COPD: Journal of Chronic Obstructive Pulmonary Disease, Nov 2, 2021
Abstract Pulmonary Rehabilitation (PR) is a key intervention in the management of people with chr... more Abstract Pulmonary Rehabilitation (PR) is a key intervention in the management of people with chronic obstructive pulmonary disease (COPD), though few studies have assessed where changes in outcomes occur during a PR program. The aim of this study was to determine the changes in exercise capacity and health-related quality of life at four and eight weeks during a twice-weekly supervised PR program in people with COPD. Fifty participants with COPD were recruited and attended PR twice-weekly for eight weeks. The outcome measures were the endurance shuttle walk test (ESWT), six-minute walk distance (6MWD), St George’s Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and the Hospital Anxiety and Depression Scale (HADS) which were measured at baseline, four and eight weeks. Compared to baseline, at week four there were significant improvements in ESWT (mean difference [95%CI] 197 [89 to 305] seconds), 6MWD (22 [8 to 36] metres), SGRQ symptom score (-6 [-12 to −1] points) and SGRQ total score (-4 [-7 to −1] points). Between week four and eight there were further significant improvements in ESWT (94 [8 to 181] seconds) only. By week eight, ESWT, 6MWD, SGRQ symptoms and total score, and CAT had all improved significantly compared to baseline measures. This study demonstrated that participants with moderate to very severe COPD who participated in a twice weekly, eight-week PR program (16 sessions) had significant improvement in ESWT, 6MWD, SGRQ, and CAT score with the greatest improvements occurring in the first four weeks of the program. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.2013793 .
Introduction: It has been estimated that 47% of people with COPD referred to pulmonary rehabilita... more Introduction: It has been estimated that 47% of people with COPD referred to pulmonary rehabilitation programs experience exercise-induced desaturation (EID) (nadir SpO2 Aim: To determine whether there is a difference in functional exercise capacity and PA levels in people with COPD with EID and without EID. Methods: This was an observational study comparing outcomes in COPD people with and without EID. PA was assessed as the average of (i) number of steps per day, and (ii) time spent in sedentary (0 to Results: 65 participants were recruited to the EID group (mean (SD) age 70 (7) years, FEV1 50 (20) %predicted, nadir SpO2 84 (4)%) and 77 participants to the no EID group (age 69 (8), FEV1 48 (14) %predicted). Functional exercise capacity was lower in the EID group compared to the no EID group (6MWD 406 (97) m vs 479 (81) m, mean difference (95% CI) -73m (-43 to -102), p Conclusion: Functional exercise capacity and PA levels were lower in people with COPD who had EID compared to those without EID, despite similar age and disease severity.
BackgroundFew studies have examined sedentary behaviour in chronic respiratory disease. The limit... more BackgroundFew studies have examined sedentary behaviour in chronic respiratory disease. The limited evidence suggests that increased levels of sedentary behaviour are associated with increased mortality.ObjectivesThis study aimed to compare the level of self-reported sedentary behaviour in people with chronic obstructive pulmonary disease (COPD) and bronchiectasis as well as to identify associations between sedentary time with functional performance measures and health-related quality of life in the chronic respiratory disease group.MethodsAn observational study design was used. Participants completed the Sedentary Behaviour Questionnaire from which average sedentary time (hours/day) was determined. Functional performance was measured using the six-minute walk test, the four-metre gait speed test and the five sit-to-stand test. Health-related quality of life was measured using the St George's Respiratory Questionnaire. Sedentary time was compared between groups using an unpaired t-test. Univariate analysis explored relationships amongst variables.ResultsThe convenience sample consisted of 103 people with COPD [52% male; mean ± SD age: 73 ± 9 years, FEV1% predicted: 56 ± 23] and 33 people with bronchiectasis [52% male; 74 ± 8 years, FEV1% predicted: 69 ± 25]. Average self-reported sedentary time in COPD was 7.6 ± 2.7 hours/day and in bronchiectasis was 8.0 ± 4.1 hours/day, with no between-group difference (−0.4, 95% CI −1.7, 0.8). No associations were found between sedentary time and any functional performance outcome or with health-related quality of life.ConclusionThere was no difference in the high sedentary time between people with COPD and bronchiectasis. Sedentary behaviour was not associated with functional performance or disease-related health-related quality of life in people with chronic respiratory disease.
BackgroundSinging is a complex physical activity dependent on the use of the lungs for air supply... more BackgroundSinging is a complex physical activity dependent on the use of the lungs for air supply to regulate airflow and create large lung volumes. In singing, exhalation is active and requires active diaphragm contraction and good posture. Chronic obstructive pulmonary disease (COPD) is a progressive, chronic lung disease characterised by airflow obstruction. Singing is an activity with potential to improve health outcomes in people with COPD.ObjectivesTo determine the effect of singing on health‐related quality of life and dyspnoea in people with COPD.Search methodsWe identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, the World Health Organization trials portal and PEDro, from their inception to August 2017. We also reviewed reference lists of all primary studies and review articles for additional references.Selection criteriaWe included randomised controlled trials in people with stable COPD, in which structured supervised singing training of at least four sessions over four weeks' total duration was performed. The singing could be performed individually or as part of a group (choir) facilitated by a singing leader. Studies were included if they compared: 1) singing versus no intervention (usual care) or another control intervention; or 2) singing plus pulmonary rehabilitation versus pulmonary rehabilitation alone.Data collection and analysisTwo review authors independently screened and selected trials for inclusion, extracted outcome data and assessed risk of bias. We contacted authors of trials for missing data. We calculated mean differences (MDs) using a random‐effects model. We were only able to analyse data for the comparison of singing versus no intervention or a control group.Main resultsThree studies (a total of 112 participants) were included. All studies randomised participants to a singing group or a control group. The comparison groups included a film workshop, handcraft work, and no intervention. The frequency of the singing intervention in the studies ranged from 1 to 2 times a week over a 6 to 24 week period. The duration of each singing session was 60 minutes.All studies included participants diagnosed with COPD with a mean age ranging from 67 to 72 years and a mean forced expiratory volume in one second (FEV1) ranging from 37% to 64% of predicted values. The sample size of included studies was small (33 to 43 participants) and overall study quality was low to very low. Blinding of personnel and participants was not possible due to the physical nature of the intervention, and selection and reporting bias was present in two studies.For the primary outcome of health‐related quality of life, there was no statistically significant improvement in the St George's Respiratory Questionnaire total score (mean difference (MD) ‐0.82, 95% confidence interval (CI) ‐4.67 to 3.02, 2 studies, n = 58, low‐quality evidence). However, there was a statistically significant improvement in the SF‐36 Physical Component Summary (PCS) score favouring the singing group (MD 12.64, 95% CI 5.50 to 19.77, 2 studies, n = 52, low‐quality evidence). Only one study reported results for the other primary outcome of dyspnoea, in which the mean improvement in Baseline Dyspnoea Index (BDI) score favouring the singing group was not statistically significant (MD 0.40, 95% CI ‐0.65 to 1.45, 1 study, n = 30, very low‐quality evidence).No studies examined any long‐term outcomes and no adverse events or side effects were reported.Authors' conclusionsThere is low to very low‐quality evidence that singing is safe for people with COPD and improves physical health (as measured by the SF‐36 physical component score), but not dyspnoea or respiratory‐specific quality of life. The evidence is limited due to the low number of studies and the small sample size of each study. No evidence exists examining the long‐term effect of singing for people with COPD. The absence of studies examining singing performed in conjunction with pulmonary rehabilitation precludes the formulation of conclusions about the effects of singing in this context. More randomised controlled trials with larger sample sizes and long‐term follow‐up, and trials examining the effect of singing in addition to pulmonary rehabilitation, are required to determine the effect of singing on health‐related quality of life and dyspnoea in people with COPD.
IntroductionThis study aimed to determine whether a 6-week behaviour change intervention was more... more IntroductionThis study aimed to determine whether a 6-week behaviour change intervention was more effective than a sham intervention for reducing sedentary behaviour (SB) in people with chronic obstructive pulmonary disease (COPD).MethodsPeople with stable COPD on the waitlist for entry into pulmonary rehabilitation were recruited to this multicentre trial with randomisation (independent, concealed allocation) to either an intervention group or sham group, assessor blinding and intention-to-treat (ITT) analysis. The behaviour change intervention consisted of once weekly sessions for 6 weeks with a physiotherapist to reduce SB through education, guided goals setting and real-time feedback on SB. The sham intervention consisted of once weekly phone calls for 6 weeks to monitor health status. SB was measured continuously over 7 days using thigh-worn accelerometry (activPAL3 micro). The primary outcome was time spent in SB. Participants with at least 4 days of ≥10 hours waking wear time were included in the ITT analysis and those who reported achieving ≥70% of goals to reduce SB or who completed all sham calls were included in a per-protocol analysis.Results70 participants were recruited and 65 completed the study (mean±SD age 74±9 years, mean FEV1 55%±19% predicted, 49% male). At 6 weeks, no between-group differences in time spent in SB were observed in the ITT analysis (mean difference 5 min/day, 95% CI −38 to 48) or per-protocol analysis (−16 min/day, 95% CI −80 to 48).DiscussionA 6-week behaviour change intervention did not reduce time in SB compared with a sham intervention in people with stable moderate-to-severe COPD prior to pulmonary rehabilitation.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Nov 2, 2021
Abstract Pulmonary Rehabilitation (PR) is a key intervention in the management of people with chr... more Abstract Pulmonary Rehabilitation (PR) is a key intervention in the management of people with chronic obstructive pulmonary disease (COPD), though few studies have assessed where changes in outcomes occur during a PR program. The aim of this study was to determine the changes in exercise capacity and health-related quality of life at four and eight weeks during a twice-weekly supervised PR program in people with COPD. Fifty participants with COPD were recruited and attended PR twice-weekly for eight weeks. The outcome measures were the endurance shuttle walk test (ESWT), six-minute walk distance (6MWD), St George’s Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and the Hospital Anxiety and Depression Scale (HADS) which were measured at baseline, four and eight weeks. Compared to baseline, at week four there were significant improvements in ESWT (mean difference [95%CI] 197 [89 to 305] seconds), 6MWD (22 [8 to 36] metres), SGRQ symptom score (-6 [-12 to −1] points) and SGRQ total score (-4 [-7 to −1] points). Between week four and eight there were further significant improvements in ESWT (94 [8 to 181] seconds) only. By week eight, ESWT, 6MWD, SGRQ symptoms and total score, and CAT had all improved significantly compared to baseline measures. This study demonstrated that participants with moderate to very severe COPD who participated in a twice weekly, eight-week PR program (16 sessions) had significant improvement in ESWT, 6MWD, SGRQ, and CAT score with the greatest improvements occurring in the first four weeks of the program. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.2013793 .
Introduction: It has been estimated that 47% of people with COPD referred to pulmonary rehabilita... more Introduction: It has been estimated that 47% of people with COPD referred to pulmonary rehabilitation programs experience exercise-induced desaturation (EID) (nadir SpO2 Aim: To determine whether there is a difference in functional exercise capacity and PA levels in people with COPD with EID and without EID. Methods: This was an observational study comparing outcomes in COPD people with and without EID. PA was assessed as the average of (i) number of steps per day, and (ii) time spent in sedentary (0 to Results: 65 participants were recruited to the EID group (mean (SD) age 70 (7) years, FEV1 50 (20) %predicted, nadir SpO2 84 (4)%) and 77 participants to the no EID group (age 69 (8), FEV1 48 (14) %predicted). Functional exercise capacity was lower in the EID group compared to the no EID group (6MWD 406 (97) m vs 479 (81) m, mean difference (95% CI) -73m (-43 to -102), p Conclusion: Functional exercise capacity and PA levels were lower in people with COPD who had EID compared to those without EID, despite similar age and disease severity.
BackgroundFew studies have examined sedentary behaviour in chronic respiratory disease. The limit... more BackgroundFew studies have examined sedentary behaviour in chronic respiratory disease. The limited evidence suggests that increased levels of sedentary behaviour are associated with increased mortality.ObjectivesThis study aimed to compare the level of self-reported sedentary behaviour in people with chronic obstructive pulmonary disease (COPD) and bronchiectasis as well as to identify associations between sedentary time with functional performance measures and health-related quality of life in the chronic respiratory disease group.MethodsAn observational study design was used. Participants completed the Sedentary Behaviour Questionnaire from which average sedentary time (hours/day) was determined. Functional performance was measured using the six-minute walk test, the four-metre gait speed test and the five sit-to-stand test. Health-related quality of life was measured using the St George's Respiratory Questionnaire. Sedentary time was compared between groups using an unpaired t-test. Univariate analysis explored relationships amongst variables.ResultsThe convenience sample consisted of 103 people with COPD [52% male; mean ± SD age: 73 ± 9 years, FEV1% predicted: 56 ± 23] and 33 people with bronchiectasis [52% male; 74 ± 8 years, FEV1% predicted: 69 ± 25]. Average self-reported sedentary time in COPD was 7.6 ± 2.7 hours/day and in bronchiectasis was 8.0 ± 4.1 hours/day, with no between-group difference (−0.4, 95% CI −1.7, 0.8). No associations were found between sedentary time and any functional performance outcome or with health-related quality of life.ConclusionThere was no difference in the high sedentary time between people with COPD and bronchiectasis. Sedentary behaviour was not associated with functional performance or disease-related health-related quality of life in people with chronic respiratory disease.
BackgroundSinging is a complex physical activity dependent on the use of the lungs for air supply... more BackgroundSinging is a complex physical activity dependent on the use of the lungs for air supply to regulate airflow and create large lung volumes. In singing, exhalation is active and requires active diaphragm contraction and good posture. Chronic obstructive pulmonary disease (COPD) is a progressive, chronic lung disease characterised by airflow obstruction. Singing is an activity with potential to improve health outcomes in people with COPD.ObjectivesTo determine the effect of singing on health‐related quality of life and dyspnoea in people with COPD.Search methodsWe identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, the World Health Organization trials portal and PEDro, from their inception to August 2017. We also reviewed reference lists of all primary studies and review articles for additional references.Selection criteriaWe included randomised controlled trials in people with stable COPD, in which structured supervised singing training of at least four sessions over four weeks' total duration was performed. The singing could be performed individually or as part of a group (choir) facilitated by a singing leader. Studies were included if they compared: 1) singing versus no intervention (usual care) or another control intervention; or 2) singing plus pulmonary rehabilitation versus pulmonary rehabilitation alone.Data collection and analysisTwo review authors independently screened and selected trials for inclusion, extracted outcome data and assessed risk of bias. We contacted authors of trials for missing data. We calculated mean differences (MDs) using a random‐effects model. We were only able to analyse data for the comparison of singing versus no intervention or a control group.Main resultsThree studies (a total of 112 participants) were included. All studies randomised participants to a singing group or a control group. The comparison groups included a film workshop, handcraft work, and no intervention. The frequency of the singing intervention in the studies ranged from 1 to 2 times a week over a 6 to 24 week period. The duration of each singing session was 60 minutes.All studies included participants diagnosed with COPD with a mean age ranging from 67 to 72 years and a mean forced expiratory volume in one second (FEV1) ranging from 37% to 64% of predicted values. The sample size of included studies was small (33 to 43 participants) and overall study quality was low to very low. Blinding of personnel and participants was not possible due to the physical nature of the intervention, and selection and reporting bias was present in two studies.For the primary outcome of health‐related quality of life, there was no statistically significant improvement in the St George's Respiratory Questionnaire total score (mean difference (MD) ‐0.82, 95% confidence interval (CI) ‐4.67 to 3.02, 2 studies, n = 58, low‐quality evidence). However, there was a statistically significant improvement in the SF‐36 Physical Component Summary (PCS) score favouring the singing group (MD 12.64, 95% CI 5.50 to 19.77, 2 studies, n = 52, low‐quality evidence). Only one study reported results for the other primary outcome of dyspnoea, in which the mean improvement in Baseline Dyspnoea Index (BDI) score favouring the singing group was not statistically significant (MD 0.40, 95% CI ‐0.65 to 1.45, 1 study, n = 30, very low‐quality evidence).No studies examined any long‐term outcomes and no adverse events or side effects were reported.Authors' conclusionsThere is low to very low‐quality evidence that singing is safe for people with COPD and improves physical health (as measured by the SF‐36 physical component score), but not dyspnoea or respiratory‐specific quality of life. The evidence is limited due to the low number of studies and the small sample size of each study. No evidence exists examining the long‐term effect of singing for people with COPD. The absence of studies examining singing performed in conjunction with pulmonary rehabilitation precludes the formulation of conclusions about the effects of singing in this context. More randomised controlled trials with larger sample sizes and long‐term follow‐up, and trials examining the effect of singing in addition to pulmonary rehabilitation, are required to determine the effect of singing on health‐related quality of life and dyspnoea in people with COPD.
IntroductionThis study aimed to determine whether a 6-week behaviour change intervention was more... more IntroductionThis study aimed to determine whether a 6-week behaviour change intervention was more effective than a sham intervention for reducing sedentary behaviour (SB) in people with chronic obstructive pulmonary disease (COPD).MethodsPeople with stable COPD on the waitlist for entry into pulmonary rehabilitation were recruited to this multicentre trial with randomisation (independent, concealed allocation) to either an intervention group or sham group, assessor blinding and intention-to-treat (ITT) analysis. The behaviour change intervention consisted of once weekly sessions for 6 weeks with a physiotherapist to reduce SB through education, guided goals setting and real-time feedback on SB. The sham intervention consisted of once weekly phone calls for 6 weeks to monitor health status. SB was measured continuously over 7 days using thigh-worn accelerometry (activPAL3 micro). The primary outcome was time spent in SB. Participants with at least 4 days of ≥10 hours waking wear time were included in the ITT analysis and those who reported achieving ≥70% of goals to reduce SB or who completed all sham calls were included in a per-protocol analysis.Results70 participants were recruited and 65 completed the study (mean±SD age 74±9 years, mean FEV1 55%±19% predicted, 49% male). At 6 weeks, no between-group differences in time spent in SB were observed in the ITT analysis (mean difference 5 min/day, 95% CI −38 to 48) or per-protocol analysis (−16 min/day, 95% CI −80 to 48).DiscussionA 6-week behaviour change intervention did not reduce time in SB compared with a sham intervention in people with stable moderate-to-severe COPD prior to pulmonary rehabilitation.
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