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Background: Physical training, regardless of the presence of concurrent weight loss, provides numerous health benefits for individuals who are overweight and obese and have or are at risk for cardiovascular disease., Purpose: The purpose of this review was to identify different types of physical training programs (aerobic, resistance, or combined), with or without counseling/diet modifications, and their impact on physical fitness in individuals who have class II and III obesity., Data Sources: Medline and Medline In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Web of Science, LILACS, CINAHL, SPORTDiscus, PEDro, and PubMed were searched up to June 2017., Study Selection: This review had the following inclusion criteria: body mass index of ≥35 kg/m2 and age 18 years or older; supervised physical training program; randomized controlled trial; physical fitness outcome (muscular strength, muscular endurance, cardiovascular endurance, and/or flexibility); in English or Portuguese; and available full-text article., Data Extraction: Three reviewers independently extracted data, assessed study risk of bias using the Cochrane tool, and discussed disagreements until consensus was reached., Data Synthesis: Of the 9460 identified articles, 26 were included and 8 were used in a meta-analysis. The meta-analysis showed improvements in walking speed and maximal oxygen uptake but not knee extension strength in the intervention groups. The Cochrane risk-of-bias score indicated that the majority of the data were from randomized controlled trials with a low or unclear risk of bias., Limitations: The large variability of outcomes and interventions made comparisons difficult., Conclusions: A combination of aerobic exercise and resistance exercise, in addition to diet modifications, may improve cardiovascular and muscular endurance in individuals with class II and III obesity. However, conclusions must be interpreted with caution because of the heterogeneity in interventions and outcome measures among the studies and an unclear risk of bias in several studies., (© 2020 American Physical Therapy Association.)

Background: Exercise is recommended for people with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), yet there is little information to guide safe and effective mobilization and exercise for these patients., Objectives: The purpose of this study was to develop a clinical decision-making tool to guide health care professionals in the assessment, prescription, monitoring, and progression of mobilization and therapeutic exercise for patients with AECOPD., Design and Methods: A 3-round interdisciplinary Delphi panel identified and selected items based on a preselected consensus of 80%. These items were summarized in a paper-based tool titled Mobilization in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD-Mob). Focus groups and questionnaires were subsequently used to conduct a sensibility evaluation of the tool., Results: Nine researchers, 13 clinicians, and 7 individuals with COPD identified and approved 110 parameters for safe and effective exercise in AECOPD. These parameters were grouped into 5 categories: (1) "What to Assess Prior to Mobilization," (2) "When to Consider Not Mobilizing or to Discontinue Mobilization," (3) "What to Monitor During Mobilization for Patient Safety," (4) "How to Progress Mobilization to Enhance Effectiveness," and (5) "What to Confirm Prior to Discharge." The tool was evaluated in 4 focus groups of 18 health care professionals, 90% of whom reported the tool was easy to use, was concise, and would guide a health care professional who is new to the acute care setting and working with patients with AECOPD., Limitations: The tool was developed based on published evidence and expert opinion, so the applicability of the items to patients in all settings cannot be guaranteed. The Delphi panel consisted of health care professionals from Canada, so items may not be generalizable to other jurisdictions., Conclusions: The AECOPD-Mob provides practical and concise information on safe and effective exercise for the AECOPD population for use by the new graduate or novice acute care practitioner., (© 2015 American Physical Therapy Association.)

Background: The Stair Climb Power Test (SCPT) is a functional test associated with leg muscle power in older people., Objective: The purposes of this study were to compare the results of the SCPT in people with chronic obstructive pulmonary disease (COPD) and people who were healthy and to explore associations of the SCPT with muscle strength (force-generating capacity) and functional performance., Design: The study was a cross-sectional investigation., Methods: Twenty-one people with COPD and a predicted mean (SD) percentage of forced expiratory volume in 1 second of 47.2 (12.9) and 21 people who were healthy and matched for age, sex, and body mass were tested with the SCPT. Knee extensor and flexor muscle torque was assessed with an isokinetic dynamometer. Functional performance was assessed with the Timed "Up & Go" Test (TUG) and the Six-Minute Walk Test (6MWT)., Results: People with COPD showed lower values on the SCPT (28%) and all torque measures (∼ 32%), except for eccentric knee flexor muscle torque. In people with COPD, performance on the TUG and 6MWT was lower by 23% and 28%, respectively. In people with COPD, the SCPT was moderately associated with knee extensor muscle isometric and eccentric torque (r ≥.46) and strongly associated (r=.68) with the 6MWT. In people who were healthy, the association of the SCPT with knee extensor muscle torque tended to be stronger (r ≥.66); however, no significant relationship between the SCPT and measures of functional performance was found., Limitations: The observational design of the study and the use of a relatively small convenience sample limit the generalizability of the findings., Conclusions: The SCPT is a simple and safe test associated with measures of functional performance in people with COPD. People with COPD show deficits on the SCPT. However, the SCPT is only moderately associated with muscle torque and thus cannot be used as a simple surrogate for muscle strength in people with COPD.

Background and Purpose: Distance education via computer-assisted learning (CAL), including Web-based and CD-ROM learning, confers a number of advantages compared with traditional learning methods. The purposes of this study were (1) to determine the interest of Canadian physical therapists in participating in continuing education using CAL methods and (2) to determine whether interest in CAL was related to type of employment, area of practice, education, computer skill and access, and other demographic variables., Subjects and Methods: A random sample of Canadian physical therapists and all members of cardiopulmonary interest groups were surveyed., Results: Of 1,426 survey questionnaires mailed, 69 were returned (58 were unopened and 11 were duplicates). From the remaining 1,357 potential survey responses, 757 responses were received, for an overall response rate of 56%. Seventy-eight percent of the respondents indicated their interest in participating in CAL. Factors associated with interest in CAL included 2 or more hours of Internet access per week, Internet access at both home and work, computer skill, education level, practice area, and belonging to a cardiopulmonary interest group., Discussion and Conclusion: The findings indicate a large positive interest in CAL. Increasing CAL continuing education opportunities could increase options for physical therapists to meet professional expectations for continuing competency.

Background and Purpose: The purpose of this study was to use quantitative and qualitative research methods to evaluate quality-of-life (QOL) changes in patients with chronic obstructive pulmonary disease after pulmonary rehabilitation., Subjects: Twenty-nine individuals with COPD (18 women and 11 men), with a mean age of 69 years (SD=8.6, range=53-92), participated., Methods: Subjects were assessed before and after a 5-week control phase and after a 5-week rehabilitation phase using the Chronic Respiratory Questionnaire (CRQ), the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and spirometry. Our qualitative research was based on a subsample of 7 subjects who were interviewed after pulmonary rehabilitation., Results: Pulmonary rehabilitation improved QOL, as demonstrated by increases of 22% and 14% in the physical function categories of the CRQ and the SF-36, respectively, and by an increase of 10% in the CRQ's emotional function category. The qualitative data indicated how pulmonary rehabilitation influenced QOL., Conclusion and Discussion: The use of both quantitative and qualitative methods illustrated the nature of improvement in QOL after pulmonary rehabilitation. Improved physical function, less dyspnea, and a heightened sense of control over the subjects' COPD resulted in increased confidence and improved emotional well-being.

Background and Purpose: The purpose of this study was to determine the effect of a swimming endurance training program on changes in percentages and sizes of fiber types in different regions of the hamster diaphragm., Methods: Adult male golden Syrian hamsters were randomly assigned to a control group (n = 9) or a swimming group (n = 10). Hamsters in the swimming group swam for 80 minutes per session, 5 days per week, for 13 weeks. Fiber-type percentages and sizes were determined for the costal region and for the abdominal and thoracic surfaces of the crural region of the diaphragm from cross sections processed for myofibrillar adenosine triphosphatase., Results: Muscle fibers in the thoracic surface of the crural region were smaller in the swimming group than in the control group. Fiber-type percentages in the diaphragm, however, were not different between groups., Conclusion and Discussion: Swim training may have improved the endurance of the thoracic/crural region by decreasing cross-sectional area and thus decreasing the distance for oxygen to diffuse to the internal regions of the muscle fibers.

The purpose of this review is to describe the muscles of respiration, mechanisms that lead to their dysfunction, and unique features of the respiratory muscles that should be considered when designing testing and training protocols for patients with respiratory compromise. The diaphragm's unique shape is an important determinant of its function. Respiratory pathophysiology combined with systemic abnormalities may result in inspiratory muscle weakness, fatigue, and injury. The specificity of training principle, as it applies to respiratory muscle training in patients with respiratory compromise, will be described. Precautions related to this type of training will also be outlined. In conclusion, a better understanding of the mechanisms contributing to inspiratory muscle dysfunction will assist physical therapists in designing the most appropriate training programs. This article, along with the other articles in this focus on respiratory muscle training, will provide therapists with scientifically based guidelines for rehabilitation of patients with impaired respiratory muscle function.

The purpose of this article is to describe respiratory muscle training techniques and the effectiveness of this training in patients with chronic obstructive pulmonary disease (COPD). The respiratory muscles can be strengthened, but the benefit of stronger respiratory muscles in patients with COPD is not clear. Maximal sustained voluntary ventilation, inspiratory resistive breathing, and threshold loading are the three most commonly used techniques for improving the endurance of the inspiratory muscles in patients with COPD. Recent studies using inspiratory resistive breathing with targeted devices or threshold trainers have shown more consistent increases in inspiratory muscle function and exercise tolerance than studies using other techniques. Endurance exercise involving the extremities improves inspiratory muscle endurance in younger individuals with cystic fibrosis but not in older persons with COPD. Recommendations are outlined regarding the techniques to use for respiratory muscle training and which patient populations may benefit from these techniques.