Respiratory Physiotherapy and Bronchiectasis / Fisioterapia respiratoria y bronquiectasias

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Análisis del ejercicio físico en la Insuficiencia Cardíaca / Analysis of physical exercise in Heart Failure

La rehabilitación cardiaca (RC) ha demostrado ser una intervención eficaz y segura para mejorar el pronóstico de los pacientes con insuficiencia cardiaca (IC). Sin embargo, existen dudas sobre cuál es el mejor método de entrenamiento en estos pacientes. Actualmente, el más recomendado es el entrenamiento aeróbico continuo de intensidad moderada (MICT). En este trabajo se compara este tipo de entrenamiento con el entrenamiento de alta intensidad basado en intervalos (HIIT). La variable de estudio principal es la capacidad física, medida con el Vo2max. Además, también se valoran la función cardiaca y la calidad de vida relacionada con la salud. Se obtiene una ligera mejoría con HIIT, pero ambos métodos son eficaces y válidos, por lo que lo más importante será la individualización en función de las características, contexto y preferencias de cada paciente. Por otro lado, también se compara el entrenamiento basado en MICT en solitario con el entrenamiento concurrente, es decir, la combinación de MICT y entrenamiento de fuerza (EF), obteniendo conclusiones favorables para el segundo grupo. De esta manera, el EF no sustituye al entrenamiento aeróbico, pero si es fundamental para complementarlo ya que las adaptaciones son diferentes y el aumento de la fuerza y masa muscular en pacientes con IC es altamente beneficioso.(AU)

Cardiac rehabilitation (CR) has proven to be an effective and safe intervention to improve the prognosis of patients with heart failure (HF). However, there are doubts as to which is the best training method in these patients. Currently, the most recommended is the continuous moderate intensity aerobic training (MICT). In this work, this type of training is compared with high intensity interval training (HIIT). The study variableThe main one is physical capacity, measured with the Vo2max. In addition, heart function and health-related quality of life are also assessed. A slight improvement is obtained with HIIT, but both methods are effective and valid, so the most important thing will be individualization based on the characteristics, context and preferences of each patient. On the other hand, training based on MICT alone is also compared with concurrent training, that is, the combination of MICT and resistance training (PE), obtaining favorable conclusions for the second group. In this way, PE is not a substitute for aerobic training, but it is essential to complement it since the adaptations are different and the increase in strength and muscle mass in patients with HF is highly beneficial.(AU)

Management of respiratory complications and rehabilitation in individuals with muscular dystrophies: 1st Consensus Conference report from UILDM - Italian Muscular Dystrophy Association (Milan, January 25-26, 2019).

Respiratory complications are common in the patient with muscular dystrophy. The periodic clinical and instrumental respiratory evaluation is extremely important. Despite the presence in the literature of updated guidelines, patient associations often report lack of knowledge of these pathologies, particularly in peripheral hospitals. The purpose of this work, inspired by the Italian Muscular Dystrophy Association (UILDM) is to improve management of respiratory problems necessary for the management of these patients complex. To this end, the main items that the specialist can meet in the follow-up of these pathologies have been analyzed and discussed, among which the respiratory basal evaluation, the criteria of adaptation to non-invasive ventilation, management of bronchial secretions, situations of respiratory emergency, indications for tracheostomy and the subject of advance directives of treatment (DAT).

The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network.

COVID-19 is one of the biggest health crises that the world has seen. Whilst measures to abate transmission and infection are ongoing, there continues to be growing numbers of patients requiring chronic support, which is already putting a strain on health care systems around the world and which may do so for years to come. A legacy of COVID-19 will be a long-term requirement to support patients with dedicated rehabilitation and support services. With many clinical settings characterized by a lack of funding and resources, the need to provide these additional services could overwhelm clinical capacity. This position statement from the Healthy Living for Pandemic Event Protection (HL-PIVOT) Network provides a collaborative blueprint focused on leading research and developing clinical guidelines, bringing together professionals with expertise in clinical services and the exercise sciences to develop the evidence base needed to improve outcomes for patients infected by COVID-19.

Digital habits of PR service-users: Implications for home-based interventions during the COVID-19 pandemic.

Remote models of pulmonary rehabilitation (PR) are vital with suspension of face-to-face activity during the COVID-19 pandemic. We surveyed digital access and behaviours and PR delivery preferences of current PR service users. There was significant heterogeneity in access to and confidence in using the Internet with 31% having never previously accessed the Internet, 48% confident using the Internet and 29% reporting no interest in accessing any component of PR through a Web-based app. These data have implications for the remote delivery of PR during the COVID-19 pandemic and raise questions about the current readiness of service users to adopt Web-based delivered models of PR.

Pulmonary Rehabilitation.

Commenting on this book is a great privilege and an opportunity to share some emerging aspects regarding the development of pulmonary rehabilitation. Indeed, appreciating the therapeutic value of this modality is possible because of continuous research and tireless commitment of all professionals involved in the care of patients with respiratory diseases and pulmonary-related impairments....

Entrenamiento sobre cinta rodante en niños con enfermedades respiratorias crónicas: serie clínica / Treadmill training in children with chronic respiratory diseases: clinical series

INTRODUCCIÓN: Las enfermedades respiratorias crónicas (ERC) en niños han aumentado en los últimos años siendo la Rehabilitación Respiratoria uno de los tratamientos utilizados en esta población. OBJETIVO: Evaluar el impacto de un programa de entrenamiento aeróbico sobre cinta rodante en pacientes pediátricos con ERC del Hospital Josefina Martínez. METODOLOGÍA: Serie retrospectiva de casos con registro prospectivo de 9 pacientes con una edad promedio de 7,1 ± 3,9 años con ERC y entrenamiento aeróbico. Los pacientes realizaron 24 sesiones. Se analizaron los registros pre-post de los test de marcha de 6 min (TM6) y la velocidad máxima obtenida en el Test Cardiopulmonar Incremental (VTCI). RESULTADOS: Las medias de la distancia recorrida en TM6 pre y post entrenamiento fueron de 383 ± 142,4 m y 451,7 ± 142,4 m respectivamente (p < 0,0001). Las medias de las VTCI pre y post entrenamiento fueron: 4,1 ± 1,1 km/h y 5,4 ± 1,27 km/h (p = 0,001). CONCLUSIONES: La distancia recorrida en el TM6 y la capacidad máxima de trabajo mejoraron significativamente con el entrenamiento aeróbico en estos pacientes con ERC.

INTRODUCTION: Chronic respiratory diseases (CRD) in children have increased in recent years. Respiratory Rehabilitation is one of the treatments used in this population. OBJECTIVE: To evaluate the impact of a treadmill training program over pediatric patients with CRD in the Josefina Martínez Children's Hospital at Santiago de Chile. METHODS: Retrospective cases series with prospective record of 9 patients 7.1 ± 3.9 years-old with CRD and treadmill training. The patients performed 24 sessions. The Pre-post records of the 6-minute walk test (6MW) and the maximum speed obtained in the Incremental Load Test (ILT) were analyzed. RESULTS: Averages of the distance traveled pre and post-training were 383 ± 142.4 meters and 451.7 ± 142.4 meters respectively (p < 0.0001). The average maximum speed obtained in the ILT was 4.1 ± 1.1 km/h and 5.4 ± 1.27 km/h (p = 0.001). CONCLUSION: The distance walked in the 6-minute walk test and the maximum work capacity improve significantly with treadmill training in these patients with CRD.

Programa de rehabilitación respiratoria infantil en un hospital público de Chile / Pediatric pulmonary rehabilitation program at a Chilean public hospital

Introducción. La rehabilitación respiratoria infantil es relevante en el manejo de enfermedades respiratorias crónicas. En Chile, se desarrolla solo en algunos hospitales.Objetivo. Describir los resultados de un programa de rehabilitación respiratoria infantil tras 3 meses de rehabilitación.Metodología. Estudio retrospectivo de los pacientes con enfermedad pulmonar crónica, enfermedad neuromuscular y otras patologías crónicas admitidos desde junio de 2011 a junio de 2017. Se realizó evaluación física general, evaluación de musculatura respiratoria y espirometría. Se planificó entrenamiento físico general y entrenamiento muscular respiratorio, con protocolos institucional, mixto y domiciliario.Resultados. Ingresaron al programa 156 pacientes (11,45 ± 3,55 años), 68 con enfermedad pulmonar crónica (11,56 ± 4,6 años, el 43,5 %), 45 con enfermedad neuromuscular (11,4 ± 3,7 años, el 28,8 %) y 43 con patologías crónicas diversas (11,31 ± 3,9 años). Del total, se entrenaron 102 (el 65,4 %); dirigido (n = 27), mixto (n = 23) y domiciliario (n = 50) con adherencia del 69 %, del 87,5 % y del 70 %, respectivamente. Aumentó el 19,3 % la presión inspiratoria máxima (p = 0,001), el 14,5 % la presión espiratoria máxima (p = 0,001), el 12,9 % la capacidad vital forzada (p = 0,001), el 11,6 % el volumen espiratorio forzado al primer segundo (p = 0,004) y 17,6 metros en el test de marcha de 6 minutos (p = 0,036) tras 3 meses de rehabilitación.Conclusiones. El protocolo de intervención incrementó el estatus funcional cardiorrespiratorio. La adherencia fue superior al 65 %.

Introduction. Pediatric pulmonary rehabilitation is relevant in the management of chronic respiratory diseases. In Chile, it is provided only at certain hospitals.Objective. To describe the outcomes of a pediatric pulmonary rehabilitation program after 3 months of rehabilitation.Methodology. Retrospective study of patients with chronic lung disease, neuromuscular disease, and other chronic conditions admitted to the program between June 2011 and June 2017. Assessments included general physical and respiratory muscle examination, and spirometry. General physical training and respiratory muscle training were planned according to facility-based, mixed and home protocols. Results. A total of 156 patients (11.45 ± 3.55 years old) were included, 68 had chronic lung disease (11.56 ± 4.6 years old, 43.5 %); 45, neuromuscular disease (11.4 ± 3.7 years old, 28.8 %); and 43, various chronic conditions (11.31 ± 3.9 years old). Out of all patients, 102 (65.4 %) followed training protocols; targeted (n = 27), mixed (n = 23), and home (n = 50); compliance was 69 %, 87.5 %, and 70 %, respectively. Peak inspiratory pressure increased by 19.3 % (p = 0.001); peak expiratory pressure,14.5 % (p = 0.001); forced vital capacity, 12.9 % (p = 0.001); forced expiratory volume in 1 second, 1.6 % (p = 0.004); and the six-minute walk test, 17.6 meters (p = 0.036) after 3 months of rehabilitation.Conclusions. The intervention protocol improved cardiorespiratory functional capacity. Compliance was over 65 %.

Prediction of Maximal Oxygen Uptake From Submaximal Exercise Testing in Chronic Respiratory Patients. New Perspectives / Predicción del consumo máximo de oxígeno mediante pruebas de ejercicio submáximo en pacientes con patología respiratoria crónica

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Personalized exercise training in chronic lung diseases.

Chronic respiratory diseases (CRD) are characterized by exertional dyspnoea, exercise limitation and reduced health-related quality of life (QoL). Exercise training is essential for improving symptoms, physical function and QoL. Current research available supports the effectiveness of exercise training in patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis and interstitial lung disease (ILD). However, recent studies have also shown safety and effectiveness of exercise training in patients with pulmonary arterial hypertension (PAH) and asthma. Despite the lack of clinical guidelines for exercise training in PAH, a recent Cochrane review has reported improvements in functional capacity and effective reductions in mean pulmonary arterial pressure. In the other CRD, a number of Cochrane reviews, supported by numerous randomized controlled trials, have been published outlining the benefits of different types of exercise training. The aim of this review is to establish the principles and modalities of personalized exercise training and the effects of exercise training across a number of CRD. In addition, this review provides information on personalized exercise prescription for CRD patients with co-morbidities.

[The new concept of rehabilitation space in the era of the Digital Health in cardio-respiratory rehabilitation]. / Nuovo concetto di spazio riabilitativo nell'era della Digital Health in riabilitazione cardio-respiratoria.

SUMMARY: Rehabilitation Specialized Medicine offers new developments in relation to the new technologies, new demography, life expectation and chronicity. The same attention that in modern health systems is given to quality process and outcome, should also concern the hospital structural aspects, in order to humanize these spaces. In this perspective, the definition of a structure easy to access with well-defined areas within it, such us an external waiting area, reception area and work area, represents an integration which allows to achieve the goal of providing quality performance. The need of a new concept of rehabilitation space in the cardio-respiratory area, especially that of the Gymnasium, must be developed keeping in consideration the main scientific guidelines in cardio-respiratory field. Consequently, this will have four dedicated areas respectively to evaluation, aerobic training, strength training and educational, each one characterized by different colors. The abstract idea of "digital comprehensive rehabilitation", in which are inserted all rehabilitative services facilitated by the gym digitalization, are located in this context, and their main aim is to answer to the patient needs.

Rehabilitation in lung diseases: 'Education' component of pulmonary rehabilitation.

Pulmonary rehabilitation (PR) is a complex intervention with described core components of individualized exercise training and inter-disciplinary education in international guidelines. Compared to the overwhelming evidence of benefit for exercise training, the education component has received little attention. Educating patients about their symptoms and disease management appears intuitive to improve their health, but how and when is less clear. PR has provided an opportunity for educational activities and traditionally this has been delivered in the form of didactic lectures. The field is evolving and challenges are apparent raising important questions. What is the purpose and outcomes of the education component? Do specific diseases require specific education or PR programmes? How to provide interdisciplinary education? Is the timing optimal within the disease trajectory (most patients are referred to PR with moderate to severe disease)? Can technology help? Our review explores the recent evidence for the 'education' component of PR synthesizing the global guidelines. We discuss the challenges for patients as learners, healthcare professionals as educators and propose future directions for this core component of PR.

Systematic review (protocol) of clinical effectiveness and models of care of low-resource pulmonary rehabilitation.

More than half of the people with chronic respiratory diseases (CRDs) live in low- and middle-income countries (LMICs). The increasing disability, reduced productivity, associated anxiety and depression from CRDs result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) is a guideline-recommended multidisciplinary and multifaceted intervention that improves the physical and psychological condition of people with CRD. However, PR services are underprovided and uptake is poor in LMICs, especially in low-resourced setting. We aim to systematically assess the effectiveness, applicable components and mode of delivery of PR. We will search MEDLINE, EMBASE, CABI, AMED and CENTRAL from January 1990 using a PICOS search strategy (Population: adults with CRD (including chronic obstructive pulmonary disease, post-tuberculosis, remodelled asthma); Intervention: PR; Comparator: usual care; Outcomes: functional exercise capacity and Health-Related Quality-of-Life; Setting: low-resource settings). Two reviewers will independently screen titles/abstracts and full texts for eligibility and extract data from included papers. We will use the Cochrane Risk-of-Bias tool, rating the quality of evidence using GRADE. We will use narrative synthesis to answer our three objectives: What is the effectiveness of PR in low-resource settings? What components are used in effective studies? What models of service delivery are used? This systematic review will inform the potential impact and practical models of low-resource PR for the betterment of patients with CRDs to improve their substantial health-care burden and address poor quality of life.

The past, present and future of pulmonary rehabilitation.

Abundant evidence supports the use of pulmonary rehabilitation as a treatment for stable and exacerbated chronic obstructive pulmonary disease. Several questions around the science base of rehabilitation in other patient groups as well as the role of rehabilitation as a component in other comprehensive care trajectories remain to be addressed. The impact of a rehabilitation programme could also perhaps be enhanced if clear guidance would be available on how to individualize the components of a rehabilitation programme in individual patients. The rehabilitation community, in an attempt to increase access to programmes, has developed less rigorous interventions. These may serve specific patients (e.g. less severe patients or may be used as a maintenance programme), but in order to have conceptual clarity they should not be called substitutes for rehabilitation if they do not meet the definition of rehabilitation. Reaching clarity on the best format for maintenance programmes in order to achieve long-lasting health benefits for patients is another challenge. Furthermore, as many patients as possible should be referred to adequate rehabilitation programmes within their reach with fair reimbursement. Programmes should take into account the burden of the disease of a patient, the required components to tackle the problems, adequate assessment to document the outcome and the patient's preference. In summary, pulmonary rehabilitation is one of the most potent evidence-based therapies for patients with respiratory diseases. Researchers should continue to fine tune the interventions, get clarity on terminology as well as the ultimate outcomes for rehabilitation to ensure sustainable health effects.

Changes in physical activity during hospital admission for chronic respiratory disease.

BACKGROUND AND OBJECTIVE: Establishing the amount of inpatient physical activity (PA) undertaken by individuals hospitalized for chronic respiratory disease is needed to inform interventions. This observational study investigated whether PA changes when a person is an inpatient, how long is required to obtain representative PA measures and whether PA varies within a day and between patients of differing lengths of stay. METHODS: A total of 389 participants were recruited as early as possible into their hospitalization. Patients wore a PA monitor from recruitment until discharge. Step count was extracted for a range of wear time criteria. Single-day intraclass correlation coefficients (ICC) were calculated, with an ICC ≥ 0.80 deemed acceptable. RESULTS: PA data were available for 259 participants. No changes in daily step count were observed during the inpatient stay (586 (95% CI: 427-744) vs 652 (95% CI: 493-812) steps/day for day 2 and 7, respectively). ICC across all wear time criteria were > 0.80. The most stringent wear time criterion, retaining 80% of the sample, was ≥11 h on ≥1 day. More steps were taken during the morning and afternoon than overnight and evening. After controlling for the Medical Research Council (MRC) grade or oxygen use, there was no difference in step count between patients admitted for 2-3 days (short stay) and those admitted for 7-14 days (long stay). CONCLUSION: Patients move little during their hospitalization, and inpatient PA did not increase during their stay. A wear time criterion of 11 waking hours on any single day was representative of the entire admission whilst retaining an acceptable proportion of the initial sample size. Patients may need encouragement to move more during their hospital stay.

[The DISC tool improves communication and results in pulmonary rehabilitation]. / L'outil DISC améliore la communication et les résultats de la réhabilitation respiratoire : une approche comportementale adaptée.

INTRODUCTION: Competence in personal relationships is essential for a caregiver, especially in pulmonary rehabilitation (PR). Considering the behavioral profile of patients might help to optimize their management and the results of PR. METHODS: We evaluated eight hundred and thirty-two consecutive patients with chronic respiratory disease who received eight weeks of home-based PR. Their exercise tolerance (six-minute stepper test, 6MST), mood (HAD), and quality of life (VSRQ, MRF28) were evaluated at the beginning and end of PR. For six hundred and ninety patients, a behavioral approach was implemented at the beginning of PR by using the DISC tool to identify four behavioral profiles: dominance, influence, steadiness, conscientiousness. The remaining 142 patients served as the control group. RESULTS: Subjectively, the therapeutic alliance was more easily established with the behavioral approach. Compared with the control group, patients with the "steadiness" profile were younger (60.7±12 years) and mostly female (52.8%), whereas patients with the "conscientiousness" profile were older (67.5±10.6 years) and mostly male (85.5%). The four behaviorally profiled groups showed no differences in exercise tolerance, mood, or quality of life scores at baseline. Globally, all patients improved their exercise tolerance, mood and quality of life. The percentage of responders to 6MST and VSRQ (>MCID) was 7.5% and 5.3% higher with the behavioral approach. For non-responders to 6MST and VSRQ (