Health literacy in older patients with abdominal tumours and its association with clinical characteristics: A cross-sectional study.

PURPOSE: Health literacy (HL) is pivotal in managing patients with abdominal cancer and is associated with treatment outcomes and care experience. However, detailed characteristics of HL and their associations with clinical features remain uncertain in the population. Therefore, we aimed to comprehensively investigate HL and its associations with clinical characteristics in older patients with abdominal tumours. METHODS: We analysed 103 older patients with abdominal tumours prescribed perioperative rehabilitation programs in an acute care hospital. The Japanese version of the European Health Literacy Survey Questionnaire was used to measure comprehensive HL. Multivariate ordinal or linear regression analyses were used to explore the associations between HL and the following clinical characteristics: physical status, physical function, cardiopulmonary function, levels of activities of daily living (ADL), physical activity level, and health-related quality of life (HR-QoL). All regression analyses included patient demographics as covariates. RESULTS: Approximately 50%-70% of the participants had difficulty accessing and appraising health-related information, and 20%-45% thought it was difficult to understand and apply the information. The percentage of limited HL levels in general HL, three health-relevant domains, and four competencies ranged from 62% to 83%. Moreover, regression analyses revealed that lower HL was associated with worse physical status/function, lower ADL, and poorer HR-QoL. CONCLUSION: Most older patients with abdominal tumours have limited HL, which may lead them to make treatment decisions without fully understanding what healthcare providers advise. Furthermore, patients with lower HL are at a higher risk of poor treatment outcomes because of their worse clinical characteristics.

Physical activity measurements in individuals with interstitial lung disease: a systematic review and meta-analysis.

BACKGROUND: Physical activity (PA) measurements are becoming common in interstitial lung disease (ILD); however, standardisation has not been achieved. We aimed to systematically review PA measurement methods, present PA levels and provide practical recommendations on PA measurement in ILD. METHODS: We searched four databases up to November 2022 for studies assessing PA in ILD. We collected information about the studies and participants, the methods used to measure PA, and the PA metrics. Studies were scored using 12 items regarding PA measurements to evaluate the reporting quality of activity monitor use. RESULTS: In 40 of the included studies, PA was measured using various devices or questionnaires with numerous metrics. Of the 33 studies that utilised activity monitors, a median of five out of 12 items were not reported, with the definition of nonwear time being the most frequently omitted. The meta-analyses showed that the pooled means (95% CI) of steps, time spent in moderate to vigorous PA, total energy expenditure and sedentary time were 5215 (4640-5791) steps·day-1, 82 (58-106) min·day-1, 2130 (1847-2412) kcal·day-1 and 605 (323-887) min·day-1, respectively, with considerable heterogeneity. CONCLUSION: The use of activity monitors and questionnaires in ILD lacks consistency. Improvement is required in the reporting quality of PA measurement methods using activity monitors.

Association of health literacy with short-term postoperative outcomes in older adult patients with abdominal tumors undergoing surgery and perioperative rehabilitation program: A prospective cohort study.

INTRODUCTION: Low health literacy (HL) is associated with poor surgical outcomes in patients with abdominal tumors, despite enhanced recovery programs. However, the relationship between HL and postoperative outcomes, including health-related quality of life (HRQOL) and physical functions, has been unclear in patients with abdominal tumors receiving perioperative rehabilitation programs (PRPs). Our objective was to identify associations of HL with postoperative functional and general outcomes in patients with abdominal tumors undergoing surgery and PRPs, controlling for critical covariates. MATERIALS AND METHODS: The prospective cohort study was conducted from April 2020 to December 2021 in a single acute care hospital in Akita City, Japan. Out of 112 consecutive older adults with abdominal tumors referred to PRPs before surgery for tumors, 101 participated. Three patients declined undergoing follow-up assessment, and thus 97 were analyzed. Demographic data, comorbidities, education, surgical procedure, frailty status, cognitive functions, physical activity, nutritional status, tumor sites, types, and stages were collected as covariates at baseline. All participants underwent PRPs. HL was measured using the Japanese version of the European Health Literacy Survey Questionnaire, a comprehensive HL measurement. Primary endpoints were changes in HRQOL, measured using the EuroQol 5-dimension 5-level (EQ-5D-5L) index and EuroQol-visual analog scale (EQ-VAS), and physical functions (chair-stand ability, usual gait speed, and grip strength) from before surgery to discharge. Secondary endpoints were 90-day readmissions, postoperative complications, and length of hospital stay. Multivariate regression with inverse probability weighting, using propensity scores, estimeted associations of HL with the outcomes. RESULTS: Of the 97 patients (36 [37.1%] women, mean [standard deviation] age 74.4 [6.3] years), 42 (43.3%) reported low HL. At baseline, patients with low HL exhibited worse EQ-5D-5L scores (P = .001), EQ-VAS values (P = .03), chair-stand ability (P = .001), and gait speed (P = .03) than controls. Low HL was associated with a low risk of grip strength declines (risk ratio, 0.13; 95% confidence interval, 0.12-0.99) but not with any other outcome. DISCUSSION: There appeared to be no apparent associations of HL with surgical outcomes in patients with abdominal tumors receiving PRPs. Thus, HL might not be a crucial predictor of surgical outcomes when combined with PRPs.

Respiratory sarcopenia: A position paper by four professional organizations.

We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. Although respiratory muscle function is indispensable for life support, its evaluation has not been included in the regular assessment of respiratory function or adequately evaluated in clinical practice. Considering this situation, we prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass. It was jointly prepared by the representative authors and authorized by the Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy and Japanese Association of Rehabilitation Nutrition. Geriatr Gerontol Int 2023; 23: 5-15.

Objective physical activity level is associated with rectus femoris muscle echo-intensity in patients with chronic obstructive pulmonary disease.

INTRODUCTION: Skeletal muscle dysfunction is one of the major extrapulmonary complications of chronic obstructive pulmonary disease (COPD). Some studies have reported a relationship between physical activity (PA) level and skeletal muscle quality assessed by echo-intensity (EI) in healthy individuals but not in patients with COPD. OBJECTIVES: The aim of this study is to investigate the relationships between PA level and both skeletal muscle EI and skeletal muscle mass in patients with COPD. METHODS: We employed a cross-sectional design. Forty male outpatients with stable COPD were enrolled. Using B-mode ultrasonography, we measured the rectus femoris muscle cross-sectional area (RF-CSA) and EI (RF-EI). The RF-CSA and RF-EI were measured on frozen images using an electronic caliper and 8-bit gray-scale analysis, respectively. The objective PA level was determined by monitoring daily step counts and moderate-to-vigorous physical activity time (MVPA) with an activity monitor. A general regression model was used to assess the relationships between PA level and both RF-CSA and RF-EI. Age and body mass index (BMI) were adopted as confounding variables. RESULTS: Twenty-five outpatients with stable COPD (age, 70 ± 7 years old; forced expiratory volume in 1 s, 55.0 ± 24.9% of predicted values) were finally enrolled in the present study. Even after adjusting for age and BMI, the daily step counts and MVPA were significantly associated with RF-EI, and knee extensor force was associated with RF-CSA. CONCLUSION: The present study showed that PA level was associated with RF-EI in patients with COPD. In addition, RF-CSA was associated with knee extensor force. When assessing skeletal muscle using ultrasonography in patients with COPD, we should also assess EI.

Prediction of Low-intensity Physical Activity in Stable Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVE: To develop an equation of the predicted amount of low-intensity physical activity (LPA) by analyzing clinical parameters in patients with chronic obstructive pulmonary disease (COPD). METHODS: In this cross-sectional study, we analyzed the assessments of clinical parameters evaluated every 6 months from the start of pulmonary rehabilitation in 53 outpatients with stable COPD (age 77 ± 6 yrs; 46 men; body mass index 21.8 ± 4.1 kg/m2; forced expiratory volume in one second 63.0 ± 26.4% pred). An uniaxial accelerometer was used to measure the number of steps and the time spent in LPA of 1.8-2.3 metabolic equivalents during 14 consecutive days. We also evaluated body composition, respiratory function, skeletal muscle strength, inspiratory muscle strength, exercise capacity, and gait speed. Factors associated with the time spent in LPA were examined by multivariate regression analysis. Internal validity between the predicted amount of LPA obtained by the equation and the measured amount was examined by regression analysis. RESULTS: Multivariate regression analysis revealed that gait speed (ß = 0.369, p = 0.007) and maximum inspiratory mouth pressure (PImax) (ß = 0.329, p = 0.016) were significant influence factors on LPA (R2 = 0.354, p <0.001). The stepwise regression analysis showed a moderate correlation between the measured amount and predicted amount of LPA calculated by the regression equation (r = 0.609, p <0.001; LPA = 31.909 × gait speed + 0.202 × PImax - 20.553). CONCLUSION: Gait speed and PImax were extracted as influence factors on LPA, suggesting that the regression equation could predict the amount of LPA.

Functionally relevant threshold of inspiratory muscle strength in patients with chronic obstructive pulmonary disease.

OBJECTIVES: We aimed to identify the inspiratory muscle strength thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD). METHODS: We measured the maximum static inspiratory mouth pressure (PImax) and the percentage of predicted values (%PImax) in 113 patients with COPD. Six-minute walk distance (6-MWD) was measured as an indicator of functional exercise capacity, and a 6-MWD of <350 m was defined as functional exercise intolerance. Thresholds were determined as values with high specificity (>0.90) and maximal sensitivity. Statistical significance was set at P < 0.01. RESULTS: The data of 96 patients (74 ± 6 years old; forced expiratory volume in 1-s [FEV1], 56.5 ± 26.2% predicted) were analyzed; three women and 14 participants with missing data were excluded. Multivariate logistic regression models identified significant associations of PImax (odds ratio at 99% confidence interval [CI]: 0.95 [0.92-0.98]) and %PImax (odds ratio at 99% CI: 0.97 [0.95-0.99]) with 6-MWD, after adjustments for height and FEV1. C-statistics showed that the area under the curves (99% CI) of PImax and %PImax were comparable (0.87 [0.77-0.96] and 0.83 [0.72-0.94]). The thresholds of PImax and %PImax were 45.1 cmH2O and 66%; PImax and %PImax also had moderate positive likelihood ratios of 4.44 and 5.00. CONCLUSIONS: Thresholds of inspiratory muscle strength in men with COPD could help clinicians evaluate whether their patient's inspiratory muscle strength is inadequate to achieve a 6-MWD of ≥350 m, and identify patients who should be targeted for inspiratory muscle training.

Estimation of minimal clinically important difference for quadriceps and inspiratory muscle strength in older outpatients with chronic obstructive pulmonary disease: a prospective cohort study.

OBJECTIVE: To estimate the minimal clinically important difference (MCID) of quadriceps and inspiratory muscle strength after a home-based pulmonary rehabilitation program (PRP) in chronic obstructive pulmonary disease (COPD). METHOD: Eighty-five COPD patients were included. Quadriceps maximal voluntary contraction (QMVC) was measured. We measured maximal inspiratory mouth pressure (PImax), the 6-minute walk distance (6MWD), the chronic respiratory questionnaire (CRQ) and the modified Medical Research Council dyspnoea score (mMRC). All measurements were conducted at baseline and at the end of the PRP. The MCID was calculated using anchor-based (using 6MWD, CRQ, and mMRC as possible anchor variables) and distribution-based (half standard deviation and 1.96 standard error of measurement) approaches. Changes in the five variables were compared in patients with and without changes in QMVC or PImax >MCID for each variable. RESULTS: Sixty-nine COPD patients (age 75±6 years) were analysed. QMVC improved by 2.4 (95%CI 1.1-3.7) kgf, PImax by 5.8 (2.7-8.8) cmH2O, 6MWD by 21 (11-32) meters and CRQ by 3.9 (1.6-6.3) points. The MCID of QMVC and PImax was 3.3-7.5 kgf and 17.2-17.6 cmH2O, respectively. The MCID of QMVC (3.3 kgf) could differentiate individuals with significant improvement in 6MWD and PImax from those without. CONCLUSION: The MCID of QMVC (3.3 kgf) can identify a meaningful change in quadriceps muscle strength after a PRP. The MCID of PImax (17.2 cmH2O) should be used with careful consideration, because the value is estimated using distributionbased method.

Functionally Relevant Threshold of Quadriceps Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVES: We aimed to identify the quadriceps muscle strength (QMS) thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD). METHODS: We measured the quadriceps isometric maximum voluntary contraction (QMVC) and calculated the QMVC values normalized to weight (QMVC-BW), height squared (QMVC-H2), and body mass index (QMVC-BMI) in 113 patients with COPD. The functional exercise capacity was evaluated using the 6-minute walk distance (6MWD), and 6MWD <350 m was defined as functional exercise intolerance. Thresholds were determined for QMVC and its normalized values to achieve high specificity (>0.90) with maximal sensitivity. P-values <0.01 were considered statistically significant. RESULTS: Data from 99 male patients (age, 74 ± 6 years; percentages of predicted forced expiratory volume in 1-s, 56.9 ± 26.4%) were analyzed; 3 women and 11 participants with the missing data were excluded. Multivariate logistic regression models identified significant associations of QMVC and QMVC-H2 with 6MWD, after adjustment for age and dyspnea. C-statistics showed that the area under the curves of all QMVC parameters were comparable. The thresholds of QMVC and QMVC-H2 for predicting compromised exercise capacity were 26.2 kg and 9.6 kg/m2, respectively. CONCLUSIONS: QMS thresholds in men with COPD could help clinicians evaluate whether QMS is insufficient to achieve 6MWD ≥350 m and thereby identify patients who should be specifically targeted for muscle strengthening training during their pulmonary rehabilitation program.

The association between systemic inflammation and the time spent in posture and movement during daytime in patients with chronic obstructive pulmonary disease and lower weight.

[Purpose] The effect of physical activity on systemic inflammation remains unclear and might be negative in patients with chronic obstructive pulmonary disease (COPD) and lower weight. We investigated the amount of physical activity as the time spent in posture and movement and its association with systemic inflammation. [Participants and Methods] In this retrospective cross-sectional pilot study, we evaluated 11 patients with COPD (age, 73 ± 7 years; body mass index, 18.9 ± 2.9 kg/m2). A recently developed triaxial accelerometer was used to measure the time spent in posture and movement. We also evaluated body composition, physiological indexes, and serum levels of inflammatory cytokines. Single correlation coefficients were calculated as the association between physical activity and other outcomes. [Results] The walking time was 36 ± 32 min/d, and the standing time was 151 ± 118 min/d. The time spent walking significantly correlated with the fat-free mass index (r=0.73) and interleukin (IL)-8 level (r=0.76). The time spent standing significantly correlated with the C-reactive protein (r=0.80) and IL-6 levels (r=0.74). [Conclusion] These data indicate that increased physical activity is associated with higher systematic inflammation. We should consider that the systemic inflammation may have been affected by the increased physical activity of the patients with COPD and lower weight in this study.

Effects of Exercise-Based Interventions on Fall Risk and Balance in Patients With Chronic Obstructive Pulmonary Disease: A SYSTEMATIC REVIEW.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease characterized by airflow limitation and is associated with decreased balance and increased fall risk. Since falls are related to increased mortality, interventions targeting balance and fall risk could reduce morbidity and mortality. The objective of this review was to systematically assess the effects of exercise-based interventions on fall risk and balance in patients with COPD. METHODS: PubMed, Web of Science, EMBASE, and CINAHL were screened for randomized controlled trails and within-group studies evaluating effects of exercise-based interventions on fall risk or balance in patients with COPD. Data were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: Fifteen studies were identified, 6 randomized controlled trails and 9 within-group studies. All interventions reported positive effects on balance outcomes. No studies reported fall risk. Taking current recommendations of balance outcome measures in patients with COPD into account, pulmonary rehabilitation combined with balance training had the highest effect size. Nine papers had concerns regarding bias, mostly due to the lack of blinding outcome assessors. CONCLUSIONS: Exercise-based interventions have a positive effect on balance in patients with COPD. Pulmonary rehabilitation with balance training seems to have the most beneficial effect on balance. The effects on fall risk, as well as the long-term intervention effects remain unclear. A standardized balance assessment and research on long-term effects and fall risk are recommended.

Diaphragm thickening assessed by ultrasonography is lower than healthy adults in patients with chronic obstructive pulmonary disease.

BACKGROUND: Ultrasound imaging has been widely used for imaging of the diaphragm thickness (Tdi) and thickening. Few studies assessed the Tdi using ultrasonography in patients with chronic obstructive pulmonary disease (COPD). We measured the Tdi and thickening in patients with COPD compared with healthy younger and healthy older adults to reveal the influence of ageing and/or COPD. METHODS: Thirty-eight male patients with COPD (age 72 ± 8 years), 15 healthy younger (age 22 ± 1 years) and 15 healthy older (age 72 ± 5 years) male volunteers were recruited. We measured Tdi at total lung capacity (TdiTLC ), functional residual capacity (TdiFRC ) and residual volume (TdiRV ) using B-mode ultrasonography. We calculated the change ratio of TdiTLC and TdiRV (ΔTdi%). We used a one-way analysis of variance and multiple comparison test for the comparison analysis. RESULTS: The TdiTLC and the ΔTdi% were significantly lower in patients with COPD compared to the healthy adults. There was no significant difference in these values with age. There was no between group difference in the TdiFRC or TdiRV . CONCLUSIONS: Our results indicate significant differences in TdiTLC and ΔTdi% between patients with COPD and healthy adults. Therefore, diaphragm ultrasonography can assess diaphragm dysfunction associated with COPD. We suggest that it is better to use TdiTLC and ΔTdi% (not only Tdi at rest) to assess diaphragm function.

Gait characteristics and their associations with clinical outcomes in patients with chronic obstructive pulmonary disease.

BACKGROUND: Abnormalities of spatiotemporal gait parameters are frequently observed in chronic obstructive pulmonary disease (COPD). However, associations of gait parameters with clinical outcomes and their implementation into clinical practice have not been established. RESEARCH QUESTION: To investigate gait abnormalities and their association with clinical outcomes of COPD. METHODS: This study included 34 male outpatients with COPD and 16 community-dwelling healthy men aged ≥65 years. The subjects underwent a ten-metre walk test wearing an accelerometer. Data on gait speed, step length, cadence, walk ratio, acceleration magnitude, and standard deviation of step time (step time SD) were collected. Forced expiratory volume in 1-second, modified Medical Research Council dyspnoea score, six-minute walk distance (6MWD), quadriceps muscle strength (QMVC), and physical activity (daily steps and time spent in moderate to vigorous physical activity per day) were measured in the COPD group as clinical outcomes of COPD. We tested group differences in gait parameters, associations between gait parameters and COPD clinical outcomes, and predictive capability of gait parameters for reductions in 6MWD, QMVC, and daily steps in COPD. RESULTS: All gait parameters except walk ratio deteriorated in COPD. Step time SD and gait speed were significant independent predictors of 6MWD in COPD (B=-0.440, p = 0.001, B = 0.339, p = 0.007, respectively). Step length was a significant independent predictor of QMVC (B=-0.609, p < 0.001) and daily steps (B=-0.453, p = 0.006). Step length was a significant predictor of muscle weakness and physical inactivity, and step time SD was significant in predicting poor 6MWD in COPD. SIGNIFICANCE: Significant associations between gait abnormalities measured by an accelerometer and deficits in extra-pulmonary features of COPD were observed. An accelerometer-based gait analysis could be an alternative approach to assessing gait abnormalities and screening of functional decline in COPD.

New evaluation of trunk movement and balance during walking in COPD patients by a triaxial accelerometer.

BACKGROUND: Individuals with COPD may experience ambulatory difficulty due to both effort intolerance arising from respiratory dysfunction and impaired balance control during walking. However, the trunk movement during walking has not been evaluated or adjusted for patients with COPD. The Lissajous index (LI) visually and numerically evaluates the left-right symmetry of the trunk movement during walking and is useful in clinical practice. In COPD patients, the LI is used as an indicator of the left-right symmetry of the trunk during walking. Here, we used the LI to evaluate the symmetry of COPD patients based on bilateral differences in mediolateral and vertical accelerations, and we investigated the correlation between the patients' symmetry evaluation results and their physical function. PATIENTS AND METHODS: Sixteen stable COPD patients (all males; age 71.3±9.2 years) and 26 healthy control subjects (15 males; age 68.2±6.9 years) participated in this study. They performed the 10-minute walk test at a comfortable gait speed wearing a triaxial accelerometer, and we measured their trunk acceleration for the evaluation of symmetry. Motor functions were also evaluated in the patients with COPD. RESULTS: The average mediolateral bilateral difference and LI values of the COPD patients were significantly larger than those of the healthy subjects. The COPD patients' LI values were significantly correlated with their static balance. CONCLUSION: The LI measured using a triaxial accelerometer during walking is useful in balance assessments of patients with COPD.

Contractile capability of the diaphragm assessed by ultrasonography predicts nocturnal oxygen saturation in COPD.

BACKGROUND AND OBJECTIVE: Diaphragm function might be useful to predict nocturnal oxygen desaturation in COPD. Ultrasonography has been widely used for the assessment of the diaphragm. We aimed to investigate the relationship between the contractile capability of the diaphragm assessed by ultrasonography and the nocturnal percutaneous arterial oxygen saturation (NSpO2 ) in COPD. METHODS: Twenty-eight male patients with COPD (age, 73 ± 7 years; forced expiratory volume in 1 s (FEV1 ), 54.2 ± 17.0% predicted) were included. The thickness of the diaphragm (Tdi) was assessed by ultrasonography. We calculated the change ratio of Tdi at the end of maximal inspiration and expiration (%ΔTdi). The mean value of NSpO2 (NSpO2mean ), the percentage of total sleep time (TST) with desaturation above 4% (DA4%) and the percentage of TST with saturation below 90% (SB90%) were measured by overnight oximetry. Daytime arterial oxygen pressure (PaO2 ) and maximal inspiratory mouth pressure (PImax ) were also measured. RESULTS: All participants had mild or no daytime hypoxaemia (PaO2 , 77.3 ± 8.6 mm Hg). The NSpO2mean , DA4% and SB90% were significantly correlated with %ΔTdi, PaO2 , %PImax of the predicted value and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. The %ΔTdi and PaO2 were predictors of NSpO2 mean by multiple regression analysis. CONCLUSION: This study suggested a close relationship between the NSpO2 and the contractile capability of the diaphragm assessed by ultrasonography in COPD. The %ΔTdi combined with PaO2 might predict NSpO2 in COPD patients with mild or no daytime hypoxaemia.

Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients.

BACKGROUND: Little is known regarding the relationship between balance impairments and physical activity in COPD. There has been no study investigating the relationship between balance and objectively measured physical activity. Here we investigated the association between balance and physical activity measured by an activity monitor in elderly COPD patients. MATERIALS AND METHODS: Twenty-two outpatients with COPD (mean age, 72±7 years; forced expiratory volume in 1 second, 53%±21% predicted) and 13 age-matched healthy control subjects (mean age, 72±6 years) participated in the study. We assessed all 35 subjects' balance (one-leg standing test [OLST] times, Short Physical Performance Battery total scores, standing balance test scores, 4 m gait speed, and five-times sit-to-stand test [5STST]) and physical activity (daily steps and time spent in moderate-to-vigorous physical activity per day [MV-PA]). Possible confounders were assessed in the COPD group. The between-group differences in balance test scores and physical activity were analyzed. A correlation analysis and multivariate regression analysis were conducted in the COPD group. RESULTS: The COPD patients exhibited significant reductions in OLST times (P=0.033), Short Physical Performance Battery scores (P=0.013), 4 m gait speed (P<0.001), five-times sit-to-stand times (P=0.002), daily steps (P=0.003), and MV-PA (P=0.022) compared to the controls; the exception was the standing balance test scores. The correlation and multivariate regression analyses revealed significant independent associations between OLST times and daily steps (P<0.001) and between OLST times and MV-PA (P=0.014) in the COPD group after adjusting for possible confounding factors. CONCLUSION: Impairments in balance and reductions in physical activity were observed in the COPD group. Deficits in balance are independently associated with physical inactivity.

Effects of low-intensity exercise and home-based pulmonary rehabilitation with pedometer feedback on physical activity in elderly patients with chronic obstructive pulmonary disease.

PURPOSE: We evaluated the effects of low-intensity and home-based pulmonary rehabilitation (PR) on physical activity (PA) and the feedback provided by a pedometer in stable elderly patients with chronic obstructive pulmonary disease (COPD). METHODS: We assessed PA using a newly developed triaxial accelerometer (A-MES™, Kumamoto, Japan), which measures the time spent walking, standing, sitting and lying down. Twenty-seven elderly patients with COPD (age 74 ± 8 yrs; %FEV1 56.6 ± 18.7%) participated. They were randomly selected to undergo PR (pulmonary rehabilitation only) or PR + P (PR plus the feedback from using a pedometer). Their PA and pulmonary function, exercise capacity (6-min walking distance; 6MWD), quadriceps femoris muscle force (QF) were evaluated before the PR began (baseline) and at 1 year later. We compared the patients' changes in PA and other factors between the baseline values and those obtained 1 year later and analyzed the relationships between the changes in PA and other factors in the both groups. RESULTS: The increase in the time spent walking in the PR + P group (51.3 ± 63.7 min/day) was significantly greater than that of PR group (12.3 ± 25.5 min/day) after the PR. The improvement rate of daily walking time after PR was significantly correlated with that of the 6MWD and QF in all subjects. CONCLUSIONS: These data suggest that low-intensity and home-based PR with the feedback from using pedometer was effective in improving PA, and the improvements of physiological factors were correlated with increased walking time in stable elderly patients with COPD.

Dynamic hyperinflation and dyspnea during the 6-minute walk test in stable chronic obstructive pulmonary disease patients.

The purpose of this study was to investigate the relationship between dynamic hyperinflation and dyspnea and to clarify the characteristics of dyspnea during the 6-minute walk test (6MWT) in chronic obstructive pulmonary disease patients. Twenty-three subjects with stable moderate chronic obstructive pulmonary disease (age 73.8±5.8 years, all male) took part in this study. During the 6MWT, ventilatory and gas exchange parameters were measured using a portable respiratory gas analysis system. Dyspnea and oxygen saturation were recorded at the end of every 2 minute period during the test. There was a significant decrease in inspiratory capacity during the 6MWT. This suggested that dynamic hyperinflation had occurred. Dyspnea showed a significant linear increase, and there was a significant negative correlation with inspiratory capacity. It was suggested that one of the reasons that dyspnea developed during the 6MWT was the dynamic hyperinflation. Even though the tidal volume increased little after 2 minutes, dyspnea increased linearly to the end of the 6MWT. These results suggest that the mechanisms generating dyspnea during the 6MWT were the sense of respiratory effort at an early stage and then the mismatch between central motor command output and respiratory system movement.

Quantitative assessment of walking time and postural change in patients with COPD using a new triaxial accelerometer system.

BACKGROUND: The purpose of this study was to quantify the walking time and frequency of postural changes in daily life in patients with chronic obstructive pulmonary disease (COPD) using a new triaxial accelerometer system. METHODS: Twenty-six elderly patients with stable COPD (age 76.8 ± 6.2 years; percent forced expiratory volume in one second [%FEV1] 52.9% ± 26.3%) and 20 age-matched elderly subjects (age 73.0 ± 4.2 years; %FEV1 124.0% ± 22.3%) participated in the study. The subjects' time spent walking (slow, fast), standing, sitting, and lying down and the frequency of their postural changes (getting up, standing up) were assessed for 7 consecutive days using an Activity Monitoring And Evaluation System (A-MES™). We analyzed the relationships among walking times, frequency of postural changes, and physiologic factors in both COPD patients and controls. RESULTS: The COPD patients' total walking time, including slow (<2 km/hour) and fast (≥2 km/hour) walking, and their frequency of standing up were significantly lower than those of the age-matched controls (P < 0.01). The fast walking time in daily life was significantly correlated with the 6-minute walking distance, quadriceps femoris muscle force, and dyspnea (P < 0.01). CONCLUSION: These results suggest that both slow (<2 km/hour) and fast (≥2 km/hour) walking time and frequency of postural changes is significantly decreased in COPD patients compared with healthy elderly subjects. The data also suggest that the COPD patients' different walking times in daily life are significantly correlated with exercise capacity and dyspnea. The 6-minute walking distance had the strongest correlation with fast walking time.

Effect of anti-inflammatory supplementation with whey peptide and exercise therapy in patients with COPD.

BACKGROUND: One of the major pathophysiologies in advanced chronic obstructive pulmonary disease (COPD) has been attributed to systemic inflammation. Meta-analysis of the 2005 Cochrane Database concluded the effect of nutritional supplementation alone on stable COPD was insufficient to promote body weight gain or exercise capacity. The aim of this study was to investigate the effectiveness of nutritional supplementation therapy using a nutritional supplement containing whey peptide with low-intensity exercise therapy in stable elderly patients with COPD. METHOD: In stable elderly COPD patients with %IBW and %FEV(1) of less than 110 and 80%, respectively, anti-inflammatory nutritional supplementation therapy was added to low-intensity exercise therapy. Thirty-six COPD patients were divided into those with and those without the ingestion of an anti-inflammatory nutritional supplement containing whey peptide, which exhibited an anti-inflammatory effect. These two groups were designated as the nutritional support and the control groups, respectively. The body composition, skeletal muscle strength, exercise tolerance, health-related QOL (HRQOL), and inflammatory cytokines were evaluated before and three months after nutritional support combined with exercise therapy in both the nutritional support group and the control group. RESULTS: In the nutritional support group, the body weight, %IBW, FM, energy intake, %AC, Alb, PImax, PEmax, 6MWD, WBI, emotional function, and CRQ total were significantly increased, and the levels of hsCRP, IL-6, IL-8, and TNF-α were reduced significantly, while no significant change was noted in any item of physiological evaluation or any biomarker in the control group. CONCLUSION: Concomitant use of a anti-inflammatory nutritional supplement containing whey peptide, which exhibits an anti-inflammatory effect, with exercise therapy in stable elderly COPD patients with %IBW<110% and %FEV(1)<80% may not only increase body weight but may also inhibit systemic inflammation and thus improve exercise tolerance and HRQOL.