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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. Plain Language Summary: This study investigated the relationship between objectively measured physical activity levels and the prevalence of comorbidities in lung transplant recipients. It shows that active lung recipients (≥7,500 steps/day) demonstrated significantly fewer comorbidities compared to severely inactive recipients (<2,500 steps/day). More specifically, muscle weakness and high symptoms of depression were significantly less prevalent in the active group. Severely inactive patients had more cardiovascular comorbidities compared to more active patients (p < 0.05). No significant differences were observed in the prevalence of other comorbidities. [ABSTRACT FROM AUTHOR]

Background: Disability and loss of function are acknowledged as important problems for people living with COPD, but there is a need for validated tools to assess them., Research Question: The Late-Life Function and Disability Instrument (LLFDI) was originally validated for community-dwelling older adults. The full instrument has not been validated to assess disability and loss of function in people with COPD., Methods: People with COPD from 6 European countries completed the LLFDI as part of an observational study. Its validity was assessed in terms of 1) levels and distribution of LLFDI domain and subdomain scores; 2) floor and ceiling effects; 3) instrument structure (3 domains, 7 subdomains) by confirmatory factor analysis; and 4) construct validity by (i) convergent validity, based on Spearman correlation with COPD-relevant and related constructs (functional exercise capacity, severity of dyspnea and COPD-related health status), and (ii) known-groups validity, based on the distribution of LLFDI scores according to COPD-meaningful groups (disease severity, age groups and use of a walking aid)., Results: The study included 605 participants (aged 68±8 years, 37% female, FEV1 54±20%pred.). Most had impaired disability and function levels. We observed no floor effects and a ceiling effect in only two subdomains. Confirmatory factor analysis showed a moderate model fit for all LLFDI domains. Most of the correlations met our hypotheses (73%), with moderate to strong correlations for function domain (r min-max 0.25-0.70), followed by disability-limitation domain (r min-max 0.15-0.54), and weakest correlations in the disability-frequency domain (r min-max 0.04-0.41). The disability-limitation and function domains differed by disease severity, age group and use of a walking aid. The disability-frequency domain differed by disease severity and use of a walking aid, but not by age groups., Conclusion: The LLFDI, a valid patient-reported outcome to investigate disability and function, has proven good construct validity in people with COPD.

Cardiopulmonary exercise testing (CPET) is a comprehensive and invaluable assessment used to identify the mechanisms that limit exercise capacity. However, its interpretation remains poorly standardised. This scoping review aims to investigate which limitations to exercise are differentiated by the use of incremental CPET in literature and which criteria are used to identify them. We performed a systematic, electronic literature search of PubMed, Embase, Cochrane CENTRAL, Web of Science and Scopus. All types of publications that reported identification criteria for at least one limitation to exercise based on clinical parameters and CPET variables were eligible for inclusion. 86 publications were included, of which 57 were primary literature and 29 were secondary literature. In general, at the level of the cardiovascular system, a distinction was often made between a normal physiological limitation and a pathological one. Within the respiratory system, ventilatory limitation, commonly identified by a low breathing reserve, and gas exchange limitation, mostly identified by a high minute ventilation/carbon dioxide production slope and/or oxygen desaturation, were often described. Multiple terms were used to describe a limitation in the peripheral muscle, but all variables used to identify this limitation lacked specificity. Deconditioning was a frequently mentioned exercise limiting factor, but there was no consensus on how to identify it through CPET. There is large heterogeneity in the terminology, the classification and the identification criteria of limitations to exercise that are distinguished using incremental CPET. Standardising the interpretation of CPET is essential to establish an objective and consistent framework., Competing Interests: Conflict of interest: I. Gyselinck reports grants from Research Foundation Flanders, and support for attending meetings from AstraZeneca. W. Janssens reports grants from AstraZeneca and Chiesi, consultation fees from AstraZeneca, Chiesi, GSK and Sanofi, payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Chiesi and GSK, support for attending meetings from AstraZeneca and Chiesi, and the following financial (or non-financial) interests: co-founder and chairholder of ARTIQ, a spin-off company of KULeuven. M. Staes, K. Goetschalckx and T. Troosters have nothing to disclose., (Copyright ©The authors 2024.)

Background: Pulmonary rehabilitation (PR) is a well-established intervention for patients with COPD, but access, uptake and completion are low. This retrospective propensity-matched study aimed to analyse equivalence from a hybrid PR modality against conventional PR., Methods: Between 2013 and 2019, 214 patients with COPD with valid baseline physical activity assessments enrolled in conventional PR for three times per week for 3 months. In 2021-2022, 44 patients with COPD enrolled in 3 months of hybrid PR, introducing two providers: once per week in the outpatient centre and two times per week in a primary care setting near the patient's home. All sessions were supervised. Propensity score matching (1:1) was performed. Equivalence between both programmes was analysed for exercise capacity with the equivalence margins of ±30 m on the 6-min walk distance (6MWD). Clinical outcomes, accessibility and adherence were compared using t-tests., Results: 44 patients (mean±sd age 67±8 years; forced expiratory volume in 1 s (FEV 1 ) 47±15% predicted; 6MWD 355±122 m) in the hybrid PR group were matched to 44 patients (mean±sd age 66±8 years; FEV 1 46±17% predicted; 6MWD 354±103 m) in the conventional PR group. Equivalence on the increase in 6MWD could not be confirmed; nevertheless, both groups improved their 6MWD clinically significantly (hybrid PR change 63 m (90% CI 43-83 m); conventional PR change 39 m (90% CI 26-52 m)). Changes in quality of life and symptoms were similar. Dropout in hybrid PR (23%) was comparable to conventional PR (27%) (p=0.24). Adherence in both groups was high and accessibility was better for patients following hybrid PR., Conclusion: Hybrid PR can be offered as an effective alternative to conventional PR, if patients are willing to take up the offer., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest., (Copyright ©The authors 2024.)

Purpose: This study investigated the accuracy of activity trackers in chronic lower limb lymphoedema (LLL) patients and in comparison to matched controls., Materials and Methods: Seventeen LLL patients and 35 healthy subjects wore an activity tracker at the hip (Fitbit Zip/Inspire; hip-AT) and one at the wrist (Fitbit Alta/Inspire; wrist-AT) combined with a reference activity monitor (Dynaport Movemonitor; DAM), for 14 consecutive days. To analyze accuracy and agreement, mean daily step count from both AT's were compared to DAM. To evaluate the accuracy as coaching tool, day-by-day differences were calculated. The Kendall correlation coefficient was used to test consistency of ranking daily steps between the AT's and the DAM., Results: The wrist-AT significantly overestimated daily step count compared to DAM in the LLL group (+1221 ± 1754 steps per day, p = 0.011) while the hip-AT underestimated the step count, although not significantly. Similar results were found in the healthy control group. As a coaching tool, both wrist-AT and hip-AT showed a moderate correlation with the DAM (r = 0.507 and 0.622, respectively) in the LLL group regarding consistency of ranking from most to least active days., Conclusion: Wrist-AT's significantly overestimate daily step count in a LLL population. As a coaching tool, both trackers show moderate validity, indicating applicability to improve physical activity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Blondeel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Physical activity is reduced in patients with interstitial lung disease (ILD) and physical inactivity is related to poor health outcomes. We investigated the effect of a telecoaching intervention to improve physical activity in patients with ILD., Methods: Eighty patients with ILD were randomized into the intervention or control group. Patients in the intervention group received a 12-week telecoaching program including a step counter, a patient-tailored smartphone application, and coaching calls. Patients in the control group received usual care. Physical activity (primary outcome), physical fitness and quality of life were measured at baseline and 12 weeks later with an accelerometer, 6-min walking test and quadriceps muscle force and the King's Brief Interstitial Lung Disease questionnaire (K-BILD)., Results: Participation in telecoaching did not improve physical activity: between-group differences for step count: 386 ± 590 steps/day, p = .52; sedentary time: 4 ± 18 min/day, p = .81; movement intensity: 0.04 ± 0.05 m/s 2 , p = .45). Between-group differences for the 6-min walking test, quadriceps muscle force and K-BILD were 14 ± 10 m, p = .16; 2 ± 3% predicted, p = .61; 0.8 ± 1.7 points, p = .62 respectively., Conclusions: Twelve weeks of telecoaching did not improve physical activity, physical fitness or quality of life in patients with ILD. Future physical or behavioural interventions are needed for these patients to improve physical activity., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.