The Absence of Rehabilitation During the ICU Stay of Elderly Patients is Associated with a Decreased Long-Term Autonomy.

Background: The intensive care unit (ICU) stay is associated with a loss of autonomy, especially for elderly patients. We therefore conducted a study to estimate the impact of the rehabilitation performed during the ICU stay on the loss of autonomy at 6 months. Methods: We conducted an ancillary study of the multicenter FRAGIREA study, including patients between April 2018 and January 2019 aged over 70 years, admitted in ICU for an expected length of stay of more than 48 hours. We excluded the patients who died before day 180, who were lost to follow-up, and for whom the baseline autonomy (ADL) score was not available. We collected the baseline characteristics of patients, the ICU stay characteristics, and the 6-month follow-up. Were also collected the detailed rehabilitation therapy carried out during the ICU stay (passive mobilization, upright sitting, transfer to chair, standing, walking, and cycle ergometers.). Patients were classified into the rehabilitation (out of bed) or non-rehabilitation group, and the impact of rehabilitation on the decreased 6-month autonomy (loss of ADL score >1 point) was estimated after the selection of 17 potential confounders. Results: Among the 548 patients of the FRAGIREA cohort, 276 were included in the present study. Among them, 226 were rehabilitated and 50 were not. 220/276 (80%) patients benefited from the transfer to chair as rehabilitation therapy, passive mobilization and transfer to upright sitting were also frequently performed. A decrease in the 6-month autonomy was observed for 63 (23%) patients. After the elimination of potential confounders, non-rehabilitated patients had a greater risk of 6-month decreased autonomy (adjusted Odds Ratio 2.43, 95% confidence interval [1.18; 4.98]). Conclusions: Rehabilitation during the ICU stay of elderly ICU patient survivors was associated with a lower decreased autonomy at 6 months. Tweet: The absence of rehabilitation during the ICU stay of elderly patients is associated with 2.4 higher risk of a decreased 6 month autonomy

Supervised pulmonary rehabilitation using minimal or specialist exercise equipment in COPD: a propensity-matched analysis

BackgroundMany trials supporting the benefits of pulmonary rehabilitation (PR) have used specialist exercise equipment, such as treadmills and cycle ergometers. However, access to specialist equipment may not be feasible in some settings. There is growing interest in delivering PR programmes with minimal, low-cost equipment, but uncertainty remains regarding their efficacy compared with programmes using specialist equipment.MethodsUsing propensity score matching, 318 consecutive patients with COPD undergoing supervised PR using minimal equipment (PR-min) were compared 1:1 with a control group of 318 patients with COPD who underwent supervised PR using specialist equipment (PR-gym). A non-inferiority analysis was performed for the primary outcome (incremental shuttle walk (ISW)) and secondary outcomes (Chronic Respiratory Disease Questionnaire (CRQ)—domain and total scores).ResultsSimilar improvements in ISW and CRQ-domains were observed in PR-min and PR-gym groups (mean difference ISW: 3 m (95% CI −16 to 9); CRQ-total: 0.9 (95% CI −2.7 to 4.5)). The 95% CI between group differences for ISW and CRQ-total did not cross the predefined non-inferiority margins. However, completion rates were lower in PR-min compared with PR-gym (64% vs 73%; p=0.014).ConclusionsIn patients with COPD, PR delivered using minimal equipment produces clinically significant benefits in exercise capacity and health-related quality of life that are non-inferior to rehabilitation delivered using specialist equipment. This study provides support for the provision of PR using minimal exercise equipment, particularly in areas where access to specialist exercise equipment is limited.

PL-009 Not just a one HIIT wonder: two popular HIIT protocols elicit similar health benefits in a controlled but real world environment

Objective Currently 40% of the UK do not meet the physical activity guidelines with a ‘lack of time’ the most commonly cited barrier to sufficient physical activity. In laboratory based training interventions, high intensity interval training (HIT) offers a time-efficient alternative to moderate intensity continuous training (MICT) but its success requires expensive specialised cycle ergometers and vigorous encouragement from the researchers. To investigate whether two popular HIT protocols, performed using readily available cycle ergometers and without encouragement, can improve aerobic exercise capacity, arterial stiffness and body composition. Methods Eighty-two sedentary males (n=26) and females (n=56) aged 18-65 participated in the study (28±1 y, BMI 25±0.4 kg.m-2). In a randomised cross-over design, participants completed either 6 weeks of 30HIT (4-8x30s sprint with 120s active recovery) or 60HIT (6-10x60s sprint with 60s active recovery). Training sessions were completed on a Wattbike, 3 times per week. VO2peak, body composition (DXA scan), blood glucose (oral glucose tolerance test (OGTT)) and arterial stiffness (pulse wave velocity (PWV)) were assessed pre and post each 6-week training phase, with 4-6 weeks washout period between interventions. Results VO2peakincreased post intervention in 30HIT (36±1 to 39±1 ml.min-1.kg-1) and 60HIT (36±1 to 39±1 ml.min-1.kg-1) (P<0.001), with no difference between intervention group (P=0.208). Body fat percentage decreased pre to post training in both conditions (P=0.001). PWV decreased in 30HIT (2%) and 60HIT (4%) (P<0.005). During the OGTT, there was a trend towards decreasing area under the curve pre to post (P=0.083). When normalized to Watt maxthe participants producing a higher mean power output improved their VO2peakmore than those producing a low MPO (P<0.05). Following further analysis this was only true in 60HIT (P<0.05). Conclusions Both 30HIT and 60HIT could be effective real world strategies to improve aerobic capacity, body composition, arterial stiffness and insulin sensitivity. Improvements were seen even though the time spent sprinting was less in 30HIT (4mins compared to 10mins in 60HIT). In addition, how the 30HIT protocol is executed does not seem to have an effect on physiological outcomes. This suggests 30HIT may be a more applicable training intervention in the real world.