The effects of a multisite aerobic exercise intervention on asthma morbidity in sedentary adults with asthma: the Ex-asthma study randomised controlled trial protocol
To compare, in individuals with chronic obstructive pulmonary disease (COPD): 1) the effects of 12 weeks of continuous training at high intensity (CTHI), continuous training at the ventilatory thre...
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Sleep leads to the enhancement of memory, and physical exercise also improves memory along with beneficial effects on sleep quality. Potentially, sleep and exercise may operate independently upon memory; alternatively, they may operate... more
Sleep leads to the enhancement of memory, and physical exercise also improves memory along with beneficial effects on sleep quality. Potentially, sleep and exercise may operate independently upon memory; alternatively, they may operate synergistically to boost memory above and beyond exercise or sleep alone. We tested this hypothesis in 115 young healthy adults (23±3.9 years) randomly allocated to one of the four conditions in a 2 (exercise vs no exercise) x 2 (nap vs no nap) design. The exercise intervention consisted of a 40-min, moderate-intensity cycling, while the no exercise condition was an equivalent period of rest. This was followed by a learning session in which participants memorized a set of 45 neutral pictures for a later test. Subsequently, participants were exposed to either a 60-min sleep period (nap) or an equivalent time of resting wakefulness, followed by a visual recognition test. We found a significant interaction between the effects of exercise and nap (p=0.014...
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Purpose: People with chronic obstructive pulmonary disease (COPD) have reduced physical activity (PA) levels compared with healthy controls. The pattern of their PA level during the day is much less documented. A better understanding of... more
Purpose: People with chronic obstructive pulmonary disease (COPD) have reduced physical activity (PA) levels compared with healthy controls. The pattern of their PA level during the day is much less documented. A better understanding of these diurnal PA patterns could help optimize interventions targeting PA levels in this population. The aim of this study was to examine, in patients with COPD, diurnal PA patterns using accelerometer data and different approaches to data handling (arbitrary, mealtime, equal tertiles). Methods: Fourteen COPD patients (aged 71 ± 9 yr; forced expiratory volume in 1 sec [FEV1]: 58% ± 13% predicted) completed the study. Daily PA was assessed via accelerometry for 7 d, 24 hr/d. Diurnal PA patterns were evaluated using an arbitrary (08:00-12:00, 12:01-16:00, 16:01-20:00), mealtime (wake time-lunchtime, lunchtime-suppertime, suppertime-bedtime), and equal tertiles (tertiles 1, 2, and 3) approaches. Results were interpreted on the basis of descriptive statistics and effect sizes (Cohen f) for time-of-day changes in PA. Results: Regardless of the handling approach used, mean PA levels decreased in the evening and the effect size for time-of-day changes in PA level was large (f = 0.97; 1.82; and 1.66 for the arbitrary, mealtimes, and tertiles approaches, respectively). The observation of a decrease in the evening was highly homogeneous across our sample, particularly with the mealtime and equal tertiles handling approach. Conclusion: Results from this study support prior findings that PA levels decrease substantially in the evening in patients with COPD, thereby providing a better understanding of within-day PA behavior and offering valuable insight into interventions targeting PA.
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As exercise may mitigate cognitive decline in individuals with chronic obstructive pulmonary disease (COPD), its effect has been evaluated in a number of clinical trials. The objective of the present systematic review was to describe the... more
As exercise may mitigate cognitive decline in individuals with chronic obstructive pulmonary disease (COPD), its effect has been evaluated in a number of clinical trials. The objective of the present systematic review was to describe the impact of exercise training on cognition in COPD. Electronic searches of four databases were performed from inception until March 24, 2015 and last updated 23rd October 2017. Included studies reported on at least one cognitive outcome before and after a formal exercise-training program in individuals with COPD. Two reviewers independently rated study quality using the Downs and Black checklist. The protocol was registered on PROSPERO (CRD42015017884). Seven articles, representing six exercise interventions in 293 individuals with COPD (55% males, mean age 67 ± 2 year) were included. Although each study documented a significant pre-post training improvement in at least one cognitive domain, the heterogeneity in study design, exercise intervention and...
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Background: Contractile fatigue of the quadriceps occurs in a significant proportion of patients with COPD after constant-load cycling exercise. Dynamic hyperinflation, by altering cardiac output during exercise, could contribute to... more
Background: Contractile fatigue of the quadriceps occurs in a significant proportion of patients with COPD after constant-load cycling exercise. Dynamic hyperinflation, by altering cardiac output during exercise, could contribute to fatigue susceptibility in this population. The purpose of this study was to compare operational lung volumes during constant workrate exercise between COPD patients who do and those who do not develop contractile fatigue of the quadriceps (fatiguers vs non-fatiguers). Methods: Sixty-two patients with COPD (FEV1: 46±16%) completed a constant-load cycling test at 80% of the peak workrate achieved during progressive cycle ergometry. Ventilatory parameters were monitored breath-by-breath, while inspiratory capacity maneuvers were obtained every other minute during constant-load cycling. Quadriceps twitch force was measured with magnetic stimulation of the femoral nerve before and after the test. Muscle fatigue was defined as a post-exercise reduction in quad...
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Rationale: The endurance shuttle walk has recently been shown to be highly responsive to both bronchodilation and pulmonary rehabilitation. The degree to which changes in endurance shuttle walking performance are perceptible to patients... more
Rationale: The endurance shuttle walk has recently been shown to be highly responsive to both bronchodilation and pulmonary rehabilitation. The degree to which changes in endurance shuttle walking performance are perceptible to patients is unknown. Objective: To evaluate the relationship between objective and subjective measures of change in endurance shuttle walking performance. Methods: 129 comparison points were obtained from 69 patients with COPD (FEV1: 47±16%) who completed two or more endurance shuttle walking tests as part of a bronchodilation study. Patients were asked to rate their performance of the day in comparison to their previous performance on a 7&S209; point scale ranging from -3 (large deterioration) to +3 (large improvement). These ratings were related to changes in walking distance and endurance time, expressed both as delta and percent change. Results: Patient ratings of change were significantly correlated with delta walking distance (r=0.44, P < 0.001), del...
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Investigate the association between depressive symptoms severity and amplitude of diurnal variations in depression symptoms in patients with chronic obstructive pulmonary disease (COPD). Prospective, observational proof-of-concept study.... more
Investigate the association between depressive symptoms severity and amplitude of diurnal variations in depression symptoms in patients with chronic obstructive pulmonary disease (COPD). Prospective, observational proof-of-concept study. Fourteen participants with moderate/severe COPD completed a 20-item Center for Epidemiologic Studies Depression scale (CES-D) estimating depressive symptoms severity. Throughout 1 week, the 4-item very short version of the CES-D was completed every day in the morning, afternoon, and evening. Strong positive correlations were observed between depressive severity and the mean range of diurnal variations in positive (r = .61) and depressed affects (r = .67), somatic complaints (r = .82) and disturbed interpersonal relationships (r = .71). In COPD patients, a greater diurnal variation in depression symptoms was associated with greater depression severity. This relationship seems independent of COPD severity. Diurnal variation in the symptoms of depression is a new method of identifying depression severity in COPD.
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The objectives of our study were to (i) compare, in chronic obstructive pulmonary disease (COPD) patients, acute responses to continuous training at high intensity (CTHI), continuous training at ventilatory threshold (CTVT) and interval... more
The objectives of our study were to (i) compare, in chronic obstructive pulmonary disease (COPD) patients, acute responses to continuous training at high intensity (CTHI), continuous training at ventilatory threshold (CTVT) and interval training (IT); (ii) examine associations between acute responses and 12-week adherence; and (iii) investigate whether the relationship between acute responses and adherence is mediated/moderated by affect/vigour. Thirty-five COPD patients (forced expiratory volume in 1 second = 60.2 ± 15.8% predicted), underwent baseline assessments, were randomly assigned to CTHI, CTVT or IT, were monitored throughout about before training, and underwent 12 weeks of exercise training during which adherence was tracked. Compared with CTHI, CTVT was associated with lower respiratory exchange ratio, heart rate and respiratory rate (RR), while IT induced higher [Formula: see text], [Formula: see text]maximal voluntary ventilation, RR and lower pulse oxygen saturation. F...
Research Interests: Exercise therapy, Linear models, Affect, Humans, Female, and 14 moreMale, Heart rate, Patient Compliance, Exercise, Clinical Sciences, Aged, Middle Aged, Chronic obstructive pulmonary disease, Oximetry, Pulmonary ventilation, Tidal volume, Respiratory Rate, Severity of Illness Index, and Cardiovascular medicine and haematology
Physical activity has been shown to have various health benefits in patients with asthma, especially in children. However, there are still limited data on the nature of the association between physical activity and asthma control in... more
Physical activity has been shown to have various health benefits in patients with asthma, especially in children. However, there are still limited data on the nature of the association between physical activity and asthma control in adults. The objective of the current study was to determine the nature of the association between physical activity and asthma control, with particular emphasis on the intensity of the activity and seasonal variations. 643 adult patients with objectively confirmed asthma (mean age (SD)=53 (15) years, 60% women) were interviewed by telephone. Patients completed the asthma control questionnaire (ACQ), the asthma quality of life questionnaire, and a 1-year physical activity recall questionnaire to assess leisure time physical activity (LTPA). Total LTPA was related to control (β (95% CI)=-0.013 (-0.030 to 0.006)), with those doing recommended levels of LTPA being nearly 2.5 times more likely to have good control compared with inactive patients. Analysis of ...
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Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada, 2Inserm ERI17, HP2-REx-S Laboratory, Centre 1 ... Hospitalier Universitaire de Grenoble, Grenoble, France, Centre de recherche, Hôpital Sacré-Coeur and... more
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada, 2Inserm ERI17, HP2-REx-S Laboratory, Centre 1 ... Hospitalier Universitaire de Grenoble, Grenoble, France, Centre de recherche, Hôpital Sacré-Coeur and Department of Exercise Science,
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This study focused on repeatability data and minimal important difference (MID) estimates of the endurance shuttle walking test (ESWT). 255 chronic obstructive pulmonary disease patients (forced expiratory volume in 1 s 54.7±13.2%... more
This study focused on repeatability data and minimal important difference (MID) estimates of the endurance shuttle walking test (ESWT). 255 chronic obstructive pulmonary disease patients (forced expiratory volume in 1 s 54.7±13.2% predicted) completed four ESWTs at different times during the 8-week study: two under baseline conditions with tiotropium (1 week apart), one after a single dose and one after 4 weeks of either fluticasone propionate/salmeterol combination or placebo in addition to tiotropium. 97 patients performed all the tests with a portable metabolic system. Reproducibility of test performance and cardiorespiratory response was investigated with the data obtained on the first two ESWTs. The mean differences between the first two ESWT performances (-6.7±72.2 s and -7.3±113.1 m for endurance time and walking distance, respectively) were not statistically significant. The between-test end-exercise and isotime values for each cardiorespiratory parameter were not significan...
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Patients with chronic obstructive pulmonary disease (COPD) are often caught in a downward spiral that progresses from expiratory flow limitation to poor quality of life and invalidity. Within this downward spiral, exercise tolerance... more
Patients with chronic obstructive pulmonary disease (COPD) are often caught in a downward spiral that progresses from expiratory flow limitation to poor quality of life and invalidity. Within this downward spiral, exercise tolerance represents a key intermediate outcome. As recently stated by the GOLD initiative, improvement in exercise tolerance is now rec ognized as an important goal of COPD treatment. This objective will be achieved only by a comprehensive understanding of the mechanism of exercise limitation in this disease. The objective of this paper is to review the mechanisms of exercise limitation in COPD and discuss their relative contribution to exercise intolerance in patients suffering from this disease.
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Once viewed as an irreversible condition, chronic obstructive pulmonary disease (COPD) is now considered as a preventable and treatable disease. The past ten years of research have clearly indicate that dyspnea, exercise tolerance and... more
Once viewed as an irreversible condition, chronic obstructive pulmonary disease (COPD) is now considered as a preventable and treatable disease. The past ten years of research have clearly indicate that dyspnea, exercise tolerance and quality of life can be improved considerably with appropriate therapeutic interventions that include pharmacological and non-pharmacological components. It is also becoming evident that it is the concomitant use of appropriate pharmacotherapy and non-pharmacological approaches, such as exercise training and pulmonary rehabilitation, that offers the best hope for an optimal status. The objective of this short paper is to review the rationale of combining pharmacological and non-pharmacological therapeutic approaches to optimize functional status and quality of life in patients with COPD. Optimal bronchodilation is the mainstay of treatment. Leg fatigue will prevent patients with COPD from obtaining full advantage of bronchodilation. Quadriceps fatigue d...
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Field walking tests are commonly employed to evaluate exercise capacity, assess prognosis and evaluate treatment response in chronic respiratory diseases. In recent years, there has been a wealth of new literature pertinent to the conduct... more
Field walking tests are commonly employed to evaluate exercise capacity, assess prognosis and evaluate treatment response in chronic respiratory diseases. In recent years, there has been a wealth of new literature pertinent to the conduct of the 6-min walk test (6MWT), and a growing evidence base describing the incremental and endurance shuttle walk tests (ISWT and ESWT, respectively). The aim of this document is to describe the standard operating procedures for the 6MWT, ISWT and ESWT, which can be consistently employed by clinicians and researchers. The Technical Standard was developed by a multidisciplinary and international group of clinicians and researchers with expertise in the application of field walking tests. The procedures are underpinned by a concurrent systematic review of literature relevant to measurement properties and test conduct in adults with chronic respiratory disease. Current data confirm that the 6MWT, ISWT and ESWT are valid, reliable and responsive to chan...
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This systematic review examined the measurement properties of the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease. Studies that report the... more
This systematic review examined the measurement properties of the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease. Studies that report the evaluation or use of the 6MWT, ISWT or ESWT were included. We searched electronic databases for studies published between January 2000 and September 2013. The 6-min walking distance (6MWD) is a reliable measure (intra-class correlation coefficients ranged from 0.82 to 0.99 in seven studies). There is a learning effect, with greater distance walked on the second test (pooled mean improvement of 26 m in 13 studies). Reliability was similar for ISWT and ESWT, with a learning effect also evident for ISWT (pooled mean improvement of 20 m in six studies). The 6MWD correlates more strongly with peak work capacity (r=0.59-0.93) and physical activity (r=0.40-0.85) than with respiratory function (r=0.10-0.59). Methodological factors affecting 6MWD include track l...
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Page 1. / Thematic Poster Session / Sunday, May A45 BRONCHODILATORS FOR COPD: OLD FAITHFULS AND NOVEL COMPOUNDS 15/8:15 AM-4:30 PM / Area D, Hall B (Upper Level), Colorado Convention Center Tiotropium ...
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Pulmonary rehabilitation (PR) participation is the standard of care for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite bronchodilator therapies. However, there are questions about specific... more
Pulmonary rehabilitation (PR) participation is the standard of care for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite bronchodilator therapies. However, there are questions about specific aspects of PR programming including optimal site of rehabilitation delivery, components of rehabilitation programming, duration of rehabilitation, target populations and timing of rehabilitation. The present document was compiled to specifically address these important clinical issues, using an evidence-based, systematic review process led by a representative interprofessional panel of experts. The evidence reveals there are no differences in major patient-related outcomes of PR between nonhospital- (community or home sites) or hospital-based sites. There is strong support to recommend that COPD patients initiate PR within one month following an acute exacerbation due to benefits of improved dyspnea, exercise tolerance and health-related quality of life r...
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Background. Studies have shown that asthma and asthma exacerbations are related to body weight and that this relationship might be sex-specific. While oral corticosteroids have been associated with weight gain, little is known about the... more
Background. Studies have shown that asthma and asthma exacerbations are related to body weight and that this relationship might be sex-specific. While oral corticosteroids have been associated with weight gain, little is known about the effect of inhaled corticosteroid (ICS) use on short-term weight gain. The purpose of the present study was to examine whether ICSs would be associated with weight gain among asthmatic patients. Methods. A total of 180 adult patients with physician-diagnosed asthma provided details of their medical history and demographic information, along with height and weight at baseline and at one year. Weight change was defined as follow-up minus baseline weight. General linear models were used to assess the relationship between ICS dose (fluticasone propionate equivalent) and sex. Results. Significant main effects of sex (P=.005) and ICS dose (P=.036) and an interaction effect of sex and ICS dose (P=.003) on weight change were observed. Further analysis of the ...
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Sleep and physical activity are important health behaviors promoting cardiovascular health. Large bodies of literature have documented the direct effects of sleep and physical activity on risk factors for cardiovascular disease (CVD).... more
Sleep and physical activity are important health behaviors promoting cardiovascular health. Large bodies of literature have documented the direct effects of sleep and physical activity on risk factors for cardiovascular disease (CVD). This review aimed to highlight the interactive effect of sleep and physical activity on CVD risk. The extant literature suggests that sleep and physical activity are lifestyle behaviors that interact and act synergistically to influence CVD risk. Adopting healthy lifestyles encompassing both adequate sleep and regular physical activity is optimal to maintain cardiovascular health.
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Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current... more
Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current randomised controlled trial is that aerobic exercise will be superior to usual care in improving asthma control. Key secondary outcomes are asthma quality of life and inflammatory profiles. A total of 104 sedentary adults with physician-diagnosed asthma will be recruited. Eligible participants will undergo a series of baseline assessments including: the asthma control questionnaire; the asthma quality-of-life questionnaire and the inflammatory profile (assessed from both the blood and sputum samples). On completion of the assessments, participants will be randomised (1:1 allocation) to either 12-weeks of usual care or usual care plus aerobic exercise. Aerobic exercise will consist of three supervised training sessions per week. Each session will consist of t...
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Research Interests: Treatment Outcome, Response to Intervention, Exercise therapy, Medicine, Humans, and 15 morePulmonary Rehabilitation, Female, Thorax, Male, Regression Analysis, Clinical Sciences, Aged, Middle Aged, Adult, Vital Capacity, Chronic obstructive pulmonary disease, Exercise Test, Exercise Tolerance, attitude to health, and Bronchodilator agents
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To compare the response to constant-workrate cycling exercise between the mouthpiece and the facemask in patients with chronic obstructive pulmonary disease (COPD). Ten patients with COPD (FEV1: 48 +/- 14% pred, mean +/- SD) performed two... more
To compare the response to constant-workrate cycling exercise between the mouthpiece and the facemask in patients with chronic obstructive pulmonary disease (COPD). Ten patients with COPD (FEV1: 48 +/- 14% pred, mean +/- SD) performed two symptom-limited constant-workrate cycling exercise tests at 80% of their predetermined peak exercise capacity. One test was performed using a mouthpiece and the other with a facemask, in a random order. The endurance time to constant-workrate exercise was compared between the two interfaces. VO2, VCO2, ventilation (VE), inspiratory capacity, dyspnea Borg score, and heart rate responses during exercise were also compared. Endurance time was similar between the two interfaces (mean difference +/- SD, 30 +/- 74 s, P = 0.23). Except for the end-exercise values, which were lower with the facemask, the VO2, VCO2, and VE responses to submaximal exercise were similar between the two interfaces. Perception of dyspnea, inspiratory capacity, and heart rate kinetics were similar during the two exercise tests. No clear preference about either interface was expressed by the patients. The mouthpiece and the facemask can be used with comparable results to determine the endurance time to constant-workrate cycling exercise in patients with COPD. Compared with the mouthpiece, the end-exercise values for VO2, VCO2, and VE were underestimated when a facemask was used. The similar responses in heart rate and symptom perception suggest that this could be due to an air leak at end-exercise with the facemask.
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Research Interests: Skeletal muscle biology, Medicine, Humans, Bicycling, Female, and 15 moreMale, Exercise, Dyspnea, Middle Aged, Muscle Fatigue, Chronic obstructive pulmonary disease, Exercise Test, Oxygen Consumption, Exercise Tolerance, Ipratropium Uk, Physical Endurance, Respiratory function tests, Cardiovascular medicine and haematology, Quadriceps Muscle, and Bronchodilator agents
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Research Interests: Treatment Outcome, Medicine, Humans, Arizona, Female, and 14 moreFeasibility Studies, Male, Physical Fitness, Aged, Middle Aged, Coronary heart disease, Cardiac rehabilitation, Cardiopulmonary Rehabilitation, Age Factors, Exercise Test, Exercise Tolerance, Cardiopulmonary, Statistics as Topic, and Cardiovascular medicine and haematology
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Research Interests: Aging, Treatment Outcome, Medicine, Humans, Physical Fitness, and 13 moreAged, Self Assessment, Myocardial Infarction, Cardiac rehabilitation, Proxy, Cardiopulmonary Rehabilitation, Age Factors, Geriatric Assessment, Physical Function, Cardiac Rehab, Cardiopulmonary, Disability Evaluation, and Cardiovascular medicine and haematology
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Research Interests: Lung Function, Humans, Female, Male, Dyspnea, and 15 moreAged, Middle Aged, Capacity, Vital Capacity, Chronic obstructive pulmonary disease, Physical Exercise, Cross-Over Studies, Exercise Test, Exercise Tolerance, Cohort Studies, Activity of Daily Living, Inspiratory capacity, Albuterol, Medical and Health Sciences, and Bronchodilator agents
Spousal perceptions and/or attitudes to their patient partners' capabilities have been shown to affect the effectiveness of the cardiac rehabilitation (CR) process. The purpose of this study was (a) to assess differences between... more
Spousal perceptions and/or attitudes to their patient partners' capabilities have been shown to affect the effectiveness of the cardiac rehabilitation (CR) process. The purpose of this study was (a) to assess differences between patient and proxy responses to the Medical Outcomes Survey-Short Form 36 (SF36) and (b) suggest how such information may contribute to enhancing rehabilitation outcomes. Fifty-eight patients completed the SF36 prior to entering Phase II CR. Patient spouses completed a proxy version of the same questionnaire. The authors found that spouses' perceptions of their patient partners physical functioning (PF) was approximately 10% lower than patients' perceptions of their own PF(p