Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice.

INTRODUCTION AND HYPOTHESIS: Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research. METHODS: For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification. RESULTS: Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design. CONCLUSIONS: Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.

Remote administration of the short physical performance battery, the 1-minute sit to stand, and the Chester step test in post-COVID-19 patients after hospitalization: establishing inter-reliability and agreement with the face-to-face assessment.

PURPOSE: To assess the inter-reliability of the Short Physical Performance Battery (SPPB), the 1-min Sit to Stand test (1-MSTS), and the Chester Step Test (CST) via remote assessment in post-COVID-19 patients after hospitalization. METHODS: Twenty-five post-COVID-19 patients randomly performed the functional tests via remote assessment using a software platform at home and via face-to-face assessment at the rehabilitation center 24-72 h apart. One day before the remote assessment, all participants had a 1-h guidance session regarding the platform use, safety instructions, and home equipment preparation. RESULTS: Participants completed all tests for both assessment procedures without experience of adverse events. The mean age was 53 (SD = 10) years old, and the median days of hospitalization were 23 (IQR = 10-33). The inter-reliability was moderate for the total score in the SPPB: Cohen's kappa = 0.545 (95% CI: 0.234 to 0.838), excellent for the number of repetitions in the 1-MSTS: ICC = 0.977 (95% CI: 0.948 to 0.990) and good for the total number of steps in the CST: ICC = 0.871 (95% CI: 0.698 to 0.944). CONCLUSION: Remote functional assessments for SPPB, 1-MSTS, and CST indicated moderate to excellent inter-reliability in post-COVID-19 patients after hospitalization.

Functional performance assessment in post-COVID-19 patients is considered important throughout the whole process of rehabilitation.The face-to-face assessment is the standard practice in the rehabilitation clinical setting however, new approaches by distance assessment are proposed when physical attendance is not feasible.The Short Physical Performance Battery (SPPB), the 1-minute Sit to Stand test (1-MSTS), and the Chester Step Test (CST) showed moderate to excellent reliability when performed remotely at home in post-COVID-19 patients after hospitalization.

Mobile health applications designed for self-management of chronic pulmonary diseases in children and adolescents: a systematic mapping review.

OBJECTIVE: Mobile health (mHealth) applications are scarce for children and adolescents with chronic pulmonary diseases (CPDs). This study aimed to map and describe the contents of the mHealth apps available for use in children and adolescents with CPDs. METHODS: We performed a systematic mapping review of published scientific literature in PubMed, Scopus, and Cochrane Library by February of 2023, using relevant keywords. Inclusion criteria were as follows: children aged < 18 years with CPDs; and studies published in English on mHealth apps. RESULTS: A total number of 353 studies were found, 9 of which met the inclusion criteria. These studies described seven mHealth apps for Android and iOS, designed either for asthma (n = 5) or for cystic fibrosis (n = 2). Five content areas were identified: education/information; pharmacological treatment; emergency; support; and non-pharmacological treatment. The studies (4, 2, and 3, respectively) showed consistent findings using qualitative, quantitative, and mixed methodologies. CONCLUSIONS: This mapping review provided a guided selection of the most appropriate mHealth apps for use in children and adolescents with CPDs based on the needs of each target population. However, these mHealth apps have limited capabilities to reinforce disease self-management and provide information related to treatment compliance.

Technical Factors That May Influence mHealth Adherence in Children With Chronic Pulmonary Diseases: Scoping Review.

PURPOSE: To synthesize the technical factors influencing adherence to nonpharmacological treatment (NPhT) in children with chronic pulmonary diseases (CPDs), using mobile health (mHealth) technology. METHODS: Five electronic databases were searched from inception to October 12, 2022, with terms related to pediatrics, CPDs, adherence, NPhT, and mHealth. The methodological quality was assessed using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool checklist. RESULTS: Eleven articles were included. Six major technical themes were supported by the evidence that may influence adherence to NPhT: design and context, technical support/business model, connectivity, free availability, privacy and security, and cultural readiness. CONCLUSIONS: The design of mHealth applications (apps) should be done according to the needs of pediatric patients. This may mitigate any barriers and potentially foster adherence to the use of the apps. WHAT THIS ADDS TO THE EVIDENCE: Six major technical themes may influence adherence to NPhT in children with chronic respiratory diseases.Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A487 .

Mobile health applications designed for self-management of chronic pulmonary diseases in children and adolescents: a systematic mapping review / Aplicativos de saúde móvel projetados para a autogestão de doenças pulmonares crônicas em crianças e adolescentes: revisão sistemática de mapeamento

ABSTRACT Objective: Mobile health (mHealth) applications are scarce for children and adolescents with chronic pulmonary diseases (CPDs). This study aimed to map and describe the contents of the mHealth apps available for use in children and adolescents with CPDs. Methods: We performed a systematic mapping review of published scientific literature in PubMed, Scopus, and Cochrane Library by February of 2023, using relevant keywords. Inclusion criteria were as follows: children aged < 18 years with CPDs; and studies published in English on mHealth apps. Results: A total number of 353 studies were found, 9 of which met the inclusion criteria. These studies described seven mHealth apps for Android and iOS, designed either for asthma (n = 5) or for cystic fibrosis (n = 2). Five content areas were identified: education/information; pharmacological treatment; emergency; support; and non-pharmacological treatment. The studies (4, 2, and 3, respectively) showed consistent findings using qualitative, quantitative, and mixed methodologies. Conclusions: This mapping review provided a guided selection of the most appropriate mHealth apps for use in children and adolescents with CPDs based on the needs of each target population. However, these mHealth apps have limited capabilities to reinforce disease self-management and provide information related to treatment compliance.

RESUMO Objetivo: Aplicativos de saúde móvel (mHealth, do inglês mobile health) para crianças e adolescentes com doenças pulmonares crônicas (DPC) são escassos. Este estudo teve como objetivo mapear e descrever o conteúdo dos aplicativos de mHealth disponíveis para uso em crianças e adolescentes com DPC. Métodos: Realizamos uma revisão sistemática de mapeamento da literatura científica publicada nos bancos de dados PubMed, Scopus e Cochrane Library até fevereiro de 2023, utilizando descritores relevantes. Os critérios de inclusão foram os seguintes: crianças menores de 18 anos com DPC e estudos publicados em inglês sobre aplicativos de mHealth. Resultados: Foram encontrados 353 estudos, dos quais 9 atenderam aos critérios de inclusão. Esses estudos descreveram sete aplicativos de mHealth para Android e iOS projetados para asma (n = 5) ou para fibrose cística (n = 2). Foram identificadas cinco áreas de conteúdo: educação/informação, tratamento farmacológico, emergência, suporte e tratamento não farmacológico. Os estudos (4, 2 e 3, respectivamente) apresentaram achados consistentes utilizando metodologias qualitativas, quantitativas e mistas. Conclusões: Esta revisão de mapeamento forneceu uma seleção guiada dos aplicativos de mHealth mais adequados para uso em crianças e adolescentes com DPC com base nas necessidades de cada população-alvo. No entanto, esses aplicativos de mHealth têm capacidades limitadas para reforçar a autogestão da doença e fornecer informações relacionadas à adesão ao tratamento.

Factors underlying denial of and disbelief in COVID-19.

OBJECTIVE: To investigate factors that influence or promote disbelief and negative attitudes toward COVID-19. METHODS: This was cross-sectional study involving 544 males and females ≥ 18 years of age in Greece between December of 2020 and January of 2021. All participants were informed about the purpose of the study, protection of anonymity, and volunteer participation. Participants completed an online anonymous 40-item questionnaire. Analysis of data included the identification of correlations and use of t-tests and ANOVA. RESULTS: The level of knowledge regarding COVID-19 transmission routes, manifestations, and prevention was high in our sample. Women appeared to have a more positive attitude toward COVID-19 prevention and management than did men (p = 0.032 and p = 0.018, respectively). Younger people (18-30 years of age) seemed to deny the validity of scientific data and mass media reports about ways to deal with the pandemic more commonly than did those > 30 years of age (p = 0.003 and p = 0.001, respectively). People who resided in cities more commonly believed in scientific announcements than did those living in villages (p = 0.029). CONCLUSIONS: In order to minimize cases of denial of and disbelief in COVID-19 and to promote vaccination, a series of actions are required. Governments should implement a series of measures to contain the disease, taking into consideration the psychological and social aspects of those policies.

Factors underlying denial of and disbelief in COVID-19 / Fatores subjacentes à negação e descrença em relação à COVID-19

ABSTRACT Objective: To investigate factors that influence or promote disbelief and negative attitudes toward COVID-19. Methods: This was cross-sectional study involving 544 males and females ≥ 18 years of age in Greece between December of 2020 and January of 2021. All participants were informed about the purpose of the study, protection of anonymity, and volunteer participation. Participants completed an online anonymous 40-item questionnaire. Analysis of data included the identification of correlations and use of t-tests and ANOVA. Results: The level of knowledge regarding COVID-19 transmission routes, manifestations, and prevention was high in our sample. Women appeared to have a more positive attitude toward COVID-19 prevention and management than did men (p = 0.032 and p = 0.018, respectively). Younger people (18-30 years of age) seemed to deny the validity of scientific data and mass media reports about ways to deal with the pandemic more commonly than did those > 30 years of age (p = 0.003 and p = 0.001, respectively). People who resided in cities more commonly believed in scientific announcements than did those living in villages (p = 0.029). Conclusions: In order to minimize cases of denial of and disbelief in COVID-19 and to promote vaccination, a series of actions are required. Governments should implement a series of measures to contain the disease, taking into consideration the psychological and social aspects of those policies.

RESUMO Objetivo: Investigar fatores que influenciam ou promovem a descrença e atitudes negativas em relação à COVID-19. Métodos: Estudo transversal envolvendo 544 homens e mulheres com ≥ 18 anos de idade na Grécia entre dezembro de 2020 e janeiro de 2021. Todos os participantes foram informados sobre o objetivo do estudo, proteção do anonimato e participação voluntária. Os participantes responderam a um questionário on-line anônimo com 40 itens. A análise dos dados incluiu a identificação de correlações e o uso de testes t e ANOVA. Resultados: O nível de conhecimento sobre as vias de transmissão, manifestações e prevenção da COVID-19 foi alto em nossa amostra. As mulheres pareceram ter uma atitude mais positiva em relação à prevenção e manejo da COVID-19 do que os homens (p = 0,032 e p = 0,018, respectivamente). As pessoas mais jovens (18-30 anos de idade) pareceram negar mais a validade dos dados científicos e reportagens da mídia sobre as formas de lidar com a pandemia do que aquelas com > 30 anos de idade (p = 0,003 e p = 0,001, respectivamente). As pessoas que residiam em cidades grandes acreditavam mais nos pronunciamentos científicos do que as que residiam em vilas (p = 0,029). Conclusões: Para minimizar o número de casos de negação e descrença em relação à COVID-19 e promover a vacinação, é necessária uma série de ações. Os governos devem implementar uma série de medidas para conter a doença, levando em consideração os aspectos psicológicos e sociais dessas políticas.

Long COVID-19 Pulmonary Sequelae and Management Considerations.

The human coronavirus 2019 disease (COVID-19) and the associated acute respiratory distress syndrome (ARDS) are responsible for the worst global health crisis of the last century. Similarly, to previous coronaviruses leading to past pandemics, including severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), a growing body of evidence support that a substantial minority of patients surviving the acute phase of the disease present with long-term sequelae lasting for up to 6 months following acute infection. The clinical spectrum of these manifestations is widespread across multiple organs and consists of the long-COVID-19 syndrome. The aim of the current review is to summarize the current state of knowledge on the pulmonary manifestations of the long COVID-19 syndrome including clinical symptoms, parenchymal, and functional abnormalities, as well as highlight epidemiology, risk factors, and follow-up strategies for early identification and timely therapeutic interventions. The literature data on management considerations including the role of corticosteroids and antifibrotic treatment, as well as the therapeutic potential of a structured and personalized pulmonary rehabilitation program are detailed and discussed.

Respiratory, cardiac and metabolic responses during electrical muscle stimulation in quadriceps muscle versus comparable voluntary muscle contractions.

Electrical Muscle Stimulation (EMS) and voluntary muscle contraction (VMC) are both acceptable rehabilitative modalities to preserve muscle strength loss. The study aimed to compare respiratory, metabolic, and cardiac parameters during quadriceps muscle contraction (QMC) using either EMS or VMC with comparable generated low intensity muscle force. Thirty healthy non-smoker males, age 20-58 years with normal BMI and low to moderate physical activity, underwent two 20-min sessions of comparable QMC using EMS vs VMC at the same day. The BIODEX III isokinetic dynamometer was used to assess maximum isometric force and the comparable force generated during each condition (EMS vs VMC), while the METAMAX 3B portable metabolic system was used to measure continuously the physiological parameters. Tolerable EMS was used (mean: 33 ± 1.5 mA, at 75 Hz). Each contraction lasted 10 sec followed by 20 sec rest. Paired t-tests were used for comparisons between sessions. A relatively low proportion of maximum isometric force (EMS: 8.5% vs VMC: 8.6%) and torque (EMS: 16 ± 1.3 vs VMC: 16 ± 1.1 Nm) were generated during each session. Mean minute ventilation (EMS: 10.8 L vs VMC: 9.8 L), tidal volume (EMS: 0.6 L vs VMC: 0.5 L), O2 uptake (EMS: 0.31 L/min vs VMC: 0.26 L/min) and O2 pulse (EMS: 3.9 ml/beat vs VMC: 3.6 ml/beat) were different between sessions (p ≤ .05); while heart rate (EMS: 72 beats/min vs VMC: 71 beats/min) was equal. Quadriceps muscle EMS induces higher respiratory and metabolic responses compared to equal magnitude VMC in healthy males.

Heart Rate Recovery After 6-min Walking Test Predicts Acute Exacerbation in COPD.

INTRODUCTION: Abnormalities of autonomic function have been reported in patients with chronic obstructive pulmonary disease (COPD). Our objectives were to identify determinants of abnormal heart rate recovery at 1 min (HRR1) following completion of the 6-min walk test (6MWT) in COPD and to establish whether abnormal HRR1 predicts acute exacerbations (AECOPD). METHODS: Hundred one COPD patients (FEV1 (SD) 53 (19)  % predicted) were prospectively recruited in a multi-center study. HRR1 after the 6MWT was evaluated as the difference between heart rate at the end of the test and 1 min into the recovery (HRR1). Linear and logistic regression was used to identify predictors of HRR1 and AECOPD, respectively. The best HRR1 cut-off point to predict AECOPD was selected using the receiver operating characteristics (ROC) curves. The follow-up period was 12 months. RESULTS: Distance covered during the 6MWT (m) and DLco (% predicted) were independently associated with HRR1 (r 2 = 0.51, p = 0.001). Among several potential covariates, HRR1 emerged as the most significant predictor of AECOPD (Odds ratio [OR], 0.91 per beat of recovery; 95% confidence interval [CI], 0.85-0.97; p = 0.02). The ROC analysis indicated that subjects with HRR1 less than 14 beats (AUC, 0.71 [CI] 0.60-0.80; p = 0.0001) were more likely to suffer an exacerbation during the follow-up period (for HRR1, p = 0.004 [log-rank test]). CONCLUSIONS: HRR1 after the 6MWT is an independent predictor factor for AECOPD. Further studies are warranted to examine the physiological mechanisms associating a delayed HRR and acute exacerbations in COPD patients.

Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits.

Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits.Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance tele-rehabilitation (n=47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n=50) and also to 12 months of usual care treatment (n=50) without initial PR.In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389-0.687, and IRR 0.635, 95% CI 0.473-0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100-0.358, and IRR 0.375, 95% CI 0.207-0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072-0.185).Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR.

Limitation in tidal volume expansion partially determines the intensity of physical activity in COPD.

In patients with chronic obstructive pulmonary disease (COPD), reduced levels of daily physical activity are associated with the degree of impairment in lung, peripheral muscle, and central hemodynamic function. There is, however, limited evidence as to whether limitations in tidal volume expansion also, importantly, determine daily physical activity levels in COPD. Eighteen consecutive patients with COPD [9 active (forced expiratory volume in 1 s, FEV1: 1.59 ± 0.64 l) with an average daily movement intensity >1.88 m/s(2) and 9 less active patients (FEV1: 1.16 ± 0.41 l) with an average intensity <1.88 m/s(2)] underwent a 4-min treadmill test at a constant speed corresponding to each individual patient's average movement intensity, captured by a triaxial accelerometer during a preceding 7-day period. When chest wall volumes, captured by optoelectronic plethysmography, were expressed relative to comparable levels of minute ventilation (ranging between 14.5 ± 4.3 to 33.5 ± 4.4 l/min), active patients differed from the less active ones in terms of the lower increase in end-expiratory chest wall volume (by 0.15 ± 0.17 vs. 0.45 ± 0.21 l), the greater expansion in tidal volume (by 1.76 ± 0.58 vs. 1.36 ± 0.24 l), and the larger inspiratory reserve chest wall volume (IRVcw: by 0.81 ± 0.25 vs. 0.39 ± 0.27 l). IRVcw (r(2) = 0.420), expiratory flow (r(2) change = 0.174), and Borg dyspnea score (r(2) change = 0.123) emerged as the best contributors, accounting for 71.7% of the explained variance in daily movement intensity. Patients with COPD exhibiting greater ability to expand tidal volume and to maintain adequate inspiratory reserve volume tend to be more physically active. Thus interventions aiming at mitigating restrictions on operational chest wall volumes are expected to enhance daily physical activity levels in COPD.

Intensity of daily physical activity is associated with central hemodynamic and leg muscle oxygen availability in COPD.

In chronic obstructive pulmonary disease (COPD), daily physical activity is reported to be adversely associated with the magnitude of exercise-induced dynamic hyperinflation and peripheral muscle weakness. There is limited evidence whether central hemodynamic, oxygen transport, and peripheral muscle oxygenation capacities also contribute to reduced daily physical activity. Nineteen patients with COPD (FEV1, 48 ± 14% predicted) underwent a treadmill walking test at a speed corresponding to the individual patient's mean walking intensity, captured by a triaxial accelerometer during a preceding 7-day period. During the indoor treadmill test, the individual patient mean walking intensity (range, 1.5 to 2.3 m/s2) was significantly correlated with changes from baseline in cardiac output recorded by impedance cardiography (range, 1.2 to 4.2 L/min; r = 0.73), systemic vascular conductance (range, 7.9 to 33.7 ml·min(-1)·mmHg(-1); r = 0.77), systemic oxygen delivery estimated from cardiac output and arterial pulse-oxymetry saturation (range, 0.15 to 0.99 L/min; r = 0.70), arterio-venous oxygen content difference calculated from oxygen uptake and cardiac output (range, 3.7 to 11.8 mlO2/100 ml; r = -0.73), and quadriceps muscle fractional oxygen saturation assessed by near-infrared spectrometry (range, -6 to 23%; r = 0.77). In addition, mean walking intensity significantly correlated with the quadriceps muscle force adjusted for body weight (range, 0.28 to 0.60; r = 0.74) and the ratio of minute ventilation over maximal voluntary ventilation (range, 38 to 89%, r = -0.58). In COPD, in addition to ventilatory limitations and peripheral muscle weakness, intensity of daily physical activity is associated with both central hemodynamic and peripheral muscle oxygenation capacities regulating the adequacy of matching peripheral muscle oxygen availability by systemic oxygen transport.

Effect of rehabilitative exercise training on peripheral muscle remodelling in patients with COPD: targeting beyond the lungs.

Locomotor muscle dysfunction and weakness are frequently observed in patients with Chronic Obstructive Pulmonary Disease (COPD). In addition to intolerable sensations of dyspnoea which importantly contribute to exercise limitation, intrinsic muscle abnormalities have also been implicated in inducing leg muscle fatigue/discomfort during exercise in these patients. It is, however, uncertain whether these intrinsic muscle abnormalities are linked to a specific 'myopathy' or they constitute a consequence of the disease. Besides muscle disuse, other factors which may contribute to peripheral muscle dysfunction include systemic inflammation, oxidative and nitrosative stress, chronic hypoxia, corticosteroid use and malnutrition. There is clear evidence that rehabilitative exercise training induces significant skeletal muscle fibre remodelling and improvements in functionality in the absence of changes in lung function. The ultimate purpose of this review is to identify and summarize the results of studies implementing diverse types of exercise training on peripheral muscle fibre phenotypic and genotypic modifications in patients with COPD.

Smoking and physical activity interrelations in health science students. Is smoking associated with physical inactivity in young adults?

BACKGROUND: Smoking and physical inactivity constitute a major public health concern for Greece. The purpose of this study was to examine smoking behaviour and physical activity (PA) in Greek health science students. METHODS: A standardised questionnaire and the Greek version of IPAQ-short were given to 2000 health science students, randomly selected from five higher education institutions, in order to record smoking behaviour and PA status. All healthy young adults aged 19-30 years old were eligible. The final cohort size of the study was 1651 students (690 men). RESULTS: In the overall population, smoking prevalence was 37.6%, with 23.1% being heavy smokers (=21 cig/day). Smoking prevalence did not differ significantly between sexes, but heavy smoking was more prevalent in males. Age at smoking initiation was negatively associated with the daily number of cigarettes smoked (smoking volume), but only in females. The prevalence of health-enhancing PA (high PAclass) was only 14.2%, while 45.4% of the study population was classified as insufficiently active (low PAclass). Males were more physically active than females. Logistic regression analysis showed a strong inverse association between smoking and PA that was more pronounced in males. Smoking was associated with significantly decreased odds of being either moderately or highly physically active. Smoking volume was also negatively related with PA, but this relation was more pronounced in females. CONCLUSION: Smoking prevalence and rates of physical inactivity are considerably high in Greek health science students. Smoking was strongly and inversely associated with PA in this sample of Greek young adults.

Effectiveness of Interval Exercise Training in Patients with COPD.

Physical training is beneficial and should be included in the comprehensive management of all patients with COPD independently of disease severity. Different rehabilitative strategies and training modalities have been proposed to optimize exercise tolerance. Interval exercise training has been used as an effective alternative modality to continuous exercise in patients with moderate and severe COPD.Although in healthy elderly individuals and patients with chronic heart failure there is evidence that this training modality is superior to continuous exercise in terms of physiological training effects, in patients with COPD, there is not such evidence. Nevertheless, in patients with COPD application of interval training has been shown to be equally effective to continuous exercise as it induces equivalent physiological training effects but with less symptoms of dyspnea and leg discomfort during training.The main purpose of this review is to summarize previous studies of the effectiveness of interval training in COPD and also to provide arguments in support of the application of interval training to overcome the respiratory and peripheral muscle limiting factors of exercise capacity. To this end we make recommendations on how best to implement interval training in the COPD population in the rehabilitation setting so as to maximize training effects.