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Breuls S, Blondeel A, Wuyts M, Verleden GM, Vos R, Janssens W, Troosters T, Demeyer H. The Association between Objectively Measured Physical Activity and the Prevalence of Comorbidities in Lung Transplant Recipients. Respiration 2024; 103:251-256. [PMID: 38447551 DOI: 10.1159/000536607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Lung transplant recipients are often physically inactive and are at risk of developing comorbidities. We investigated whether objectively measured physical activity was associated with the prevalence of comorbidities. METHODS Physical activity (accelerometry) and the presence of cardiovascular disease, symptoms of depression and anxiety, diabetes, dyslipidaemia, hypertension, lower extremity artery disease, muscle weakness, obesity, and osteoporosis were assessed in 108 lung transplant recipients. Patients were divided into four groups based on daily step count. RESULTS A cohort of 108 patients (60 ± 7 years, 51% male, 20 ± 14 months since transplantation) was included. Active patients (>7,500 steps/day) had significantly fewer comorbidities (4 comorbidities) compared to severely inactive patients (<2,500 steps/day, 6 comorbidities), and muscle weakness and high symptoms of depression were less prevalent. Severely inactive patients had significantly more cardiovascular comorbidities compared to all other groups. No other significant differences were observed. CONCLUSION Physically active lung transplant recipients have fewer comorbidities, lower prevalence of muscle weakness, and fewer symptoms of depression compared to very inactive patients.
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Affiliation(s)
- Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium,
| | - Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Geert M Verleden
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | | | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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R van Buul A, J Kasteleyn M, Poberezhets V, N Bonten T, De Mutsert R, S Hiemstra P, le Cessie S, R Rosendaal F, H Chavannes N, Taube C. Factors associated with physical activity among COPD patients with mild or moderate airflow obstruction. Monaldi Arch Chest Dis 2021; 92. [PMID: 34523325 DOI: 10.4081/monaldi.2021.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Physical inactivity is already present among patients with chronic obstructive pulmonary disease (COPD) of mild or moderate airflow obstruction. Most previous studies that reported on determinants of physical activity in COPD included patients with severe COPD. Therefore, the aim of this study was to explore which patient characteristics were related with physical activity in COPD patients with mild or moderate airflow obstruction. Cross-sectional analyses were performed on patients selected from the population-based Netherlands Epidemiology of Obesity study. Patients were included if they had a physician-diagnosed COPD GOLD 0-2 or had newly diagnosed COPD GOLD 1-2. Physical activity was evaluated using the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) questionnaire and reported in hours per week of metabolic equivalents (MET-h/week). Associations between sociodemographic, lifestyle, clinical and functional characteristics were examined using regression analysis. 323 patients were included in research (77 with physician-diagnosed and 246 with newly diagnosed COPD). We found that physical activity was positively associated with pulmonary function: FEV1 (regression coefficient 0.40 (95% CI 0.09,0.71)) and FVC (regression coefficient 0.34 (95% CI 0.06,0.61)). Physical activity was associated with anxiety (regression coefficient =0.9 (95% CI 0.3,1.6)) only for physician-diagnosed patients. Lung function and anxiety level determine level of physical activity among COPD patients with mild or moderate airflow obstruction. Thus, integrating it into the physical activity plans could help to increase physical activity level of the patients.
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Affiliation(s)
- Amanda R van Buul
- Department of Pulmonology, Leiden University Medical Center, Leiden.
| | - Marise J Kasteleyn
- Department of Pulmonology; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden.
| | - Vitalii Poberezhets
- Department of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya.
| | - Tobias N Bonten
- Department of Pulmonology; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden.
| | - Renée De Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden.
| | - Saskia le Cessie
- Department of Clinical Epidemiology; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden.
| | - Frits R Rosendaal
- Department of Clinical Epidemiology; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden.
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center.
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen, Ruhrlandklinik, University Duisburg-Essen, Essen.
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Abstract
Lung transplantation (LT) is proved to be effective in patients with end-stage lung disease who are failing optimal therapy. Chronic obstructive pulmonary disease (emphysema) is the most common indication for adult lung transplantation. As most patients with emphysema (EMP) can survive long term, it could be difficult to decide which patient should be listed for LT. LT is a complex surgery. Therefore, it is extremely important to choose a recipient in whom expected survival is at less equal or comparable to the survival without surgery. This paper reviews patient selection, bridging strategies until lung transplantation, surgical approach and choice of the procedure, and functional outcome in emphysema recipients.
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Affiliation(s)
- Ilhan Inci
- Department of Thoracic Surgery, University Hospital, Raemistrasse, Zurich, Switzerland
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Holland AE, Malaguti C, Hoffman M, Lahham A, Burge AT, Dowman L, May AK, Bondarenko J, Graco M, Tikellis G, Lee JY, Cox NS. Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review. Chron Respir Dis 2020; 17:1479973120952418. [PMID: 32840385 PMCID: PMC7450293 DOI: 10.1177/1479973120952418] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To identify exercise tests that are suitable for home-based or remote
administration in people with chronic lung disease. Methods: Rapid review of studies that reported home-based or remote administration of
an exercise test in people with chronic lung disease, and studies reporting
their clinimetric (measurement) properties. Results: 84 studies were included. Tests used at home were the 6-minute walk test
(6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go
(TUG, 4 studies) and step tests (two studies). Exercise tests administered
remotely were the 6MWT (two studies) and step test (one study). Compared to
centre-based testing the 6MWT distance was similar when performed outdoors
but shorter when performed at home (two studies). The STS, TUG and step
tests were feasible, reliable (intra-class correlation coefficients
>0.80), valid (concurrent and known groups validity) and moderately
responsive to pulmonary rehabilitation (medium effect sizes). These tests
elicited less desaturation than the 6MWT, and validated methods to prescribe
exercise were not reported. Discussion: The STS, step and TUG tests can be performed at home, but do not accurately
document desaturation with walking or allow exercise prescription. Patients
at risk of desaturation should be prioritised for centre-based exercise
testing when this is available.
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Affiliation(s)
- Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Carla Malaguti
- Department of Cardiorespiratory and Skeletal muscle, 28113Federal University of Juiz de Fora, São Pedro, Juiz de Fora, Brazil
| | - Mariana Hoffman
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Aroub Lahham
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Angela T Burge
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Leona Dowman
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Anthony K May
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Australia.,Allied Health, 5392Alfred Health, Melbourne, Victoria, Australia
| | - Gabriella Tikellis
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Joanna Yt Lee
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Narelle S Cox
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Institute for Breathing and Sleep, Australia
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Ulvestad M, Durheim M, Kongerud J, Hansen B, Lund M, Edvardsen E. Cardiorespiratory Fitness and Physical Activity following Lung Transplantation: A National Cohort Study. Respiration 2020; 99:316-324. [DOI: 10.1159/000506883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/27/2020] [Indexed: 11/19/2022] Open
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Correlates and Outcomes of Low Physical Activity Posttransplant: A Systematic Review and Meta-Analysis. Transplantation 2019; 103:679-688. [DOI: 10.1097/tp.0000000000002543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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7
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Sehgal S, Small B, Highland KB. Activity monitors in pulmonary disease. Respir Med 2019; 151:81-95. [PMID: 31047122 DOI: 10.1016/j.rmed.2019.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022]
Abstract
Physical activity is reduced in patients with chronic pulmonary diseases. Activity monitors can measure physical activity objectively and accurately over prolonged periods of time. Research grade and commercially available devices, using accelerometer technology, are being increasingly used in clinical studies. Physical activity levels have been found to have a moderate to strong correlation with important measures such as pulmonary function, exercise capacity, quality of life, and mortality and hospitalizations in patients with COPD, interstitial lung disease, pulmonary arterial hypertension and cystic fibrosis. Their use as a clinical trial end-point and as a tool to augment rehabilitation efforts has also been explored in patients with COPD with variable results. Due to the ease of use, economic viability, widespread availability and good patient compliance, their use in adult and pediatric medicine is expanding. This narrative review summarizes the current evidence of use of activity monitors in COPD, interstitial lung disease, asthma, pulmonary arterial hypertension, cystic fibrosis and lung transplant patients for the purposes of prognostication, monitoring, outcome measures and intervention.
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Affiliation(s)
- Sameep Sehgal
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
| | - Bronwyn Small
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Quadriceps Muscle Strength and Body Mass Index Are Associated With Estimates of Physical Activity Postheart Transplantation. Transplantation 2018; 103:1253-1259. [PMID: 30335695 DOI: 10.1097/tp.0000000000002488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although exercise capacity improves postheart transplantation (HTx), it remains unclear if the level of physical activity (PA) shows similar improvement. The purpose of this study was to (1) describe PA levels and (2) identify factors which may be associated with levels of PA post-HTx. METHODS A prospective observational cross-sectional study was conducted at a single center HTx outpatient clinic. Medically stable adult recipients 6 months or longer post-HTx were recruited. Physical activity level (PAL) and average daily time spent at least moderately active (≥3 metabolic equivalents) were estimated using a multisensor device. Factors investigated were demographic (age, sex, body mass index [BMI], time post-HTx, and reason for HTx), corticosteroid use, exercise capacity (6-min walk distance), and quadriceps muscle strength corrected for body weight (QS%). RESULTS The mean post-HTx time of the 75 participants was 9.2 ± 7.0 years (0.5-26 y). Twenty-seven (36%) participants were classified as extremely inactive (PAL, <1.40), 26 (34.6%) sedentary (1.40 ≤ PAL ≤ 1.69), and 22 (29.3%) active (PAL, ≥1.70). Multivariable analysis showed greater QS% (β = 0.004 (0.002-0.006) P = 0.001) to be independently associated with increased PAL. For increased time, 3 or more metabolic equivalents both greater QS% (β = 0.0164 [0.003-0.029]; P = 0.014) and lower BMI (β = -0.0626 [-0.115 to -0.0099]; P = 0.021) were independently associated. CONCLUSIONS The degree of observed sedentary behavior post-HTx is surprising, with the majority of participants not reaching levels of PA recommended for health benefits. QS% and BMI were the only factors found to be independently associated with estimates of PA. Further quality trials are required to demonstrate the long-term benefits of regular PA and investigate ways of increasing adherence to PA post-HTx.
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Hennegrave F, Le Rouzic O, Fry S, Behal H, Chenivesse C, Wallaert B. Factors associated with daily life physical activity in patients with asthma. Health Sci Rep 2018; 1:e84. [PMID: 30623040 PMCID: PMC6266451 DOI: 10.1002/hsr2.84] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about the consequences of asthma on daily life physical activity (DLPA). The aim of this study was to evaluate DLPA and determine its relationship to clinical and functional parameters in patients with asthma. METHODS This was a single-center prospective study of DLPA conducted between May 2015 and June 2016 in northern France. Fifty-one adult patients with asthma and 36 healthy control subjects were enrolled. Four DLPA parameters were assessed for 5 consecutive days with a physical activity monitor: number of steps walked per day (SPD), total energy expenditure (EE, in kcal/day), EE spent in physical activity requiring ≥3 metabolic equivalents (METs), and time (min) spent in activities requiring ≥3 METs. Clinical characteristics, pulmonary function tests, 6-minute walk test, and four questionnaires (modified Medical Research Council [mMRC] for dyspnea, asthma control test [ACT], quality of life [AQLQ], and hospital anxiety and depression scale [HADS]), were evaluated. Comparisons of DLPA parameters between the two groups were performed using an analysis of covariance adjusted for age, sex, and body mass index (BMI). Relationships between DLPA parameters and patient characteristics were assessed in multivariable linear regression models. RESULTS Compared with patients with mild/moderate asthma, those with severe asthma had lower mean (± standard deviation) forced expiratory volume in 1 s (FEV1) (66 ± 24 vs 94 ± 15% predicted, P < 0.001), ACT score (16.7 ± 4.5 vs 19.8 ± 4.2, P = 0.015), and AQLQ score (157 ± 40 vs 184 ± 33, P = 0.012). There were no significant differences between the two groups in SPD (6560 ± 3915 vs 8546 ± 3431; adjusted P = 0.95), EE in physical activity requiring ≥3 METs (620 ± 360 vs 660 ± 140 kcal/day; P = 0.86), time spent in activities requiring EE ≥3 (120 ± 54 vs 121 ± 32 min/day; P = 0.69), or total EE (2606 ± 570 vs 2666 ± 551 kcal/day; P = 0.80). These four DLPA measures showed strong inter-parameter correlations in patients with asthma (r = 0.37-0.95, all P < 0.01). All four parameters were lower in the patients with asthma group than in the control group: SPD, 7651 ± 3755 vs 11704 ± 4054 (adjusted P < 0.001); EE in activities requiring ≥3 METs, 642 ± 360 vs 852 ± 374 kcal/day (adjusted P = 0.041); time spent in activities requiring ≥3 EE, 120 ± 73 vs 189 ± 85 min (adjusted P = 0.005); and total EE, 2639 ± 555 vs 2746 ± 449 kcal/day (adjusted P = 0.007). In the patients with asthma group, the number of SPD correlated with age, FEV1, mMRC score, 6-minute walk test distance, and HADS scores, but not with BMI or ACT test score. Using multivariate analysis, the number of SPD was associated with only age, anxiety, and FEV1, whereas total EE was associated with mMRC score and BMI. CONCLUSION Age, anxiety, and FEV1 were significantly associated with the number of SPD in patients with asthma. Addressing anxiety should be further studied as way to attempt to increase physical activity in patients with asthma.
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Affiliation(s)
- Florence Hennegrave
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
| | - Olivier Le Rouzic
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
| | - Stéphanie Fry
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
| | - Hélène Behal
- Department of Biostatistics, Univ. Lille, EA 2694‐Santé Publique: Epidémiologie et Qualité des SoinsCHU LilleLilleFrance
| | - Cécile Chenivesse
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
| | - Benoit Wallaert
- Service de Pneumologie et ImmunoAllergologie, Centre de Référence constitutif des Maladies Pulmonaires Rares, Univ. LilleCHU Lille, Hopital CalmetteLilleFrance
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Vardar-Yagli N, Calik-Kutukcu E, Saglam M, Inal-Ince D, Arikan H, Coplu L. The relationship between fear of movement, pain and fatigue severity, dyspnea level and comorbidities in patients with chronic obstructive pulmonary disease. Disabil Rehabil 2018; 41:2159-2163. [PMID: 29631469 DOI: 10.1080/09638288.2018.1459886] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: Dyspnea, sedentary lifestyle, and comorbid diseases may reduce the desire to engage in physical movement in chronic obstructive pulmonary disease (COPD). The aims of this study were to assess levels of kinesiophobia among stable COPD patients and evaluate the relationship between kinesiophobia and pain and fatigue severity, dyspnea level, and comorbidities in this patient group. Material and Methods: Thirty-one patients with moderate/severe COPD and thirty-one age- and sex-matched healthy controls participated in the study. All participants were assessed using Visual Analog Scale for pain severity, Fatigue Severity Scale, modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia. Results: Ninety-three percent of the patients with COPD had a high degree of kinesiophobia (Tampa Scale of Kinesiophobia score >37). The modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia scores of patients with COPD was significantly higher than those of healthy subjects (p < 0.001). Tampa Scale of Kinesiophobia score was significantly associated with modified Medical Research Council Dyspnea Scale score (r = 0.676, p < 0.001), Charlson Comorbidity Index score (r = 0.746, p < 0.001) and fatigue severity level (r = 0.524, p = 0.005). Conclusion: Most moderate/severe COPD patients express fear of movement. Kinesiophobia is strongly associated with dyspnea perception, fatigue severity, multisystemic comorbidities in COPD. Further studies are needed to determine the effects of kinesiophobia on the success of pulmonary rehabilitation. Implications for rehabilitation Most of moderate-to-severe chronic obstructive pulmonary disease patients have fear of movement. Increase fear of movement in moderate-severe chronic obstructive pulmonary disease is associated with increased dyspnea perception and fatigue severity and multisystemic comorbidities.
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Affiliation(s)
- Naciye Vardar-Yagli
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Ebru Calik-Kutukcu
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Melda Saglam
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Deniz Inal-Ince
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Hulya Arikan
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Lutfi Coplu
- b Faculty of Medicine, Department of Chest Diseases , Hacettepe University , Ankara , Turkey
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Thyregod M, Bodtger U. Coherence between self-reported and objectively measured physical activity in patients with chronic obstructive lung disease: a systematic review. Int J Chron Obstruct Pulmon Dis 2016; 11:2931-2938. [PMID: 27932873 PMCID: PMC5135064 DOI: 10.2147/copd.s116422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The beneficial effects of physical activity (PA) in patients with COPD, as well as the methods of their assessment, are well known and described. As objective measures of PA, such as the use of motion sensors, video recordings, exercise capacity testing, and indirect calorimetry, are not easily obtained in the daily clinical life, the reliability of the more accessible self-reported measurements of PA is important. In this review, we systematically identified original studies involving COPD patients and at least one parameter of self-reported and objective exercise testing, and analyzed every article for coherence between the objectively and self-reported measured PA. The studies are few, small, and very diverse, both in their use of questionnaires and objective measurements. Self-reported assessments were found to generally overestimate the level of PA compared to measurements made objectively by activity monitors; however, more studies are needed to rely solely on the use of PA questionnaires in COPD patients. The most accurate and valid questionnaires appear to be the self-completed Physical Activity Scale for the Elderly and the interviewer-completed Stanford Seven-Day Physical Activity Recall Questionnaire, but the ideal questionnaire still awaits construction. The motion sensors are accurate and validated in this patient group, especially SenseWear™, but not easily accessible in clinical practice, as they have various technical and adhesive difficulties.
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Affiliation(s)
- Mimi Thyregod
- Department of Respiratory Medicine, Naestved Hospital, Naestved; Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved; Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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Wickerson L, Rozenberg D, Janaudis-Ferreira T, Deliva R, Lo V, Beauchamp G, Helm D, Gottesman C, Mendes P, Vieira L, Herridge M, Singer LG, Mathur S. Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach. World J Transplant 2016; 6:517-31. [PMID: 27683630 PMCID: PMC5036121 DOI: 10.5500/wjt.v6.i3.517] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/31/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
Physical rehabilitation of lung transplant candidates and recipients plays an important in optimizing physical function prior to transplant and facilitating recovery of function post-transplant. As medical and surgical interventions in lung transplantation have evolved over time, there has been a demographic shift of individuals undergoing lung transplantation including older individuals, those with multiple co-morbidites, and candidates with respiratory failure requiring bridging to transplantation. These changes have an impact on the rehabilitation needs of lung transplant candidates and recipients. This review provides a practical approach to rehabilitation based on research and clinical practice at our transplant centre. It focuses on functional assessment and exercise prescription during an uncomplicated and complicated clinical course in the pre-transplant, early and late post-transplant periods. The target audience includes clinicians involved in pre- and post-transplant patient care and rehabilitation researchers.
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14
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Measuring free-living physical activity in COPD patients: Deriving methodology standards for clinical trials through a review of research studies. Contemp Clin Trials 2016; 47:172-84. [DOI: 10.1016/j.cct.2016.01.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/10/2016] [Accepted: 01/14/2016] [Indexed: 11/18/2022]
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15
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Kelm DJ, Bonnes SL, Jensen MD, Eiken PW, Hathcock MA, Kremers WK, Kennedy CC. Pre-transplant wasting (as measured by muscle index) is a novel prognostic indicator in lung transplantation. Clin Transplant 2016; 30:247-55. [PMID: 26701203 DOI: 10.1111/ctr.12683] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Frailty in non-transplant populations increases morbidity and mortality. Muscle wasting is an important frailty characteristic. Low body mass index is used to measure wasting, but can over- or underestimate muscle mass. Computed tomography (CT) software can directly measure muscle mass. It is unknown if muscle wasting is important in lung transplantation. AIM AND METHODS The aim of this single-center, retrospective cohort study was to determine whether pre-transplant low muscle mass (as measured by CT using Slice-O-matic software at L2-L3 interspace) was associated with post-transplantation mortality, hospital and intensive care unit length of stay (LOS), duration of mechanical ventilation, or primary graft dysfunction. Lung transplant recipients from 2000 to 2012 with a CT scan less than six months prior to transplant were included. Univariate, multivariate, and Kaplan-Meier analyses were conducted. RESULTS Thirty-six patients were included. Those with low muscle index (lower 25th percentile) had a worse survival (hazard ratio = 3.83; 95% confidence interval 1.42-10.3; p = 0.007) and longer hospital LOS by an estimated 7.2 d (p = 0.01) when adjusted for age and sex as compared to those with higher muscle index. CONCLUSION Low muscle index at lung transplantation is associated with worse survival and increased hospital LOS.
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Affiliation(s)
- Diana J Kelm
- Division of Pulmonary Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sara L Bonnes
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael D Jensen
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Walter K Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,William J. Von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA
| | - Cassie C Kennedy
- Division of Pulmonary Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,William J. Von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA
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Rafiq R, Aleva FE, Schrumpf JA, Heijdra YF, Taube C, Daniels JM, Lips P, Bet PM, Hiemstra PS, van der Ven AJ, den Heijer M, de Jongh RT. Prevention of exacerbations in patients with COPD and vitamin D deficiency through vitamin D supplementation (PRECOVID): a study protocol. BMC Pulm Med 2015; 15:106. [PMID: 26399451 PMCID: PMC4580355 DOI: 10.1186/s12890-015-0101-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/11/2015] [Indexed: 12/20/2022] Open
Abstract
Background Vitamin D is well known for its function in calcium homeostasis and bone mineralisation, but is increasingly studied for its potential immunomodulatory properties. Vitamin D deficiency is a common problem in patients with COPD. Previous studies have not demonstrated a beneficial effect of vitamin D on exacerbation rate in COPD patients. However, subgroup analyses suggested protective effects in vitamin D deficient patients. Our objective is to assess the effect of vitamin D supplementation on exacerbation rate specifically in vitamin D deficient COPD patients. Methods/Design We will perform a randomised, multi-center, double-blind, placebo-controlled intervention study. The study population consists of 240 COPD patients aged 40 years and older with vitamin D deficiency (25-hydroxyvitamin D concentration < 50 nmol/L). Participants will be recruited after an exacerbation and will be randomly allocated in a 1:1 ratio to receive vitamin D3 16800 IU or placebo orally once a week during 1 year. Participants will receive a diary card to register the incidence of exacerbations and changes in medication during the study period. Visits will be performed at baseline, at 6 months and at 12 months after randomisation. Participants will undergo spirometry, measurement of total lung capacity and assessment of maximal respiratory mouth pressure. Several physical performance and hand grip strength tests will be performed, questionnaires on quality of life and physical activity will be filled in, a nasal secretion sample and swab will be obtained and blood samples will be taken. The primary outcome will be exacerbation rate. Discussion This study will be the first RCT aimed at the effects of vitamin D supplementation on exacerbation rate in vitamin D deficient COPD patients. Also, in contrast to earlier studies that used infrequent dosing regimens, our trial will study effects of a weekly dose of vitamin D supplementation. Secondly, the immunomodulatory effects of vitamin D on host immune response of COPD patients and underlying mechanisms will be studied. Finally, the effects on physical functioning will be examined. Trial registration This trial is registered in ClinicalTrials.gov, ID number NCT02122627. Date of Registration April 2014.
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Affiliation(s)
- Rachida Rafiq
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Floor E Aleva
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands. .,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Jasmijn A Schrumpf
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Yvonne F Heijdra
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Christian Taube
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Johannes Ma Daniels
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Paul Lips
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands.
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.
| | - André Jam van der Ven
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Martin den Heijer
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam, The Netherlands.
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Lee AL, Harrison SL, Beauchamp MK, Janaudis-Ferreira T, Brooks D. Alternative field exercise tests for people with respiratory conditions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0097-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Physical activity levels early after lung transplantation. Phys Ther 2015; 95:517-25. [PMID: 25504488 DOI: 10.2522/ptj.20140173] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 11/25/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known of the early changes in physical activity after lung transplantation. OBJECTIVES The purposes of this study were: (1) to describe physical activity levels in patients up to 6 months following lung transplantation and (2) to explore predictors of the change in physical activity in that population. DESIGN This was a prospective cohort study. METHODS Physical activity (daily steps and time spent in moderate-intensity activity) was measured using an accelerometer before and after transplantation (at hospital discharge, 3 months, and 6 months). Additional functional measurements included submaximal exercise capacity (measured with the 6-Minute Walk Test), quadriceps muscle torque, and health-related quality of life (measured with the Medical Outcomes Study 36-Item Short-Form Health Survey 36 [SF-36] and the St George's Respiratory Questionnaire). RESULTS Thirty-six lung transplant recipients (18 men, 18 women; mean age=49 years, SD=14) completed posttransplant measurements. Before transplant, daily steps were less than a third of the general population. By 3 months posttransplant, the largest improvement in physical activity had occurred, and level of daily steps reached 55% of the general population. The change in daily steps (pretransplant to 3 months posttransplant) was inversely correlated with pretransplant 6-minute walk distance (r=-.48, P=.007), daily steps (r=-.36, P=.05), and SF-36 physical functioning (SF-36 PF) score (r=-.59, P=.0005). The SF-36 PF was a significant predictor of the change in physical activity, accounting for 35% of the variation in change in daily steps. LIMITATIONS Only individuals who were ambulatory prior to transplant and discharged from the hospital in less than 3 months were included in the study. CONCLUSIONS Physical activity levels improve following lung transplantation, particularly in individuals with low self-reported physical functioning. However, the majority of lung transplant recipients remain sedentary between 3 to 6 months following transplant. The role of exercise training, education, and counseling in further improving physical activity levels in lung transplant recipients should be further explored.
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Hunt T, Madigan S, Williams MT, Olds TS. Use of time in people with chronic obstructive pulmonary disease--a systematic review. Int J Chron Obstruct Pulmon Dis 2014; 9:1377-88. [PMID: 25548519 PMCID: PMC4271726 DOI: 10.2147/copd.s74298] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
“Physical inactivity” and “sedentary lifestyles” are phrases often used when describing lifestyles of people with chronic obstructive pulmonary disease (COPD). Evidence suggests activity types, independent of energy expenditure, influence health outcomes, so understanding patterns of time use is important, particularly in chronic disease. We aimed to identify reports of time use in people with COPD. Predefined search strategies were used with six electronic databases to identify individual activity reports (including frequencies and/or durations) in which community-dwelling people with COPD engaged. Eligible studies were assessed independently against predefined criteria and data were extracted by two reviewers. Data synthesis was achieved by aggregating activity reports into activity domains (sports/exercise, screen time, transport, quiet time, self-care, sociocultural, work/study, chores, and sleep). Twenty-six publications reported 37 specific daily activities. People with COPD were found to spend extended periods in sedentary behaviors (eg, standing [194 min/day]; sitting [359 min/day]; lying [88 min/day]), have limited engagement in physical activity (eg, walking [51 min/day]; exercising [1.2 episodes per week {ep/w}, 13 min/day]), have high health care needs (medical appointments [1.0 ep/w]), and experience difficulties associated with activities of daily living (eg, showering [2.5 ep/w, 60 minutes per episode]; preparing meals [4.7 ep/w]). Little data could be found describing how people with COPD use their time, and data synthesis was problematic because of variations in methodologies, population differences, and research emphases. Identified data largely referred to posture and were skewed according to country, assessment methods, and disease severity. Comparisons with age-matched population data showed people with COPD spent less time engaged in personal-care activities (self-care and sleeping) and chores than people in similar age groups. The incorporation of time-use outcomes in future research designs should be encouraged. Ideally, these tools should use consistent frameworks and comparable outcome measures in order to provide clearer descriptions of time use in chronic disease.
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Affiliation(s)
- Toby Hunt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, City East Campus, Adelaide, SA, Australia ; Respiratory Clinical Research Unit, Repatriation General Hospital, Daw Park, SA, Australia
| | - Sarah Madigan
- Respiratory Clinical Research Unit, Repatriation General Hospital, Daw Park, SA, Australia
| | - Marie T Williams
- School of Population Health, University of South Australia, City East Campus, Adelaide, SA, Australia
| | - Tim S Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, City East Campus, Adelaide, SA, Australia
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20
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Sarcopenia in lung transplantation: a systematic review. J Heart Lung Transplant 2014; 33:1203-12. [PMID: 25044057 DOI: 10.1016/j.healun.2014.06.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/06/2014] [Accepted: 06/04/2014] [Indexed: 12/23/2022] Open
Abstract
Lung transplant candidates and recipients have significant impairments in skeletal muscle mass, strength and function--individual measures of sarcopenia. Skeletal muscle dysfunction has been observed in the pre-transplant and post-transplant period and could have an important effect on transplant outcomes. A systematic review was performed to characterize the techniques used to study sarcopenia and assess the level of impairment throughout the transplant process. Electronic databases were searched (inception to July 2013) for prospective studies measuring at least 1 element of sarcopenia (muscle mass, strength, or function) in lung transplant patients. Eighteen studies were included, and study quality was assessed using the Downs and Black scale. A variety of measurements were used to evaluate sarcopenia in 694 lung transplant patients. Muscle mass in 7 studies was assessed using bioelectrical impedance (n = 4), computed tomography or magnetic resonance imaging (n = 2), or skin folds (n = 1), and was significantly reduced. Quadriceps strength was examined in 14 studies with computerized dynamometer (n = 10) and hand-held dynamometer (n = 4). Quadriceps strength was reduced in the pre-transplant period (mean range, 49%-86% predicted; n = 455 patients), further reduced immediately after transplant (51%-72%, n = 126), and improved beyond 3 months after transplant (58%-101%, n = 164). Only 2 studies measured lower extremity function (sit-to-stand test). A multitude of measurement techniques have been used to assess individual measures of sarcopenia, with reduced muscle mass and quadriceps strength observed in the pre-transplant and post-transplant period. Further standardization of measurement techniques is needed to assess the clinical effect of sarcopenia in lung transplantation.
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Dontje ML, de Greef MHG, Krijnen WP, Corpeleijn E, Kok T, Bakker SJL, Stolk RP, van der Schans CP. Longitudinal measurement of physical activity following kidney transplantation. Clin Transplant 2014; 28:394-402. [DOI: 10.1111/ctr.12325] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/27/2022]
Affiliation(s)
- M. L. Dontje
- Professorship in Health Care and Nursing; Hanze University of Applied Sciences; Groningen the Netherlands
- Department of Epidemiology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - M. H. G. de Greef
- Professorship in Health Care and Nursing; Hanze University of Applied Sciences; Groningen the Netherlands
- Institute of Human Movement Sciences; University of Groningen; Groningen the Netherlands
| | - W. P. Krijnen
- Professorship in Health Care and Nursing; Hanze University of Applied Sciences; Groningen the Netherlands
| | - E. Corpeleijn
- Department of Epidemiology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - T. Kok
- Department of Paramedics; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - S. J. L. Bakker
- Department of Nephrology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - R. P. Stolk
- Department of Epidemiology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - C. P. van der Schans
- Department of Rehabilitation; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
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Rosenberger EM, Dew MA, DiMartini AF, DeVito Dabbs AJ, Yusen RD. Psychosocial issues facing lung transplant candidates, recipients and family caregivers. Thorac Surg Clin 2013; 22:517-29. [PMID: 23084615 DOI: 10.1016/j.thorsurg.2012.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although lung transplantation is an accepted treatment for many individuals with severe lung disease, transplant candidates and recipients experience a range of psychosocial stressors that begin at the initiation of the transplant evaluation and continue throughout patients' wait for donor lungs, their perioperative recovery, and their long-term adjustment to posttransplant life. Transplant programs should strive to incorporate evidence-based interventions that aim to improve physical functioning, psychological distress, global quality of life, and medical adherence as well as to integrate symptom management and palliative care strategies throughout the pre- and posttransplantation course.
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Affiliation(s)
- Emily M Rosenberger
- Department of Clinical and Translational Science, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Ferguson LJ, Kowalski KC, Mack DE, Wilson PM, Crocker PRE. Women's health-enhancing physical activity and eudaimonic well being. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2012; 83:451-463. [PMID: 22978195 DOI: 10.1080/02701367.2012.10599880] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this study, we explored the role of health-enhancing physical activity (HEPA; Miilunpalo, 2001) in women's eudaimonic well being (i.e., psychological flourishing at one's maximal potential; Ryff 1989). We used a quantitative approach (N= 349) to explore the relationship between HEPA and eudaimonic well being. While HEPA was not related to eudaimonic well being, experiencing eudaimonia through HEPA contributed unique variance in eudaimonic well being beyond HEPA and experiencing hedonia through HEPA. As quality of activity was more important than quantity, a qualitative component (N = 10) provided further insight on if and how HEPA contributes to women's eudaimonic well being. Participants supported HEPA in fulfilling their potential through goal setting/striving providing bonding experiences, allowing for self-reflection, and developing a physical/able body.
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Langer D, Burtin C, Schepers L, Ivanova A, Verleden G, Decramer M, Troosters T, Gosselink R. Exercise training after lung transplantation improves participation in daily activity: a randomized controlled trial. Am J Transplant 2012; 12:1584-92. [PMID: 22390625 DOI: 10.1111/j.1600-6143.2012.04000.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The effects of exercise training after lung transplantation have not been studied in a randomized controlled trial so far. We investigated whether 3 months of supervised training, initiated immediately after hospital discharge, improve functional recovery and cardiovascular morbidity of patients up to 1 year after lung transplantation. Patients older than 40 years, who experienced an uncomplicated postoperative period, were eligible for this single blind, parallel group study. Sealed envelopes were used to randomly allocate patients to 3 months of exercise training (n = 21) or a control intervention (n = 19). Minutes of daily walking time (primary outcome), physical fitness, quality of life and cardiovascular morbidity were compared between groups adjusting for baseline assessments in a mixed models analysis. After 1 year daily walking time in the treated patients (n = 18) was 85 ± 27 min and in the control group (n = 16) 54 ± 30 min (adjusted difference 26 min [95%CI 8-45 min, p = 0.006]). Quadriceps force (p = 0.001), 6-minute walking distance (p = 0.002) and self-reported physical functioning (p = 0.039) were significantly higher in the intervention group. Average 24 h ambulatory blood pressures were significantly lower in the treated patients (p ≤ 0.01). Based on these results patients should be strongly encouraged to participate in an exercise training intervention after lung transplantation.
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Affiliation(s)
- D Langer
- Faculty of Kinesiology and Rehabilitation Sciences, KULeuven, Tervuursevest, Heverlee, Belgium
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Jones CA, Wieler M, Carvajal J, Lawrence L, Haennel R. Physical activity in persons with Parkinson disease: A feasibility study. Health (London) 2012. [DOI: 10.4236/health.2012.431173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Estenne M, Fessler HE, DeCamp MM. Lung transplantation and lung volume reduction surgery. Compr Physiol 2011; 1:1437-71. [PMID: 23733648 DOI: 10.1002/cphy.c100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since the publication of the last edition of the Handbook of Physiology, lung transplantation has become widely available, via specialized centers, for a variety of end-stage lung diseases. Lung volume reduction surgery, a procedure for emphysema first conceptualized in the 1950s, electrified the pulmonary medicine community when it was rediscovered in the 1990s. In parallel with their technical and clinical refinement, extensive investigation has explored the unique physiology of these procedures. In the case of lung transplantation, relevant issues include the discrepant mechanical function of the donor lungs and recipient thorax, the effects of surgical denervation, acute and chronic rejection, respiratory, chest wall, and limb muscle function, and response to exercise. For lung volume reduction surgery, there have been new insights into the counterintuitive observation that lung function in severe emphysema can be improved by resecting the most diseased portions of the lungs. For both procedures, insights from physiology have fed back to clinicians to refine patient selection and to scientists to design clinical trials. This section will first provide an overview of the clinical aspects of these procedures, including patient selection, surgical techniques, complications, and outcomes. It then reviews the extensive data on lung and muscle function following transplantation and its complications. Finally, it reviews the insights from the last 15 years on the mechanisms whereby removal of lung from an emphysema patient can improve the function of the lung left behind.
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Affiliation(s)
- Marc Estenne
- Chest Service and Thoracic Transplantation Unit, Erasme University Hospital, Brussels, Belgium
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Bossenbroek L, den Ouden MEM, de Greef MHG, Douma WR, Ten Hacken NHT, van der Bij W. Determinants of overweight and obesity in lung transplant recipients. ACTA ACUST UNITED AC 2011; 82:28-35. [PMID: 21212650 DOI: 10.1159/000322833] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 11/12/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obesity-related diseases have been shown to affect post-lung transplantation survival. An estimated 30% of lung transplant recipients develop overweight. OBJECTIVE The aim of this study was to examine the possible determinants of large increases in weight after lung transplantation. The contribution of physical activity, food intake, and resting energy expenditure was examined in lung transplant recipients. METHODS In this cross-sectional study 21 overweight lung transplant recipients (11 men, mean age 57 ± 7 years; BMI 30 ± 3) and 21 normal-weight lung transplant recipients (11 men, mean age 56 ± 5 years; BMI 22 ± 3) were matched for disease, gender, age, prescribed medication, and time since lung transplantation. Physical activity was measured by a pedometer and a questionnaire; resting energy expenditure was measured by the ventilated-hood technique, and daily food intake by a dietician. Additionally, fat-free mass, lower-body strength, and fatigue were measured. RESULTS The overweight lung transplant recipients had a significantly lower number of steps per day (4,686 ± 3,266 vs. 7,524 ± 3,448 steps/day, p = 0.01) and a lower fat-free mass (64 ± 9 vs. 75 ± 6%, p < 0.05) compared to normal-weight recipients. Obese subjects had a lower percentage of predicted resting energy expenditure level compared to normal-weight recipients (90 ± 14 vs. 100 ± 14% predicted, p = 0.04). CONCLUSION Our data suggest that overweight in lung transplant recipients is associated with a lower fat-free mass and lower levels of physical activity and resting energy expenditure compared to normal-weight recipients.
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Affiliation(s)
- Linda Bossenbroek
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. l.bossenbroek @ long.umcg.nl
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Current World Literature. Curr Opin Pulm Med 2010; 16:162-7. [DOI: 10.1097/mcp.0b013e32833723f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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