scholarly journals Pulmonary Rehabilitation Improves Exercise Capacity and Dyspnea in Air Pollution-Related Respiratory Disease

2014 ◽  
Vol 232 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Naomi Miyamoto ◽  
Hideaki Senjyu ◽  
Takako Tanaka ◽  
Masaharu Asai ◽  
Yorihide Yanagita ◽  
...  
Keyword(s):  
Air Pollution ◽  
Respiratory Disease ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation

scholarly journals Impact of dietary nitrate supplementation on exercise capacity and cardiovascular parameters in chronic respiratory disease: a systematic review and meta-analysis

2021 ◽  
Vol 8 (1) ◽  
pp. e000948
Author(s):  
Abdullah S Alsulayyim ◽  
Ali M Alasmari ◽  
Saeed M Alghamdi ◽  
Michael I Polkey ◽  
Nicholas S Hopkinson
Keyword(s):  
Systematic Review ◽  
Respiratory Disease ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Meta Analysis ◽  
Mean Difference ◽  
Short Term ◽  
Cardiovascular Parameters ◽  
Dietary Nitrate ◽  
Nitrate Supplementation

BackgroundDietary nitrate supplementation, usually in the form of beetroot juice, may improve exercise performance and endothelial function. We undertook a systematic review and meta-analysis to establish whether this approach has beneficial effects in people with respiratory disease.MethodsA systematic search of records up to March 2021 was performed on PubMed, CINAHL, MEDLINE (Ovid), Cochrane and Embase to retrieve clinical trials that evaluated the efficacy of dietary nitrate supplementation on cardiovascular parameters and exercise capacity in chronic respiratory conditions. Two authors independently screened titles, abstracts and full texts of potential studies and performed the data extraction.ResultsAfter full-text review of 67 papers, eleven (two randomised controlled trials and nine crossover trials) involving 282 participants met the inclusion criteria. Three were single dose; seven short term; and one, the largest (n=122), done in the context of pulmonary rehabilitation. Pooled analysis showed that dietary nitrate supplementation reduced systolic blood pressure (BP), diastolic BP and mean arterial pressure (mean difference (95% CI), −3.39 mm Hg (−6.79 to 0.01); p=0.05 and –2.20 mm Hg (−4.36 to −0.03); p=0.05 and −4.40 mm Hg (−7.49 to −1.30); p=0.005, respectively). It was associated with increased walk distance in the context of pulmonary rehabilitation (standardised mean difference (95% CI), 0.47 (0.11 to 0.83), p=0.01), but no effect was identified in short-term studies (0.08 (−0.32 to 0.49).ConclusionDietary nitrate supplementation may have a beneficial effect on BP and augment the effect of pulmonary rehabilitation on exercise capacity. Short-term studies do not suggest a consistent benefit on exercise capacity.PROSPERO registration numberCRD42019130123.

Telerehabilitation for chronic respiratory disease: a randomised controlled equivalence trial

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-216934
Author(s):  
Narelle S Cox ◽  
Christine F McDonald ◽  
Ajay Mahal ◽  
Jennifer A Alison ◽  
Richard Wootton ◽  
...  
Keyword(s):  
Respiratory Disease ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Primary Outcome ◽  
Well Being ◽  
Chronic Respiratory Disease ◽  
Meaningful Improvement ◽  
Randomised Controlled ◽  
Time Point

RationalePulmonary rehabilitation is an effective treatment for people with chronic respiratory disease but is delivered to <5% of eligible individuals. This study investigated whether home-based telerehabilitation was equivalent to centre-based pulmonary rehabilitation in people with chronic respiratory disease.MethodsA multicentre randomised controlled trial with assessor blinding, powered for equivalence was undertaken. Individuals with a chronic respiratory disease referred to pulmonary rehabilitation at four participating sites (one rural) were eligible and randomised using concealed allocation to pulmonary rehabilitation or telerehabilitation. Both programmes were two times per week for 8 weeks. The primary outcome was change in Chronic Respiratory Disease Questionnaire Dyspnoea (CRQ-D) domain at end-rehabilitation, with a prespecified equivalence margin of 2.5 points. Follow-up was at 12 months. Secondary outcomes included exercise capacity, health-related quality of life, symptoms, self-efficacy and psychological well-being.Results142 participants were randomised to pulmonary rehabilitation or telerehabilitation with 96% and 97% included in the intention-to-treat analysis, respectively. There were no significant differences between groups for any outcome at either time point. Both groups achieved meaningful improvement in dyspnoea and exercise capacity at end-rehabilitation. However, we were unable to confirm equivalence of telerehabilitation for the primary outcome ΔCRQ-D at end-rehabilitation (mean difference (MD) (95% CI) −1 point (−3 to 1)), and inferiority of telerehabilitation could not be excluded at either time point (12-month follow-up: MD −1 point (95% CI −4 to 1)). At end-rehabilitation, telerehabilitation demonstrated equivalence for 6-minute walk distance (MD −6 m, 95% CI −26 to 15) with possibly superiority of telerehabilitation at 12 months (MD 14 m, 95% CI −10 to 38).Conclusiontelerehabilitation may not be equivalent to centre-based pulmonary rehabilitation for all outcomes, but is safe and achieves clinically meaningful benefits. When centre-based pulmonary rehabilitation is not available, telerehabilitation may provide an alternative programme model.Trial registration numberACtelerehabilitationN12616000360415.

Abstract 434: Exposure To Air Pollutants And Mortality In Hypertensive Patients According To Demography: A 10 Year Case-crossover Study

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Martin C Wong ◽  
Wilson W Tam ◽  
Harry H Wang ◽  
Xiang Qian Lao ◽  
Mandy W Kwan ◽  
...  
Keyword(s):  
Air Pollution ◽  
Respiratory Disease ◽  
Air Pollutants ◽  
Health Care Services ◽  
Public Health Care ◽  
Cold Weather ◽  
Susceptible Population ◽  
Hypertensive Patients ◽  
Care Services ◽  
Case Crossover

Background: Relatively few studies have explored the relationship between air pollution and cause-specific mortality among hypertensive patients. This study evaluated whether short term exposures to nitrogen dioxide (NO2), ozone (O3), particulate matter <10 mm in diameter (PM10) were associated with higher risk of mortality among a large hypertensive patients. Methods: A total of 223,287 hypertensive patients who attended any public health-care services in Hong Kong and prescribed at least 1 antihypertensive agent for the first time between 2001 and 2005 were followed up until 2010. A time-stratified, bi-directional case-crossover design was adopted to study the association between environmental exposures and mortality outcomes. Results: For all-cause mortality, significant positive associations were observed for NO2 and PM10 at lag 0 to 3 days per 10 MIUg/m3 increase in concentration and the excess risks ranged from 1.187%- 2.501%. Significant positive associations were found for O3 at lag 1 and 2 days and the excess risks were 1.654% (95% C.I. 0.469%, 2.852%) and 1.207% (95% C.I. 0.025%, 2.404%), respectively. We found similarly positive associations between NO2 (excess risks: 1.786%-2.798%), PM10 (1.126%-1.847%), O3 (3.035%-3.355%) and mortality due to respiratory disease. In stratified analysis, these significant results were observed amongst those aged >65 years and in cold seasons only. Conclusions: Older hypertensive patients are susceptible to all-cause and respiratory disease-specific deaths from these air pollutants in cold weather. This implies urgent need for protective air pollution standards for this susceptible population.

scholarly journals Reduction in hospitalisation following pulmonary rehabilitation in patients with COPD

2008 ◽  
Vol 32 (3) ◽  
pp. 415 ◽  
Author(s):  
Nola Cecins ◽  
Elizabeth Geelhoed ◽  
Sue C Jenkins
Keyword(s):  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Hospital Admissions ◽  
Chronic Respiratory Disease ◽  
Health Care Utilisation ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Chronic Respiratory Disease Questionnaire ◽  
Number Of Patients ◽  
Bed Days

Objectives: Pulmonary rehabilitation (PR) improves exercise capacity and health-related quality of life (HRQoL), and reduces health care utilisation. This study quantified outcomes of a PR program over a 6-year period and determined the effects of PR on hospitalisation. Methods: Patients with chronic obstructive pulmonary disesae (COPD) who entered an 8-week outpatient PR program from 1998 to 2003 were included. Functional exercise capacity (6-minute walk distance [6MWD]) and HRQoL (Chronic Respiratory Disease Questionnaire) were measured before and following PR. The number of hospital admissions and total bed-days due to a COPD exacerbation in the 12 months before and following PR were recorded. Setting: Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia. Results: 187 (73%) of the 256 patients who entered PR completed the program. Improvements in 6MWD (404.2 �114.6 m to 439.6 �115.0m, P < 0.001) and HRQoL (4.1 �0.9 points per item to 4.9 �0.9 points per item, P < 0.001) occurred following PR. There was a 46% reduction in the number of patients admitted to hospital (71 to 38) with a COPD exacerbation and a 62% reduction in total bed-days (1131 to 432) following PR. Conclusion: Pulmonary rehabilitation provided in an Australian teaching hospital was associated with a reduction in COPD hospitalisation, and the resultant savings outweighed the costs of providing the program.

scholarly journals Minimal versus specialist equipment in the delivery of pulmonary rehabilitation: protocol for a non-inferiority randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047524
Author(s):  
Claire M Nolan ◽  
Jessica A Walsh ◽  
Suhani Patel ◽  
Ruth E Barker ◽  
Oliver Polgar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Disease ◽  
Exercise Capacity ◽  
Chronic Lung Disease ◽  
Pulmonary Rehabilitation ◽  
Randomised Trial ◽  
Global Rating ◽  
Process Data ◽  
Exercise Equipment

IntroductionPulmonary rehabilitation (PR), an exercise and education programme for people with chronic lung disease, aims to improve exercise capacity, breathlessness and quality of life. Most evidence to support PR is from trials that use specialist exercise equipment, for example, treadmills (PR-gym). However, a significant proportion of programmes do not have access to specialist equipment with training completed with minimal exercise equipment (PR-min). There is a paucity of robust literature examining the efficacy of supervised, centre-based PR-min. We aim to determine whether an 8-week supervised, centre-based PR-min programme is non-inferior to a standard 8-week supervised, centre-based PR-gym programme in terms of exercise capacity and health outcomes for patients with chronic lung disease.Methods and analysisParallel, two-group, assessor-blinded and statistician-blinded, non-inferiority randomised trial. 436 participants will be randomised using minimisation at the individual level with a 1:1 allocation to PR-min (intervention) or PR-gym (control). Assessment will take place pre-PR (visit 1), post-PR (visit 2) and 12 months following visit 1 (visit 3). Exercise capacity (incremental shuttle walk test), dyspnoea (Chronic Respiratory Questionnaire (CRQ)-Dyspnoea), health-related quality of life (CRQ), frailty (Short Physical Performance Battery), muscle strength (isometric quadriceps maximum voluntary contraction), patient satisfaction (Global Rating of Change Questionnaire), health economic as well as safety and trial process data will be measured. The primary outcome is change in exercise capacity between visit 1 and visit 2. Two sample t-tests on an intention to treat basis will be used to estimate the difference in mean primary and secondary outcomes between patients randomised to PR-gym and PR-min.Ethics and disseminationLondon-Camden and Kings Cross Research Ethics Committee and Health Research Authority have approved the study (18/LO/0315). Results will be submitted for publication in peer-reviewed journals, presented at international conferences, disseminated through social media, patient and public routes and directly shared with stakeholders.Trial registration numberISRCTN16196765.

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