Impact of anthropometric data and physical activity level on the closed kinetic chain upper extremity stability test (CKCUEST) score: A cross-sectional study.

OBJECTIVE: The aim of this study was to evaluate the impact of anthropometric data and the level of physical activity on the CKCUEST score on uninjured subjects. METHOD: Subjects were eligible for the study if they were aged between 18 and 25 years old. Anthropometric data were collected, and the physical activity level was assessed using the Global Physical Activity Questionnaire (GPAQ). The primary endpoint was the CKCUEST score. The CKCUEST was performed three times and the score was the mean of the 3 tries. The compared groups were posteriori dichotomized according to the median. A multivariate model has been built by step-by-step selection with a threshold set at 0.05. RESULTS: 82 subjects were included. The difference between groups determined for each variable was statistically significant for CKCUEST score (p < 0.0001) and for physical activity level (p = 0.0245). The multivariate analysis showed that arm span, sex and weight are, in order, three main variables influencing the CKCUEST score. A predictive equation was established based on these 3 factors (R2 = 0.51). CONCLUSION: The CKCUEST score seems to be impacted by sex, weight and arm span. A predictive equation for the CKCUEST score was proposed: (0.271 × Upper Limb Span)-(0.103 × Weight)-(3.219 × Sex)-17.719.

Determination of the minimal important difference for inspiratory muscle strength in people with severe and very severe COPD.

OBJECTIVE: Inspiratory muscle training is recommended for people with chronic obstructive pulmonary disease (COPD) with inspiratory muscle weakness. Clinical interpretation of changes in inspiratory muscle strength could be helped by the determination of cut-off values. The aim of this study was to estimate the minimal important difference for inspiratory muscle strength assessed with maximal inspiratory pressure (MIP) in people with COPD. DESIGN: Post hoc analysis of a randomized controlled trial (EMI2 study) including people with severe to very severe COPD undergoing a pulmonary rehabilitation program was conducted. The determination of the minimal important difference was realized using both anchor-based and distribution-based methods. SETTING: The study includes patients admitted to the rehabilitation program unit of the Centre Hospitalier des Pays de Morlaix (Morlaix, France) between March 5, 2014 and September 8, 2016. PARTICIPANTS: Seventy-three people with severe to very severe COPD (age 62.2 ± 8.0 years, forced expiratory volume in 1 s 36.4 ± 9.5% of theoretical) were analyzed. INTERVENTION: Patients followed a standardized pulmonary rehabilitation program 5 days a week for 4 weeks. The program included aerobic training, ground-based outdoor walking training, and strengthening of lower and upper limb muscles. MAIN MEASURES: At the end of the pulmonary rehabilitation program, MIP improved by 14.8 ± 14.9 cmH2O (p < 0.05). Regarding the anchor-based method, only the modified Medical Research Council was selected as an appropriate anchor. The receiver operating characteristic curve analysis reported a minimal important difference of 13.5 cmH2O (sensibility: 75% specificity: 67.5%). Using distribution-based methods, the estimate of minimal important difference was 7.9 cmH2O (standard error of measurement method) and 10.9 cmH2O (size effect method). RESULTS: The estimations proposed by this study ranged from 7.9 to 13.5 cmH2O. CONCLUSIONS: The measurement of minimal important difference is a simple tool for assessing the changes of inspiratory muscle strength during a pulmonary rehabilitation program. We propose a minimal important difference of 13.5 cmH2O for the improvement of MIP. Further studies are needed to confirm this estimation.ClinicalTrials.gov identifier: NCT02074813.

Characteristics and Predictors of Postural Control Impairment in Patients With COPD Participating in a Pulmonary Rehabilitation Program.

PURPOSE: Postural control impairment has been identified as a potential extrarespiratory manifestation in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to identify clinical factors that characterize patients with reduced postural control, to examine the correlation between clinical factors and postural control and to determine predictors of an impaired postural control among COPD participants enrolled in a pulmonary rehabilitation (PR) program. METHODS: This study is a secondary analysis of an observational study (PARACHUTE). The baseline assessment of the PR program was used for the analysis. Postural control impairment was defined using the Brief BESTest score (BBT). RESULTS: Participants (n = 73) were included in the analysis, 43 of them were classified in the reduced postural control group. The between-group comparison (non-reduced vs reduced postural control) identified differences for partial pressure in oxygen (Pa O2 ), Saint George Respiratory Questionnaire (SGRQ) total score and subscores (SGRQ-Symptoms, SGRQ-Activities, and SGRQ-Impact), COPD assessment test (CAT), and anxiety score of the Hospital Anxiety and Depression Scale. The BBT score was significantly correlated with maximal inspiratory pressure (MIP), SGRQ, SGRQ-Symptoms, SGRQ-Impact, Falls Efficacy Scale, modified Medical Research Council Scale, 6-min walk test, and Pa O2 . Logistic regression identified SGRQ-Symptoms, Pa O2 , MIP, and body mass index (BMI) as predictors of the presence of reduced postural control. CONCLUSION: Low quality of life (QoL) and Pa O2 and high anxiety seem to be discriminative characteristics of patients with COPD with reduced postural control. Furthermore, QoL, Pa O2 , inspiratory muscle strength, and BMI seem to be acceptable predictors of the presence of postural control impairment.

Telerehabilitation as a Form of Pulmonary Rehabilitation in Chronic Lung Disease: A Systematic Review.

INTRODUCTION: Tele-rehabilitation is increasingly used to deliver pulmonary rehabilitation. The aim of this systematic review was to compare the effect between tele-pulmonary rehabilitation and classical supervised pulmonary rehabilitation. METHOD: Three databases were analysed (PubMed, PEDro, Scopus). The selection and evaluation of studies followed the PRISMA guidelines. The risk of bias was evaluated using the PEDro Scale. RESULTS: From the initial selection (n = 245), ten studies were retrieved, including from 10 to 67 patients. All but two (IPF) included patients with COPD. Based on the FEV1, patients with COPD were mainly categorised as moderate and severe. The teleactivities were heterogenous in terms of proposed exercises and way of settings and often not in agreement with the guidelines about pulmonary rehabilitation. Despite this, the effects of the interventions were globally positive on functional exercise capacity, quality of life, anxiety and depression, and impact of COPD on personal life but not on dyspnoea. The PEDro scores varied from 4 to 8. The adherence was higher than 80% when supervision during the exercise was included. CONCLUSION: This review demonstrated that the telerehabilitation is safe and well accepted by the patients, and could be considered as one option of classical pulmonary rehabilitation to improve the functional exercise capacity, quality of life, anxiety and depression, and the impact of COPD on personal's life. This conclusion cannot be extrapolated to the other chronic lung diseases due to the lack of data.

Effects of pulmonary rehabilitation on fear of falling in Chronic Obstructive Pulmonary Disease (COPD) patients: An observational study.

OBJECTIVE: COPD patients have more fear of falling (FOF) in comparison with control population. One major aim of pulmonary rehabilitation (PR) is to maintain physical activity. Studies show that FOF can limit physical activity. The aim of this study was to assess the impact of PR on FOF in patients with COPD. METHODS: From January to august 2019, COPD patients (stage 2 to 4) undergoing a 4-weeks PR Program (PRP) at Morlaix Hospital Centre were included in this prospective observational study. The objectives were to assess [1] the impact of PR on FOF, [2] the correlations between evolution of FOF and evolution of parameters usually used during PRP, [3] to determine a MID for FOF. The primary endpoint was the Fall Efficacy Scale-International (FES-I) questionnaire. The secondary endpoints were tests and questionnaires usually used to assess exercise capacity, quality of life, dyspnea, anxiety, depression, and balance. RESULTS: 80 patients were included and 72 were analysed. After the PRP, there was a significant decrease of FOF, with significative decrease of FES-I score (-3.36, p<0.001) CI 95% [-5.1; -1.6]). The evolution of FES-I score was moderately correlated to changes in quality of life (QOL) using CAT (Intra-class Correlation Coefficient (ICC)=0.340, p=0.005) and SGRQ (ICC=0.454, p<0.0001), dyspnea using MMRC (ICC=0.311, p=0.009) and LCADL (ICC=0.396, p=0.001); and weakly correlated to changes in balance (ICC=-0.280, p=0.026). Using the distribution-based analysis, we found a MID between -3.6 to -4.9. CONCLUSION: We showed a significant decrease of fear of falling in COPD patients after PRP, correlated with improvement of QOL, balance and decrease of dyspnea. We propose a MID of -4.9 for FES-I. TRIAL REGISTRATION: ClinicalTrials.gov NCT03793452.

Validation of the French translation of a self-administered questionnaire looking for a history of pre-eclampsia.

We evaluated the diagnostic performances of the French translation of a self-administered questionnaire designed by Diehl et al. looking for a history of pre-eclampsia. After a phone call, 206 women who gave birth at Brest University Hospital responded to the questionnaire online. Then, their responses were compared to their medical files. The sensitivity of the questionnaire was 95.2% and its specificity was 98.0%. This French questionnaire has then demonstrated its validity. It can now be used to explore the role of a pre-eclampsia history on various pathologies and, by this mean, to improve knowledge about women's health.

Effect of neuromuscular electrical stimulation on exercise capacity in patients with severe chronic obstructive pulmonary disease: A randomised controlled trial.

OBJECTIVE: To compare strengthening by neuromuscular electrical stimulation versus cycle ergometer training during a pulmonary rehabilitation program, in patients with severe to very severe chronic obstructive pulmonary disease. DESIGN: A prospective randomized controlled study. SETTING: Two inpatient pulmonary rehabilitation centers. SUBJECTS: Patients with severe to very severe chronic obstructive pulmonary disease and multidimensional index to predict risk of death ≥5, were randomly assigned to receive neuromuscular electrical stimulation or cycle ergometer training during pulmonary rehabilitation. MAIN MEASURES: The primary endpoint was the change in exercise capacity using 1-min sit-to-stand test Secondary endpoints were the changes in exercise capacity using 6-min walk test, quadriceps strength, quality of life and dyspnea. RESULTS: 102 patients were included. After 3 weeks, 47 patients in the neuromuscular electrical stimulation group, and 45 in the cycle ergometer training group were able to be analyzed. No significant difference was seen in the evolution of exercise capacity using 1-min sit-to-stand test (3.3 ± 3.8 and 2.6 ± 4.1) and 6-min walk test (37.8 ± 58.4 and 33.1 ± 46.7), in the evolution of quadriceps strength and endurance (9.2 ± 12.9 and 6.6 ± 16.1; 9.0 ± 13.2 and 6.2 ± 17.0), in the evolution of quality of life (St George's Respiratory Questionnaire: -11.3 ± 11.7 and -8.1 ± 11.6; COPD Assessment Test: -5.7 ± 7.1 and -4.7 ± 7.0), or in the evolution of dyspnea using Dyspnea 12 (-5.5 ± 10.2 and -5.9 ± 8.5) except using modified medical research council scale (95% confidence interval: 0.48 [0.05; 0.91], p = 0.027). CONCLUSION: We found no significant difference between the two programs on exercise capacity, quadriceps strength and quality of life.

Short-term effects of menthol on walking dyspnoea in patients with COPD: a randomised, single blinded, cross-over study.

Chewing menthol gum prior to exercise is a safe, easy-to-implement, low-cost, non-pharmacologic intervention that provides a reduction in dyspnoea in a third of patients and decreases the perception of discomfort during exercise in two-thirds of patients https://bit.ly/3FoFHp1.

Dyspnea could be accurately assessed by a caregiver in hospitalized patients with respiratory diseases: Interrater reliability and agreement study.

BACKGROUND: The perception of dyspnea is a subjective feeling typically self-assessed by the patient. However, the assessment by a caregiver is sometimes required. OBJECTIVES: The primary aim was to compare patient self-assessment and caregiver assessment of dyspnea (interrater reliability) using the modified Borg and visual analog scale (VAS) in hospitalized patients. The secondary aim was to compare dyspnea assessment between the two scales for patients and caregiver (inter-instrument reliability). METHODS: Self-assessment of dyspnea intensity of hospitalized patients with respiratory diseases was compared with caregiver's assessment. Dyspnea intensity was measured using two scales, the modified Borg scale (0-10 scale) and the 10 cm VAS. Mean difference and 95% confidence interval (CI) between assessors (i.e. patient versus caregiver) were calculated for each scale. Inter- and intra-rater reliability was calculated using intraclass correlation coefficients (ICCs). RESULTS: A total of 254 patients were recruited. The mean differences between patient and caregiver ratings were 0.31 (95% CI: 0.09, 0.53) for the modified Borg scale and 0.36 (95% CI: 0.06, 0.65) for the VAS scale. Interrater reliability was good for both scales with ICC of 0.79 (95% CI: 0.73, 0.84) for VAS and 0.82 (95% CI: 0.77, 0.86) for the modified Borg scale. The mean differences in scores between scales were 0.93 (95% CI 0.69, 1.17) for patients' ratings and 0.88 (95% CI 0.72, 1.04) for caregiver's rating. The inter-instrument reliability was moderate to good and similar for both assessors. CONCLUSION: Dyspnea can be accurately estimated by caregivers when patients with lung diseases cannot self-report. Scores on the VAS to rate dyspnea were higher than the scores on the Borg scale.

Effect of Local Anesthesia on Pain During Arterial Puncture: The GAEL Randomized Placebo-Controlled Trial.

BACKGROUND: Arterial puncture is often painful for patients. The aim of this study was to compare use of local anesthesia as a eutectic mixture of 2 local anesthetics, lidocaine and prilocaine, versus placebo. METHODS: We conducted a double-blind, randomized controlled trial. Subjects were eligible if arterial puncture was indicated. The primary outcome was an experienced pain > 2 on a numerical pain rating scale. As having had a previous experience of arterial puncture was expected to be predictive of the current response, we planned 3 comparisons between use of local anesthesia and placebo: in the whole sample, among subjects with a painful previous experience, and among subjects with a painless previous experience. Multiple testing was analyzed using the Bonferroni correction for the primary outcome. The secondary outcome was the numerical pain rating scale score itself. All analyses were performed on an intention-to-treat basis. RESULTS: A total of 136 subjects were included in this study. The primary outcome occurred in 20.9% in the active arm versus 37.7% in the placebo arm in the whole sample (relative risk 0.55; 95% CI when adjusting for multiple testing ranged was 0.28-1.09, P = .10; 95% CI without adjustment was 0.32-0.97, P = .038). No significant heterogeneity in the study treatment effect was found when considering previous painful or painless arterial puncture (P = .70). The numerical pain rating scale score was 1.55 ± 2.03 in active group versus 2.09 ± 2.15 in the placebo group (P = .13). CONCLUSIONS: We found that application of a eutectic mixture reduced the number of painful arterial punctures by 50% compared with placebo. However, this result was not statistically significant. (ClinicalTrials.gov registration NCT01964248.).

Determination of the minimal important difference for Dyspnoea-12 questionnaire in patients with COPD, after pulmonary rehabilitation.

INTRODUCTION: The authors of the international task force about the management of Dyspnoea recommend assessing sensory and affective components of dyspnoea. The Dyspnoea-12 questionnaire (D-12) allows to assess both components of dyspnoea. D-12 is valid and reliable but its sensitivity to pulmonary rehabilitation was not studied. The aim of this study was to estimate the minimal important difference (MID) for D-12 in COPD patients undergoing a pulmonary rehabilitation programme (PRP). METHODS: Severe or very severe COPD patients undergoing a PRP were included. Dyspnoea was assessed using D-12, MMRC dyspnoea scale, London chest of Activity of Daily Living questionnaire (LCADL). Quality of life was assessed using Saint-George respiratory questionnaire (SGRQ) and COPD assessment Test (CAT); exercise capacity using 6-Minute walk Test (6MWT) and 1-minute sit to-stand test (1STST). The MID was evaluated using distribution and anchor-based methods. RESULTS: Sixty patients (age: 64.4 ± 8.2; FEV1 (%): 28.6 ± 8.1) were included. At the end of the PRP, patients had significantly decreased their dyspnoea measured with D-12, MMRC, LCADL (D-12:23.9 ± 8.9 to 17.6 ± 9.4; MMRC: 3 ± 0.7 to 2.2 ± 1.1, LCADL: 38 ± 13.9 to 31.6 ± 11; p < 0.0001). Using the distribution-based analysis, MID of -2.67 (standard error of measurement) or -4.45 (standard deviation) was found. According to methodology, we could only use SGRQ as anchor. With SGRQ as anchor, the receiver operating characteristic curve identified MID for the change in D-12 at -6.1 (sensibility: 58%, specificity: 79%). The correlation with SGRQ was modest (r = 0.33), so the calculated MID should be interpreted with caution. CONCLUSION: D-12 is a good tool to assess the decrease of dyspnoea after PR. We propose MID of -6 points. However, Future estimates of MID for the D-12 should use anchors that are more strongly correlated with it.

Effect of different form of upper limb muscles training on dyspnea in chronic obstructive pulmonary disease: A study protocol.

INTRODUCTION: In activities involving upper limbs, patients with chronic obstructive pulmonary disease (COPD) report an increase in dyspnea. For this reason, the authors of the recommendations about pulmonary rehabilitation propose to perform upper limbs muscle strengthening in patients with COPD. However, the modalities of strengthening are not clearly established.The aim of this study is to compare the effects of upper limbs endurance strengthening versus upper limbs force strengthening, in patients with COPD during a pulmonary rehabilitation program. METHODS: This study is a randomized, open-label, bi-center controlled trial in parallel groups distributed in a ratio (1:1) comparing upper limbs force strengthening (group F) to the upper limbs endurance strengthening (group E) during a pulmonary rehabilitation program in patients with COPD stages 2 to 4 (A-D).After randomization, patients will be allocated to follow: A 4 weeks pulmonary rehabilitation program with upper limbs resistance strengthening (group F). A 4 weeks pulmonary rehabilitation program with upper limbs endurance strengthening (group E).The primary outcome is dyspnea measured with the London Chest Activity of daily Living questionnaire. The secondary outcomes are dyspnea (using Modified Medical Research Council dyspnea Scale, dyspnea-12 questionnaire, multidimensional dyspnea profile questionnaire), upper limb exercise capacity (using the 6-minute Peg Board and Ring Test), Maximal voluntary strength of deltoid, biceps, and brachial triceps.The sample size calculated is 140 patients per group, or 280 in total. DISCUSSION: The modalities of upper limb strengthening are not very well known, and evidence based is lacking to recommend endurance or resistance upper limb strengthening.We anticipate that the results of this study will be of relevance to clinical practice. They will bring information about the best modality of upper limb strengthening to use during a pulmonary rehabilitation program. TRIAL REGISTRATION: IdRCB n°2018-A00955-50; V1.1 du 11/07/2018; REHABSUP, clinical trial.gov (NCT03611036), registered August 02, 2018, https://clinicaltrials.gov/ct2/show/NCT03611036.

Comparison of 3-minute Step Test (3MStepT) and 6-minute Walk Test (6MWT) in Patients with COPD.

Chronic obstructive pulmonary disease (COPD) is frequently associated with a reduced functional exercise capacity. This parameter is usually evaluated using 6-minute walking test (6MWT). New tools appear regularly. The aim of this study was to validate the 3-minute step test (3MStepT) and to compare 3MStepT and 6MWT in stable patients with COPD as a tool to quantify the functional exercise capacity. Patients with COPD admitted for a pulmonary rehabilitation program in a dedicated center were recruited and randomly performed both tests: 6MWT and 3MStepT. A training test was performed systematically before each test. Walking distance and number of repetitions (3MStepT) were measured. Cardiorespiratory parameters, dyspnea and lower limb fatigue (Borg) were recorded pre and post the tests. Fifty patients with COPD (FEV1: 45.2 ± 18.3) were included. 6MWT (423.6 ± 96.3 m) was strongly correlated with 3MStepT (62.1 ± 18.0; r = 0.780; p < 0.001). Heart rate and SpO2 were significantly different at the end of the 6MWT and 3MStepT (respectively, 106.2 ± 16.3 vs. 112.9 ± 13.4bpm, p = 0.002; 87.6 ± 5.4 vs. 89.6 ± 5.3bpm, p = 0.001). Lower limb fatigue was significantly higher after the 3MStepT (2.5 ± 2.6 vs. 3.4 ± 2.4, p = 0.01). The 3MStepT is an alternative to the 6MWT to estimate functional exercise capacity in stable patients with COPD but cardiorespiratory adaptation and lower limb fatigue are not similar between these tests.

Determining the minimally important difference in quadriceps strength in individuals with COPD using a fixed dynamometer.

Background: Measurement of quadriceps muscular force is recommended in individuals with COPD, notably during a pulmonary rehabilitation program (PRP). However, the tools used to measure quadriceps maximal voluntary contraction (QMVC) and the clinical relevance of the results, as well as their interpretation for a given patient, remain a matter of debate. The objective of this study was to estimate the minimally important difference (MID) of QMVC using a fixed dynamometer in individuals with COPD undergoing a PRP. Methods: Individuals with COPD undergoing a PRP were included in this study. QMVC was measured using a dynamometer (MicroFET2) fixed on a rigid support according to a standard-ized methodology. Exercise capacity was measured by 6-minute walk distance (6MWD) and evaluation of quality of life with St George's respiratory questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS) total scores. All measures were obtained at baseline and the end of the PRP. The MID was calculated using distribution-based methods. Results: A total of 157 individuals with COPD (age 62.9±9.0 years, forced expiratory volume in 1 second 47.3%±18.6% predicted) were included in this study. At the end of the PRP, the patients had improved their quadriceps force significantly by 8.9±15.6 Nm (P<0.001), as well as 6MWD by 42±50 m (P<0.001), SGRQ total score by -9±17 (P<0.001) and HADS total score by -3±6 (P<0.001). MID estimation using distribution-based analysis was 7.5 Nm by empirical rule effect size and 7.8 Nm by Cohen's effect size. Conclusion: Measurement of QMVC using a fixed dynamometer is a simple and valuable tool capable of assessing improvement in quadriceps muscle force after a PRP. We suggest an MID of 7.5 Nm to identify beneficial changes after a PRP intervention.

Validation of the French version of the London Chest Activity of Daily Living scale and the Dyspnea-12 questionnaire.

Introduction: Eighty percent of COPD patients experience dyspnea during activities of daily life (ADL). To the best of our knowledge, the Modified Medical Research Council (MMRC) dyspnea scale is the only validated scale designed to quantify dyspnea during ADL available in the French language. Two other instruments are only available in English versions: the London Chest Activity of Daily Living (LCADL) scale that allows a specific evaluation of dyspnea during ADL and the Dyspnea-12 questionnaire that evaluates the affective (emotional) and sensory components of dyspnea in daily life. The aim of this study was to translate and validate French versions of both LCADL and Dyspnea-12 questionnaires and to determine the reliability of these versions for the evaluation of dyspnea in severe to very severe COPD patients. Methods: Both translation and cultural adaptation were based on Beaton's recommendations. Fifty consecutive patients completed the French version of LCADL and Dyspnea-12 and other questionnaires (MMRC, Saint George's Respiratory Questionnaire [SGRQ], Hospital Anxiety and Depression [HAD]), at a 2-week interval. Internal consistency, validity, and reliability of LCADL and Dyspnea-12 were evaluated. Results: The French version of LCADL and Dyspnea-12 demonstrated good internal consistency with Cronbach's α of, respectively, 0.84 and 0.91. LCADL was correlated significantly with item activity of SGRQ (ρ=0.55, p<0.001), total score of SGRQ (ρ=0.63, p<0.001), item impact of SGRQ (ρ=0.57, p<0.001), and HAD-depression (HAD-D) (ρ=0.47, p=0.001); and Dyspnea-12 was correlated significantly with MMRC (ρ=0.39, p<0.001), HAD-anxiety (ρ=0.64, p<0.001), and HAD-D (ρ=0.64, p<0.001). The French version of LCADL and Dyspnea-12 demonstrated good test-retest reliability with, respectively, intraclass coefficient =0.84 (p<0.001) and 0.91 (p<0.001). Conclusion: The French versions of LCADL and Dyspnea-12 questionnaires are promising tools to evaluate dyspnea in severe to very severe COPD patients.

Effects of inspiratory muscle training in COPD patients: A systematic review and meta-analysis.

OBJECTIVES: In chronic obstructive pulmonary disease (COPD), quality of life and exercise capacity are altered in relationship to dyspnea. Benefits of inspiratory muscle training (IMT) on quality of life, dyspnea, and exercise capacity were demonstrated, but when it is associated to pulmonary rehabilitation (PR), its efficacy on dyspnea is not demonstrated. The aim of this systematic review with meta-analysis was to verify the effect of IMT using threshold devices in COPD patients on dyspnea, quality of life, exercise capacity, and inspiratory muscles strength, and the added effect on dyspnea of IMT associated with PR (vs. PR alone). STUDY SELECTION: This systematic review and meta-analysis was conducted on the databases from PubMed, Science direct, Cochrane library, Web of science, and Pascal. Following key words were used: inspiratory, respiratory, ventilatory, muscle, and training. The searching period extended to December 2017. Two reviewers independently assessed studies quality. RESULTS: Forty-three studies were included in the systematic review and thirty-seven studies in the meta-analysis. Overall treatment group consisted of six hundred forty two patients. Dyspnea (Baseline Dyspnea Index) is decreased after IMT. Quality of life (Saint George's Respiratory Questionnaire), exercise capacity (6 min walk test) and Maximal inspiratory pressure were increased after IMT. During PR, no added effect of IMT on dyspnea was found. CONCLUSION: IMT using threshold devices improves inspiratory muscle strength, exercise capacity and quality of life, decreases dyspnea. However, there is no added effect of IMT on dyspnea during PR (compared with PR alone).

Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomised trial.

The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronic obstructive pulmonary disease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe or very severe COPD patients were allocated to follow PRP+IMT versus PRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure (PImax), inspiratory capacity, 6MWT and quality of life). All analyses were performed on an intention-to-treat basis.Dyspnoea decreased significantly in both groups; however, the improvement of dyspnoea was not statistically different between the two groups. We only found a statistically significant greater increase of PImax after IMT+PRP than after PRP alone.In this trial including severe or very severe COPD patients, we did not find a significant benefit of IMT during PRP+IMT as compared to PRP alone on dyspnoea, despite a significantly higher improvement of PImax in the IMT group.

One minute sit-to-stand test is an alternative to 6MWT to measure functional exercise performance in COPD patients.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is frequently associated with a reduced functional exercise performance. Even if this parameter is routinely evaluated using 6-minute walking test (6MWT), new field tests are regularly investigated as alternative tests. The aim of this study was to compare functional exercise performance evaluation by sit-to-stand test (STST) and 6MWT and to evaluate reliability and repeatability of the STST in COPD patients. METHOD: Forty-two COPD patients performed randomly two tests: 6MWT and STST. Each test was repeated two times. Distance (6MWD) and number of repetitions were measured. Cardiorespiratory parameters, dyspnea and lower limb fatigue (Borg) were recorded before and after the tests. RESULTS: Sit-to-stand repetitions (19 ± 6) and 6MWD (441 ± 104 m) were correlated (r = .716; P < .001). Good repeatability was found for STST and 6MWT. Good reliability was observed for STST (ICC = 0.902). Variations of heart rate and pulsed oxygen saturation were significantly different between these two tests (23% ± 17% vs 13% ± 11%; P = .022 and -7.6% ± 4.6% vs -0.7% ± 2.7%; P < .001 for 6MWT and STST, respectively). Variations of dyspnea and lower limb fatigue were similar between both tests (P = .827 and P = .467). CONCLUSION: The one minute sit-to-stand test is a valuable alternative to 6MWT to estimate functional exercise performance in COPD patients. The cardiorespiratory demand is different between both tests although the variation of dypsnea is similar. No learning effect was observed for STST.