Advancing age is associated with more impaired mediolateral balance control after step down task.

BACKGROUND: To prevent the risk of stair descent falls and associated injuries in the older adults, it is important to understand the factors that affect this frequent locomotion of daily living. The fact that falls are in most cases the result of the interaction between intrinsic and extrinsic factors is very often underestimated when designing test protocols. RESEARCH QUESTION: This study aimed at evaluating balance control during and immediately after step down onto an unstable surface. METHODS: Physically active men and women aged 60-69 years (n = 28) and 70-79 years (n = 18) were asked to perform a step down onto a foam pad and stand still for 30 s (restabilization phase). Centre of pressure (CoP) velocity and standard deviation of CoP sway in anteroposterior and mediolateral direction were evaluated during the step down (CoP VAP, CoP VML, CoP SDAP, CoP SDML) and in the first 5 s of restabilization (CoP VAP5, CoP VML5, CoP SDAP5, CoP SDML5). In addition, time to complete step was investigated. RESULTS: Participants aged 70-79 years presented worse ML balance control after step down onto an unstable surface than their younger counterparts. This was represented by the significantly higher values of CoP SDML5 and CoP VML5 (p = 0.022 and p = 0.017). No other significant differences were detected. SIGNIFICANCE: Age is associated with a more significant ML center of pressure velocity and sway after step down onto a foam pad in physically active older adults. Exercises aimed at improving ML balance control in unstable conditions should be the subject of physical interventions even in older adults with overall good state of health and physical fitness.

A Sensor Network Utilizing Consumer Wearables for Telerehabilitation of Post-Acute COVID-19 Patients.

A considerable number of patients with COVID-19 suffer from respiratory problems in the post-acute phase of the disease (the second-third month after disease onset). Individual telerehabilitation and telecoaching are viable, effective options for treating these patients. To treat patients individually, medical staff must have detailed knowledge of their physical activity and condition. A sensor network that utilizes medical-grade devices can be created to collect these data, but the price and availability of these devices might limit such a network's scalability to larger groups of patients. Hence, the use of low-cost commercial fitness wearables is an option worth exploring. This article presents the concept and technical infrastructure of such a telerehabilitation program that started in April 2021 in the Czech Republic. A pilot controlled study with 14 patients with COVID-19 indicated the program's potential to improve patients' physical activity, (85.7% of patients in telerehabilitation versus 41.9% educational group) and exercise tolerance (71.4% of patients in telerehabilitation versus 42.8% of the educational group). Regarding the accuracy of collected data, the used commercial wristband was compared with the medical-grade device in a separate test. Evaluating [Formula: see text]-scores of the intensity of participants' physical activity in this test, the difference in data is not statistically significant at level [Formula: see text]. Hence, the used infrastructure can be considered sufficiently accurate for the telerehabilitation program examined in this study. The technical and medical aspects of the problem are discussed, as well as the technical details of the solution and the lessons learned, regarding using this approach to treat COVID-19 patients in the post-acute phase.

Chronic obstructive pulmonary disease: diagnosis and treatment of stable phase of disease; personalized treatment approach using phenotype features of the disease Summary of the 2020-2021 Czech Pneumological and Phthiseological Society position paper.

Chronic obstructive pulmonary disease (COPD) is a heterogenous condition affecting hundreds of millions of people worldwide. COPD is a major health problem associated with significant morbidity and mortality. In this review, the authors present the current concept of care for patients with COPD in the Czech Republic, along with a summary of treatment recommendations formulated by the expert group of the Czech Pneumological and Phthisiological Society. A more detailed version of the position paper was published in 2020. The aim of this work was to transform the most recent scientific knowledge into the context of daily practice in the Czech Republic. Our concept of care for patients with COPD uses a complex approach with special emphasis on individual phenotypic features of the disease. Maximal effort has been put into individualization of treatment according to the presence of certain clinical phenotypes/treatable traits with respect to current scientific knowledge.

Chronic obstructive pulmonary disease - diagnosis and management of stable disease; a personalized approach to care, using the treatable traits concept based on clinical phenotypes. Position paper of the Czech Pneumological and Phthisiological Society.

This position paper has been drafted by experts from the Czech national board of diseases with bronchial obstruction, of the Czech Pneumological and Phthisiological Society. The statements and recommendations are based on both the results of randomized controlled trials and data from cross-sectional and prospective real-life studies to ensure they are as close as possible to the context of daily clinical practice and the current health care system of the Czech Republic. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable heterogeneous syndrome with a number of pulmonary and extrapulmonary clinical features and concomitant chronic diseases. The disease is associated with significant mortality, morbidity and reduced quality of life. The main characteristics include persistent respiratory symptoms and only partially reversible airflow obstruction developing due to an abnormal inflammatory response of the lungs to noxious particles and gases. Oxidative stress, protease-antiprotease imbalance and increased numbers of pro-inflammatory cells (mainly neutrophils) are the main drivers of primarily non-infectious inflammation in COPD. Besides smoking, household air pollution, occupational exposure, low birth weight, frequent respiratory infections during childhood and also genetic factors are important risk factors of COPD development. Progressive airflow limitation and airway remodelling leads to air trapping, static and dynamic hyperinflation, gas exchange abnormalities and decreased exercise capacity. Various features of the disease are expressed unequally in individual patients, resulting in various types of disease presentation, emerging as the "clinical phenotypes" (for specific clinical characteristics) and "treatable traits" (for treatable characteristics) concept. The estimated prevalence of COPD in Czechia is around 6.7% with 3,200-3,500 deaths reported annually. The elementary requirements for diagnosis of COPD are spirometric confirmation of post-bronchodilator airflow obstruction (post-BD FEV1/VCmax <70%) and respiratory symptoms assessement (dyspnoea, exercise limitation, cough and/or sputum production. In order to establish definite COPD diagnosis, a five-step evaluation should be performed, including: 1/ inhalation risk assessment, 2/ symptoms evaluation, 3/ lung function tests, 4/ laboratory tests and 5/ imaging. At the same time, all alternative diagnoses should be excluded. For disease classification, this position paper uses both GOLD stages (1 to 4), GOLD groups (A to D) and evaluation of clinical phenotype(s). Prognosis assessment should be done in each patient. For this purpose, we recommend the use of the BODE or the CADOT index. Six elementary clinical phenotypes are recognized, including chronic bronchitis, frequent exacerbator, emphysematous, asthma/COPD overlap (ACO), bronchiectases with COPD overlap (BCO) and pulmonary cachexia. In our concept, all of these clinical phenotypes are also considered independent treatable traits. For each treatable trait, specific pharmacological and non-pharmacological therapies are defined in this document. The coincidence of two or more clinical phenotypes (i.e., treatable traits) may occur in a single individual, giving the opportunity of fully individualized, phenotype-specific treatment. Treatment of COPD should reflect the complexity and heterogeneity of the disease and be tailored to individual patients. Major goals of COPD treatment are symptom reduction and decreased exacerbation risk. Treatment strategy is divided into five strata: risk elimination, basic treatment, phenotype-specific treatment, treatment of respiratory failure and palliative care, and treatment of comorbidities. Risk elimination includes interventions against tobacco smoking and environmental/occupational exposures. Basic treatment is based on bronchodilator therapy, pulmonary rehabilitation, vaccination, care for appropriate nutrition, inhalation training, education and psychosocial support. Adequate phenotype-specific treatment varies phenotype by phenotype, including more than ten different pharmacological and non-pharmacological strategies. If more than one clinical phenotype is present, treatment strategy should follow the expression of each phenotypic label separately. In such patients, multicomponental therapeutic regimens are needed, resulting in fully individualized care. In the future, stronger measures against smoking, improvements in occupational and environmental health, early diagnosis strategies, as well as biomarker identification for patients responsive to specific treatments are warranted. New classes of treatment (inhaled PDE3/4 inhibitors, single molecule dual bronchodilators, anti-inflammatory drugs, gene editing molecules or new bronchoscopic procedures) are expected to enter the clinical practice in a very few years.

Balance control during stair descent on compliant surface is associated with knee flexor and ankle plantar flexor strength in older adults.

Balance and lower limb strength deficits are associated with a high incidence of falls in older adults. This study investigated the association between balance control during and after stair descent onto a compliant surface and lower limb strength. Thirty-five women and 14 men participated in this study. Stair descent time, mean center of pressure velocity in anteroposterior and mediolateral direction during stair descent (CoP VAP and CoP VML), and CoP velocity in the first 5 s of restabilization phase (CoP V5) were evaluated. Bilateral strength of the knee flexors and extensors, and ankle plantar and dorsal flexors was evaluated. Spearman correlation analysis with Bonferroni correction yielded a significant association between the strength of the knee flexors on the trailing limb and stair descent time in women (r = 0.502, p = 0.002, R2 = 0.246). The same analysis in men revealed a significant association between the strength of the knee flexors on the trailing limb and CoP VAP (r = -0.820, p < 0.001, R2 = 0.280) and CoP VML (r = -0.697, p = 0.006, R2 = 0.359). The strength of the ankle plantar flexors on the trailing limb was significantly associated with stair descent time (r = 0.684, p = 0.007, R2 = 0.429) and CoP VAP (r = -0.723, p = 0.003, R2 = 0.408) in men. Stair descent balance control is associated with knee flexion strength on trailing limb in women, and with ankle plantar flexion and knee flexion strength on the same limb in men.

Pulmonary rehabilitation and oropharyngeal exercises as an adjunct therapy in obstructive sleep apnea: a randomized controlled trial.

OBJECTIVE: It is well recognized that the most effective treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). Different treatment possibilities comprise surgery, mandibular advancement, pulmonary rehabilitation, and oropharyngeal and facial exercises (PR program). However, these treatments showed inconsistent results. The purpose of the study was to compare the short-term effects of CPAP and the combination of PR program with CPAP on OSA severity, ventilatory functions, and changes in body characteristics in a newly diagnosed patient. METHODS: This study was a single-center, two-arm, parallel, randomized, controlled, open-label trial. Forty patients with OSA (20 men, 20 women, aged 54.2 ± 6.8 years) with moderate to severe obstructive sleep apnea were randomized to CPAP and CPAP + PR. The PR group underwent six weeks of 60-min twice-weekly individual PR programs. The primary outcome measure was apnea/hypopnea index, oxygen desaturation index, and Epworth Sleepiness Scale. The secondary outcome measures were a percentage of total sleep time with oxygen saturation below 90%, body mass index (BMI), vital capacity and forced expiratory volume in 1 s (% of predicted), neck, waist, and hip circumferences. RESULTS: Five patients with OSA did not complete the program. The comparison between baseline and final assessment was made in 15 patients in the CPAP + PR group and 20 patients in the control group with CPAP only. Although OSA severity was controlled with CPAP treatment in both groups, a significant reduction of neck, waist, and hip circumferences, BMI, and improvement of pulmonary function were confirmed only in the CPAP + PR group after treatment. CONCLUSION: Treatment with CPAP combined with the PR program improved OSA patients to a greater extent than only CPAP.

[Non-CF bronchiectasis of adults: short review for clinical practice Position paper of Board of disease with bronchial obstruction Czech Pulmonological and Phthiseological Society Czech Medical Association of J. E. Purkyne]. / Non-CF bronchiektázie dospelých: strucný prehled pro praxi Dokument Sekce chorob s bronchiální obstrukcí Ceské pneumologické a ftizeologické spolecnosti Ceské lékarské spolecnosti J. E. Purkyne.

Bronchiectasis is a clinically important, but poorly understood, pulmonary condition characterized by dilated and thick-walled bronchi. Bronchiectasis remains a significant cause of morbidity and mortality around the world. Targeted effort to early high-resolution computed tomography diagnosis and detailed confirmation of causation are in the spotlight of respiratory physicians in the developed countries. The risk population consists of subjects with persistent and/or productive cough, where another clear diagnosis has not been performed. Specific treatment tailored on underlying diseases and non-specific airway clearance techniques are able to improve symptoms, and reduce lung impairment. Evidence-based treatment algorithms for anti-inflammatory, and antibiotic treatment of stable non-CF BE will have to await large-scale, long-term controlled studies. Surgery should be reserved for individuals with highly symptomatic, localized bronchiectasis who have failed medical management. Unfortunately, there have been few well designed longitudinal or cross-sectional studies in the field of bronchiectasis. To give truly meaningful and generalizable results, a longitudinal observational study of bronchiectasis would require to enrol several thousand patients, more than any one center can enrol. The European Bronchiectasis Registry will create an open, pan-European registry of patients with non-CF bronchiectasis. The authors emphatically recommend that all respiratory specialist managed non-CF BE subjects should be actively involved in the European Bronchiectasis Registry.Key words: bronchiectasis - diagnosis - registry - treatment.

The effect of balance training intervention on postural stability in children with asthma.

OBJECTIVE: Pulmonary rehabilitation is mainly focused on exercise training and breathing retraining in children with asthma. Conversely, balance training is not usually recommended for the treatment, although postural deficits were found in these patients. Therefore, this study assessed the effect of balance training intervention on postural stability in children with asthma. METHODS: Nineteen children with mild intermittent asthma (age 11.1 ± 2.1 years, height 147.6 ± 13.9 cm, weight 41.8 ± 13.3 kg) were randomly assigned to an experimental group or a control group and completed a four-week physiotherapy program including breathing exercises and aerobic physical training (six times/week, 45 minutes). Both groups performed the same training, but only the experimental group underwent exercises on balance devices. The center of pressure (CoP) velocity in the anteroposterior (Vy) and mediolateral (Vx) directions, and total CoP velocity (Vtot) were recorded before and after training in the preferred and the adjusted stances under eyes open (EO) and eyes closed (EC) conditions. RESULTS: The addition of balance intervention led to significant improvements of Vtot (p = 0.02, p = 0.04) in both types of stance, Vx in the preferred stance (p = 0.03) and Vy in the adjusted stance (p = 0.01) under EO conditions. Significant improvements were also found in Vy in the adjusted stance (p = 0.01) under EC conditions. CONCLUSIONS: Results of this study support the effectiveness of balance training as a part of physiotherapy treatment for improving balance performance, predominantly under EO conditions, in children with mild asthma.

The Effect of Respiratory Muscle Training on Fin-Swimmers' Performance.

Although respiratory muscle functions can influence swimming performance, respiratory muscle training (RMT) is not routinely used for improving fin-swimmers´ performance. The aim of our study was to verify the benefit of a one month of RMT in young fin-swimmers. We assessed the effect of this training on respiratory muscles and on maximal underwater swimming distance. 28 fin-swimmers were randomly divided into an experimental group (EG) and a control group (CG). The study finished with 20 fin-swimmers (EG: n = 12; average age 12.0; weight 47.4 kg; height 1.58 m; CG: n = 8; age 11.5; weight 49.6 kg; height 1.53 m). Both group performed regular swimming training, during which the EG used Threshold PEP (positive expiratory pressure) and IMT (inspiratory muscle trainer) for RMT for one month. After one-month washout period, the CG also performed RMT. RMT showed significant improvement of inspiratory muscles in both groups (Z = <1.96; 2.59>; p < 0.05). Significant improvement was observed also in apnoea (AP) max (ZCG = 2.03; p < 0.05; ZEG=2.93; p < 0.01). A long-term effect was observed in the respiratory muscle strength and AP max in the EG (ZEG = 2.52; p < 0.05). RMT in fin-swimmers improves both respiratory muscle strength and the performance in AP max.

Breathing changes accompanying balance improvement during biofeedback.

The aim of this study was to determine whether respiration would be altered during visual biofeedback condition while standing on a foam surface. Fifty young, healthy subjects (24 men, 26 women) were divided into a spirometry group, in which additional spirometry analysis was performed, and a control group. All subjects were tested in two conditions: 1) standing on a foam surface and 2) standing on a foam surface with visual biofeedback (VF) based on the centre of pressure (CoP). CoP amplitude and velocity in anterior-posterior (Aap, Vap) and medial-lateral (Aml, Vml) directions were measured by the force platform. Breathing movements were recorded by two pairs of 3D accelerometers attached on the upper chest (upper chest breathing - UCB) and the lower chest (lower chest breathing - LCB). Results showed that significant decreases of CoP amplitude and velocity in both directions were accompanied by a significant decrease of lower chest breathing, and an increase of LCB frequency was seen during VF condition compared to control condition in both groups. Moreover, a significant decrease in tidal volume and increased breathing frequency during VF condition were confirmed by spirometric analysis. Reduced breathing movements and volumes as well as increased breathing frequency are probably part of an involuntary strategy activated to maximize balance improvement during VF condition.

Postural stability in school-age children with mild bronchial asthma disease (a pilot study).

OBJECTIVE: This study assessed the postural stability in children with asthma using balance tests under conditions of a comfortable foot placement and with a foot placement provoking instability. METHODS: A group of 10 school children from 8 to 10 years old with mild intermittent asthma and 10 healthy children of the same age range performed four balance tests in a randomized order: preferred stance, adjusted stance, and tandem stance each under both conditions of eyes opened (EO) and eyes closed (EC), as well as a one-legged stance with eyes-opened conditions. To determine postural stability, the center of pressure (CoP) movement was recorded. Basic stabilographic parameters were calculated: CoP velocity in the anterior-posterior direction, CoP velocity in the medial-lateral direction, and the total CoP velocity. RESULTS: Statistically significant differences between the groups were found only for the one-legged stance. Significantly greater anterior-posterior CoP velocity (p = 0.05) and total CoP velocity (p = 0.03) were found in children with asthma when standing on the preferred foot. A significantly greater medial-lateral velocity (p = 0.02) was also found in the non-preferred foot of children with asthma. CONCLUSIONS: We can conclude that standing on one leg might be an appropriate test with which to identify balance differences between young children with mild intermittent asthma and healthy children.

[Use of pulmonary rehabilitation in the treatment of decreased respiratory muscle strength]. / Moznosti vyuzití technik plicní rehabilitace pro lécbu snízené síly dýchacích svalu.

Decreased respiratory muscle strength could lead to other health problems, which can decrease the quality of life of those patients. Ineffective expectoration and dyspnoea during physical activities and during activity of daily living are the most frequent disorders associated with decreased respiratory muscle strength. Multidisciplinary treatment including pulmonary rehabilitation programme is very important for those patients. Ventilatory muscle training (strength and endurance type of training), airway clearance techniques - active (e.g. autogenic drainage, instrumental techniques) and passive (e.g. manual thoracic compression, mechanical insufflator/exsufflator machine) and exercise training are the most frequent used techniques in these patients. Assessment of all respiratory muscles function - especially their respiratory and postural function - is important at the beginning of rehabilitation treatment.

The role of lateral preference of lower limbs in a postural stabilization task.

OBJECTIVE: Postural control is a complex skill based on the interaction of dynamic sensorimotor processes. This study assessed the effect of lateral perturbations on postural re-stabilization regarding lower limb preference. METHODS: A group of 14 physically active individuals (9 male, 5 female) randomly underwent postural perturbations in lateral-left and lateral-right directions at a velocity of 0.2 m.s-1 and a platform shift of 6 cm. Perturbation to the preferred limb side (PS) was noted when the contralateral body movement was primarily controlled by the preferred limb and perturbation to the non-preferred limb side (NS) was noted when the contralateral body movement was primarily controlled by the non-preferred (stabilizing) limb. Prior to, during and after the perturbation centre of pressure (CoP) was registered using a computerized motor driven FiTRO Dynamic Posturography System based on force plate (Fitro Sway Check) with a sampling rate of 100 Hz. The basic stabilographic parameters of peak displacement (Peak 1), peak-to-peak displacement (Peak 2), time to peak displacement (Time 1), time to peak-to-peak displacement (Time 2) and re-stabilization time (Time 3) were analyzed. RESULTS: Results showed significantly larger Time 3 on PS than on NS (2.81 ± 1.32 s and 1.73 ± 1.10 s; p=0.02). However, there were no significant differences in other parameters between PS and NS. CONCLUSION: It may be concluded that the observed shorter re-stabilization time at NS was due to the stabilization role of the non-preferred limb.

Chronic Obstructive Pulmonary Disease: official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care.

BACKGROUND: COPD is a global concern. Currently, several sets of guidelines, statements and strategies to managing COPD exist around the world. METHODS: The Czech Pneumological and Phthisiological Society (CPPS) has commissioned an Expert group to draft recommended guidelines for the management of stable COPD. Subsequent revisions were further discussed at the National Consensus Conference (NCC). Reviewers' comments contributed to the establishment of the document's final version. DIAGNOSIS: The hallmark of the novel approach to COPD is the integrated evaluation of the patient's lung functions, symptoms, exacerbations and identifications of clinical phenotype(s). The CPPS defines 6 clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD-bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and pulmonary cachexia phenotype. TREATMENT: Treatment recommendations can be divided into four steps. 1(st) step = Risk exposure elimination: reduction of smoking and environmental tobacco smoke (ETS), decrease of home and occupational exposure risks. 2(nd) step = Standard treatment: inhaled bronchodilators, regular physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccination. 3(rd) step = Phenotype-specific therapy: PDE4i, ICS+LABA, LVRS, BVR, AAT augmentation, physiotherapy, mucolytic, ABT. 4(th) step = Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation, high intensity-NIV and palliative care. CONCLUSION: Optimal treatment of COPD patients requires an individualised, multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. The new Czech COPD guideline reflects and covers these requirements.