pericyte/endothelium interdigitations and F2-IsoP levels in response to exercise training were negatively correlated (r = - 0.62, p = 0.025). This study is the first to show abnormal capillary remodelling and to reveal impairments during the whole process of angiogenesis (capillary creation and maturation) in COPD patients. TRIAL REGISTRATION: NCT01183039 & NCT01183052, both registered 7 August 2010 (retrospectively registered).


Asunto(s)
Terapia por Ejercicio/métodos , Músculo Esquelético/efectos de los fármacos , Neovascularización Fisiológica/fisiología , Enfermedad Pulmonar Obstructiva Crónica/patología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Inductores de la Angiogénesis/administración & dosificación , Biopsia con Aguja , Capilares/patología , Ejercicio Físico , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Músculo Esquelético/irrigación sanguínea , Estrés Oxidativo , Valores de Referencia , Remodelación Vascular
11.
Ther Umsch ; 76(6): 323-327, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31762415

RESUMEN

Pulmonary Rehabilitation Abstract. Pulmonary rehabilitation is a comprehensive therapeutic approach for patients with advanced chronic lung diseases which leads to a decline of dyspnea, an increase of exercise capacity and an increase of quality of life. Further effects are a reduction of frequency of hospitalisations and an increase of physical activity, if a self management education program is integrated. Pulmonary rehabilitation incorporates an individualised training program with focus on endurance, strength and mobility, further a disease specific education with the goal to improve self efficacy and self management of the patients, specially with the goal to improve their daily physical activity. Due to the good evidence of pulmonary rehabilitation, the accredited programs are accepted and paid by the swiss insurances.


Asunto(s)
Terapia por Ejercicio , Enfermedades Pulmonares , Enfermedad Pulmonar Obstructiva Crónica , Disnea/etiología , Disnea/prevención & control , Ejercicio Físico , Humanos , Enfermedades Pulmonares/rehabilitación , Resistencia Física , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Calidad de Vida , Resultado del Tratamiento
12.
Int J Chron Obstruct Pulmon Dis ; 14: 2291-2304, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31631999

RESUMEN

Purpose: Pulmonary rehabilitation (PR) is essential to manage patients with COPD. The aim of this study was to investigate the appropriate intensity of PR exercise training for patients with moderate-to-severe COPD. Patients and methods: A prospective multicenter randomized controlled trial was conducted from January 2014 to October 2018. The subjects were randomly assigned to three groups with different intensities of PR, according to their maximum oxygen uptake percentage determined by cardiopulmonary exercise testing. After 20 weeks of exercise training, the effects of low-, moderate-, and high-intensity exercise interventions on patients were compared to determine the most appropriate PR prescription. Results: For patients with moderate COPD, all the measured parameters were significantly improved in the moderate- and high-intensity PR groups (P<0.01), while there was no significant difference in the frequency of acute exacerbations and the mMRC questionnaire after 20 weeks of PR exercise in the low-intensity PR group. For patients with severe COPD, all variables were also improved in the high-intensity PR group (P<0.05), while the mean differences of pre- and post-PR were lower than those in patients with moderate COPD. Moreover, the Hamilton Anxiety Scale and body mass index showed no significant difference in low-intensity PR group (P>0.05). Conclusion: High-intensity PR exercise is helpful for patients with moderate to severe COPD. Moderate COPD patients need to receive intensive PR training; the improvement degrees from PR intervention were higher than those of the severe COPD patients. For patients with severe COPD, high-intensity PR exercise may be more beneficial if patients can tolerate it.


Asunto(s)
Terapia por Ejercicio , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Método Simple Ciego
13.
J Bras Pneumol ; 45(6): e20180132, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31618297

RESUMEN

OBJECTIVE: Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. METHODS: We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. RESULTS: There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). CONCLUSIONS: Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/rehabilitación , Terapia por Ejercicio/métodos , Neoplasias Pulmonares/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Anciano , Dióxido de Carbono/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/fisiopatología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Prueba de Esfuerzo , Femenino , Volumen Espiratorio Forzado/fisiología , Humanos , Neoplasias Pulmonares/fisiopatología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/fisiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Valores de Referencia , Estudios Retrospectivos , Espirometría , Factores de Tiempo , Resultado del Tratamiento , Capacidad Vital/fisiología
14.
Chron Respir Dis ; 16: 1479973119880893, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31569958

RESUMEN

This study aimed to investigate (a) the association between psychological flexibility and engagement in pulmonary rehabilitation within 8 weeks following hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and (b) how psychological (in)flexibility presents in this context. A mixed-methods study was conducted. Psychological flexibility during an AECOPD was assessed using The Acceptance and Action Questionnaire-II (AAQ-II) (n = 41) and the Engaged Living Scale (ELS) (n = 40). Engagement in post-AECOPD pulmonary rehabilitation was then recorded. Twenty-three patients also participated in cognitive interviews. Psychological flexibility was associated with a greater chance of accepting a pulmonary rehabilitation referral following an AECOPD. Small numbers prohibited analysis on attendance or completion. An AAQ-II score of 11 translated to a 60 (37-82)% probability of accepting a referral to pulmonary rehabilitation and an ELS score of 73 was associated with a 68 (46-91)% probability of accepting. Four themes were extracted from interviews: (1) family values, (2) self as abnormal, (3) 'can't do anything' versus 'I do what I can' and (4) disability, and related emotions, as barriers to action. Randomised clinical trials are needed to evaluate interventions designed to increase psychological flexibility (i.e. acceptance and commitment therapy) to support acceptance of pulmonary rehabilitation post-AECOPD.


Asunto(s)
Adaptación Psicológica , Participación del Paciente/psicología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Aguda , Anciano , Personas con Discapacidad/psicología , Progresión de la Enfermedad , Emociones , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Autoimagen , Encuestas y Cuestionarios
15.
Medicine (Baltimore) ; 98(38): e17129, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31567952

RESUMEN

BACKGROUND: Pulmonary rehabilitation (PR) is an indispensable component in the nonpharmacological management of patients with chronic obstructive pulmonary disease (COPD) with significant improvements in quality of life and exercise capacity. It is strongly supported by systematic reviews (SR) as part of the treatment of these patients. However, it is not known which PR components are essential, such as duration, ideal locations, type and intensity of training, degree of supervision, adherence, cost-effectiveness challenge, and how long the program effects last. This overview aims to evaluate and describe different pulmonary rehabilitation interventions for individuals with COPD. METHODS: Only systematic reviews of randomized controlled trials (RCTs) published in the Cochrane Database of Systematic Reviews will be included. The following results were analyzed: health-related quality of life, functional capacity, mortality, dyspnea, cost-effectiveness, and adverse events. The risk of bias will be assessed by the Risk of Bias in Systematic Reviews (ROBIS). The methodological quality will be analyzed through the Assessment of Multiple Systematic Reviews (AMSTAR-2). We will use the evaluations of the Classification of Recommendations, Evaluation, Development and Evaluation (GRADE) of the authors of the included systematic reviews. The screening of systematic reviews, eligibility evaluation, data extraction, methodological quality, and quality of evidence will be performed in pairs by independent reviewers. The results that have been reported in the included reviews will be summarized in an "Overview of Reviews" table. The main conclusions about the effects of the interventions studied in the included reviews will be summarized and organized in clinically meaningful categories. RESULTS: The article in this overview will be submitted for publication in a peer-reviewed journal. The results will also be included in a doctoral thesis and disclosed in medical conferences. CONCLUSIONS: We expect to compile evidence from multiple systematic reviews of pulmonary rehabilitation in people with COPD in an accessible and useful document. REGISTRATION NUMBER PROSPERO: CRD42019111564.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Literatura de Revisión como Asunto , Resultado del Tratamiento
16.
J Bras Pneumol ; 45(6): e20180011, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576905

RESUMEN

OBJECTIVE: To evaluate the effects of high-intensity interval training (HIIT), in comparison with those of continuous exercise, on functional capacity and cardiovascular variables in patients with COPD, through a systematic review and meta-analysis of randomized controlled trials. METHODS: We searched PubMed, the Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, and EMBASE, as well as performing hand searches, for articles published up through January of 2017. We included studies comparing exercise regimens of different intensities, in terms of their effects on functional capacity and cardiovascular variables in patients with COPD. RESULTS: Of the 78 articles identified, 6 were included in the systematic review and meta-analysis. Maximal oxygen consumption (VO2max) did not differ significantly between HIIT and control interventions. That was true for relative VO2max (0.03 mL/kg/min; 95% CI: -3.05 to 3.10) and absolute VO2max (0.03 L/min, 95% CI: -0.02 to 0.08). CONCLUSIONS: The effects of HIIT appear to be comparable to those of continuous exercise in relation to functional and cardiovascular responses. However, our findings should be interpreted with caution because the studies evaluated present a high risk of bias, which could have a direct influence on the results.


Asunto(s)
Terapia por Ejercicio/métodos , Entrenamiento de Intervalos de Alta Intensidad/métodos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Humanos , Consumo de Oxígeno/fisiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del Tratamiento
19.
Chron Respir Dis ; 16: 1479973119867952, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31526047

RESUMEN

Combined exercise rehabilitation for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) is potentially attractive. Uncertainty remains as to the baseline profiling assessments and outcome measures that should be collected within a programme. Current evidence surrounding outcome measures in cardiac and pulmonary rehabilitation were presented by experts at a stakeholder consensus event and all stakeholders (n = 18) were asked to (1) rank in order of importance a list of categories, (2) prioritise outcome measures and (3) prioritise baseline patient evaluation measures that should be assessed in a combined COPD and CHF rehabilitation programme. The tasks were completed anonymously and related to clinical rehabilitation programmes and associated research. Health-related quality of life, exercise capacity and symptom evaluation were voted as the most important categories to assess for clinical purposes (median rank: 1, 2 and 3 accordingly) and research purposes (median rank; 1, 3 and 4.5 accordingly) within combined exercise rehabilitation. All stakeholders agreed that profiling symptoms at baseline were 'moderately', 'very' or 'extremely' important to assess for clinical and research purposes in combined rehabilitation. Profiling of frailty was ranked of the same importance for clinical purposes in combined rehabilitation. Stakeholders identified a suite of multidisciplinary measures that may be important to assess in a combined COPD and CHF exercise rehabilitation programme.


Asunto(s)
Terapia por Ejercicio , Insuficiencia Cardíaca/rehabilitación , Evaluación de Resultado en la Atención de Salud/métodos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Ansiedad/diagnóstico , Consenso , Depresión/diagnóstico , Tolerancia al Ejercicio , Insuficiencia Cardíaca/psicología , Humanos , Escalas de Valoración Psiquiátrica , Enfermedad Pulmonar Obstructiva Crónica/psicología , Calidad de Vida , Autoeficacia , Participación de los Interesados , Evaluación de Síntomas
20.
Artículo en Inglés | MEDLINE | ID: mdl-31505861

RESUMEN

Background: More feasible rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD) are warranted. Even so, still in its infancy, telerehabilitation to COPD patients reveals promising results, wherefore it is anticipated to contribute significant value to the current challenges of rehabilitation to these patients. To expand useful knowledge in the field, more sophisticated telerehabilitation interventions must be developed and appraised, but first and foremost, thoroughly described. Aims and methods: The aim of this article is to give a detailed description of the rationale and content of the >C☺PD-Life>> programme, within the bounds of the checklist of Template for Intervention Description and Replication (TIDieR). Approach: >C☺PD-Life>> is a telerehabilitation programme for COPD patients delivered as a study intervention by an interprofessional team of clinicians collaborating from both the hospital and the municipal healthcare system. Making use of two-way audio and visual communication software, 15 patients participated in the intervention via a tablet computer from their private setting. The programme was a six-month-long empowerment-based rehabilitation that aimed to support COPD patients in leading a satisfactory and confident life with appropriate physical activity and high disease management. Conclusions: A long-term interprofessional cross-sectoral telerehabilitation programme has been justified and described. The intervention was tested in 2017-2018 and the qualitative appraisal, along with an analysis of case-based measurements of development in physical capacity, COPD Assesment Test, and health management, is currently under production.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Calidad de Vida/psicología , Telerrehabilitación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción Personal , Enfermedad Pulmonar Obstructiva Crónica/psicología , Autoimagen
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