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1.
Phys Ther ; 2024 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-38943360

RESUMO

OBJECTIVE: COVID-19 has led to significant morbidity and mortality globally. Post-COVID sequelae can persist beyond the acute and subacute phases of infection, often termed Post-COVID Syndrome (PCS). There is limited evidence on the appropriate rehabilitation for people with PCS. The aim of this study is to evaluate the effect on exercise capacity, symptoms, cognition, anxiety, depression, health-related quality of life (HRQoL), and fatigue, of a 4-week, twice-weekly supervised pulmonary telerehabilitation program compared to usual medical care for people with PCS with persistent respiratory symptoms. METHODS: The study will be a multi-site randomized controlled trial (RCT) with assessor blinding. Participants with confirmed previous COVID-19 infection and persistent respiratory symptoms who attend a post-COVID respiratory clinic will be randomized 1:1 to either an intervention group (IG) of 4 weeks, twice-weekly pulmonary telerehabilitation or a control group (CG) of usual medical care. Participants in the CG will be invited to cross-over into the IG after the week 4 assessment. Primary outcome: exercise capacity measured by the 1-minute sit-to-stand test. Secondary outcomes: 5 repetition sit-to-stand test; Montreal Cognitive Assessment; COVID-19 Yorkshire Rehabilitation Scale; COPD Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; and the Kessler Psychological Distress Scale. Outcomes will be collected at baseline, after 4-weeks intervention or control period, after intervention in the cross-over group, and at 12-month follow-up. IMPACT STATEMENT: Research into effective rehabilitation programs is crucial given the substantial morbidity associated with PCS and the lack of long-term data for COVID-19 recovery. A short duration pulmonary telerehabilitation program, if effective compared to usual care, could inform practice guidelines and direct future clinical trials for the benefit of individuals with persistent respiratory symptoms post-COVID.

2.
Braz J Phys Ther ; 25(1): 97-102, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32499168

RESUMO

OBJECTIVES: The aims of this study were to determine, in Australian pulmonary rehabilitation programs for people with COPD: (1) whether oxygen saturation (SpO2) was monitored during exercise testing; (2) whether supplemental oxygen was available during exercise testing and/or training; (3) whether oxygen was prescribed during exercise training; and the reason for providing oxygen; (4) whether a protocol was available for supplemental oxygen prescription during exercise training. METHODS: This was a cross-sectional multi-center study using a purposed-designed survey. De-identified survey data were analyzed and the absolute number and percentage of responses were recorded for each question. RESULTS: The survey was sent to 261 pulmonary rehabilitation programs and 142 surveys (54%) were available for analysis. Oxygen saturation was monitored during exercise testing in 92% of programs. Supplemental oxygen was available in the majority of programs during exercise testing (82%) and training (84%). The rationale cited by 87 programs (73%) for prescribing oxygen during exercise training was maintaining SpO2 above a threshold ranging from SpO2 80-88%. Forty-five (32%) programs had a protocol for oxygen prescription during exercise training. CONCLUSION: While monitoring of SpO2 during exercise testing and using supplemental oxygen during testing and training is common in Australian pulmonary rehabilitation programs, few programs had a protocol in place for the prescription of supplemental oxygen for people with COPD who were not on long-term oxygen therapy. This may be due to lack of strong evidence to support the use of supplemental oxygen during exercise training.


Assuntos
Terapia por Exercício/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Austrália , Estudos Transversais , Teste de Esforço , Tolerância ao Exercício , Humanos , Oxigenoterapia , Qualidade de Vida
4.
BMJ Open ; 9(3): e023863, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30826759

RESUMO

INTRODUCTION: Simple and scalable strategies are needed to improve 'out-of-hospital' support and management for people living with cardiovascular disease (CVD) and respiratory disease. Text messaging via mobile phones has been shown to be effective in helping promote lifestyle change and is supported by quantitative and qualitative evidence. The aim of this study is to test the effectiveness and implementation of a 6-month text messaging support programme for people with CVD and respiratory disease as an addition to cardiac and pulmonary outpatient rehabilitation. METHODS AND ANALYSIS: Pragmatic randomised controlled trial (n=310) to test the effectiveness of a 6-month text message support programme on clinical outcomes in people with CVD and chronic respiratory disease who are attending outpatient cardiac and pulmonary rehabilitation. The study includes a nested process evaluation to inform scalability and implementation across settings. The intervention group will receive a text message support programme comprising five messages per week for 26 weeks and the control group will continue with standard care. The primary outcome is exercise capacity (6 min walk distance). Secondary outcomes include clinical measures (proportion of people meeting the Australian guideline-recommended blood pressure and cholesterol targets), lifestyle outcomes (smoking rates, achievement of national guidelines for nutrition and physical activity), quality of life, mood (Hospital Anxiety and Depression Scale), medication adherence and attendance at and completion of rehabilitation. ETHICS AND DISSEMINATION: Primary ethics approval was received from the Sydney Local Health District Hospital Human Research Ethics Committee and associated Governance committees at sites. Results will be disseminated via the usual scientific forums including peer-reviewed publications and presentations at international conferences. At its conclusion, the study will determine the effectiveness and implementation of a simple programme that aims to improve health outcomes and attendance at rehabilitation for people with CVD and chronic respiratory disease. TRIAL REGISTRATION NUMBER: ACTRN12616001167459.


Assuntos
Doenças Cardiovasculares/terapia , Adesão à Medicação , Educação de Pacientes como Assunto/métodos , Doenças Respiratórias/terapia , Envio de Mensagens de Texto , Austrália , Pressão Sanguínea , Telefone Celular , Doença Crônica , Dieta , Exercício Físico , Humanos , Estilo de Vida , Motivação , Ensaios Clínicos Pragmáticos como Assunto , Qualidade de Vida , Sistemas de Alerta , Autocuidado/métodos
5.
Eur Respir J ; 53(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30880289

RESUMO

Almost half the patients referred to pulmonary rehabilitation with chronic obstructive pulmonary disease (COPD) desaturate during exercise. Although oxygen supplementation may ameliorate oxygen desaturation, the effects on outcomes of exercise training have not been rigorously evaluated. This study aimed to determine whether supplemental oxygen during exercise training was more effective than medical air in improving exercise capacity and health-related quality of life (HRQoL) in people with COPD.People with COPD who demonstrated oxygen desaturation <90% during the 6-min walk test were recruited to this multicentre trial with randomisation (independent, concealed allocation) to either an Oxygen group or Air group, blinding (participants, exercise trainers and European Respiratory Journal assessors) and intention-to-treat analysis. Both groups received the respective gas from concentrators via nasal prongs at 5 L·min-1 during exercise training consisting of treadmill and cycle exercise, three times per week for 8 weeks. Primary outcomes were the endurance shuttle walk test (ESWT) time and Chronic Respiratory Disease Questionnaire (CRQ)-Total score.111 participants (60 males), mean±sd age 69±7 years, with moderate to severe COPD were recruited and 97 completed (Oxygen group n=52; Air group n=45). At the end of the 8-week training programme there were no between-group differences in change in ESWT (mean difference 15 s (95% CI -106-136 s) or change in CRQ-Total (0.0 points (95% CI -0.3-0.3 points)). Within-group changes at end-training were significant for ESWT and CRQ-Total (all p<0.01).Exercise capacity and HRQoL improved in both groups, with no greater benefit from training with supplemental oxygen than medical air.


Assuntos
Terapia por Exercício/métodos , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Idoso , Austrália , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Resultado do Tratamento , Teste de Caminhada
6.
BMC Pulm Med ; 16: 25, 2016 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-26846438

RESUMO

BACKGROUND: Oxygen desaturation during exercise is common in people with chronic obstructive pulmonary disease (COPD). The aim of the study is to determine, in people with COPD who desaturate during exercise, whether supplemental oxygen during an eight-week exercise training program is more effective than medical air (sham intervention) in improving exercise capacity and health-related quality of life both at the completion of training and at six-month follow up. METHODS/DESIGN: This is a multi-centre randomised controlled trial with concealed allocation, blinding of participants, exercise trainers and assessors, and intention-to-treat analysis. 110 people with chronic obstructive pulmonary disease who demonstrate oxygen desaturation lower than 90 % during the six-minute walk test will be recruited from pulmonary rehabilitation programs in seven teaching hospitals in Australia. People with chronic obstructive pulmonary disease on long term oxygen therapy will be excluded. After confirmation of eligibility and baseline assessment, participants will be randomised to receive either supplemental oxygen or medical air during an eight-week supervised treadmill and cycle exercise training program, three times per week for eight weeks, in hospital outpatient settings. Primary outcome measures will be endurance walking capacity assessed by the endurance shuttle walk test and health-related quality of life assessed by the Chronic Respiratory Disease Questionnaire. Secondary outcomes will include peak walking capacity measured by the incremental shuttle walk test, dyspnoea via the Dyspnoea-12 questionnaire and physical activity levels measured over seven days using an activity monitor. All outcomes will be measured at baseline, completion of training and at six-month follow up. DISCUSSION: Exercise training is an essential component of pulmonary rehabilitation for people with COPD. This study will determine whether supplemental oxygen during exercise training is more effective than medical air in improving exercise capacity and health-related quality of life in people with COPD who desaturate during exercise. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000395831, 5th Jan,2012.


Assuntos
Terapia por Exercício/métodos , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Austrália , Método Duplo-Cego , Dispneia/fisiopatologia , Teste de Esforço , Tolerância ao Exercício/fisiologia , Volume Expiratório Forçado , Nível de Saúde , Humanos , Análise de Intenção de Tratamento , Oximetria , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Resultado do Tratamento , Capacidade Vital
7.
Expert Rev Respir Med ; 7(6): 587-92, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24224506

RESUMO

Tai Chi is an ancient Chinese martial art which incorporates elements of strengthening, balance, postural alignment and concentration. The benefits of Tai Chi in the healthy population have been widely examined. In comparison, only three studies have evaluated the effects of Tai Chi in people with chronic obstructive pulmonary disease (COPD). Existing evidence suggests that the exercise intensity of Tai Chi reaches a moderate level in people with COPD. Furthermore, a short-term program of Tai Chi improves exercise capacity, health-related quality of life, balance and quadriceps strength in people with mild to moderate COPD. More studies are warranted to examine the effects of different styles of Tai Chi and the long-term benefits of Tai Chi as an exercise regimen for people with COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Doença Pulmonar Obstrutiva Crônica/terapia , Tai Chi Chuan , Tolerância ao Exercício/fisiologia , Humanos , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Resultado do Tratamento
8.
Am J Phys Med Rehabil ; 90(1): 35-9, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20975522

RESUMO

This study was undertaken in people with chronic obstructive pulmonary disease to determine differences in incremental shuttle walk test distance and endurance shuttle walk test time when two of each shuttle test were performed before (n = 53 participants) and after an exercise training program (n = 31 participants) and whether the results altered program outcomes. There was a significant increase in incremental shuttle walk test distance between the two incremental shuttle walk tests before (P < 0.001) and after training (P < 0.01). There was no significant difference in the endurance shuttle walk test time between the two endurance shuttle walk tests before (P = 0.95) or after training (P = 0.07). There was a significant increase in both incremental shuttle walk test distance and endurance shuttle walk test time after training (all P < 0.01); however, the increase was greater if the better of the two tests was reported at both time points. The incremental shuttle walk test should be performed twice before and after an exercise training program. This does not seem to be necessary for the endurance shuttle walk test; however, improvement after training was greater if the better of two endurance shuttle walk tests were used to evaluate program outcomes.


Assuntos
Teste de Esforço , Terapia por Exercício , Avaliação de Resultados em Cuidados de Saúde/métodos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Caminhada/fisiologia , Idoso , Tolerância ao Exercício/fisiologia , Feminino , Humanos , Masculino , Resistência Física/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
9.
J Physiother ; 56(2): 105-12, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20482477

RESUMO

QUESTIONS: Does an eight-week program of walk training improve endurance walking capacity in people with COPD compared to cycle training? Does walk training improve peak walking capacity, cycle capacity, and quality of life compared to cycle training? Is the endurance shuttle walk test (ESWT) responsive to change in walking capacity elicited by exercise training? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: 36 people with stable COPD recruited with four dropouts. INTERVENTION: Participants were randomised into either a walk or cycle training group. Both groups trained indoors for 30 to 45 minutes per session, three times weekly over eight weeks at Concord Hospital. Training intensities were based on baseline peak exercise tests and progressed as able. OUTCOME MEASURES: The primary outcome was endurance walking capacity measured by the ESWT. Secondary outcomes included peak walking capacity, peak and endurance cycle capacity, and health-related quality of life. Measures were taken at baseline (Week 0) and following training (Week 8). RESULTS: The walk training group increased their endurance walking time by 279 seconds (95% CI 70 to 483) more than the cycle training group. No significant differences between the groups were found for any other outcome. CONCLUSION: Ground walk training increased endurance walking capacity more than cycle training and was similar to cycle training in improving peak walking capacity, peak and endurance cycle capacity and quality of life. This study provides evidence for ground walking as a mode of exercise training in pulmonary rehabilitation programs.


Assuntos
Terapia por Exercício/métodos , Resistência Física/fisiologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Caminhada/fisiologia , Idoso , Feminino , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida
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