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Background Pulmonary rehabilitation (PR) (primarily composed of an exercise training program (ET) and educational workshops) is an effective intervention for patients with chronic obstructive pulmonary disease. Although factors which influence participation in the full PR program have been reported, specific data on the educational component of PR have not been published. We aimed to identify factors which predict refusal to participate in the educational component of PR. Research design and methods 201 patient charts were retrospectively included in the analysis. Patients were classified according to their acceptance or refusal to participate in the educational workshops. Results The location of ET outside the center was independently related to refusal to participate in the educational workshops (OR =0.01 [95%CI 0.00 to 0.17]). Patients who refused the workshops were less disabled according to the number of prescriptions of non-invasive ventilation, oxygen consumption and workload achieved during cardiopulmonary exercise testing, and use of medical transport. Conclusions The location of exercise sessions during PR influences patients' decisions to refuse or accept center-based educational workshops. When center-based PR programs are limited, and the ET is relocated to the patient's home, the educational workshops should also be relocated. Trial registration The trial is registered at ClinicalTrials.gov (NCT04301245).

Exertional respiratory discomfort is the most common symptom in patients with COPD [1]. Menthol has recently been proposed as an ergogenic aid to decrease the perception of dyspnoea during exercise [2–4]. Menthol activates the transient receptor potential melastatin 8 (TRPM8) channels in the sensory nerve fibres of the tongue, promoting a feeling of freshness and a cognitive illusion of airflow into the airways [2, 5, 6]. We hypothesised that chewing menthol-flavoured gum before exercise would decrease the perception of dyspnoea during walking in COPD patients., Chewing menthol gum prior to exercise is a safe, easy-to-implement, low-cost, non-pharmacologic intervention that provides a reduction in dyspnoea in a third of patients and decreases the perception of discomfort during exercise in two-thirds of patients https://bit.ly/3FoFHp1

IntroductionExercise training before lung resection for non-small cell lung cancer is believed to decrease postoperative complications (POC) by improving cardiorespiratory fitness. However, this intervention lacks a strong evidence base.AimTo assess the effectiveness of preoperative exercise training compared with usual care on POC and other secondary outcomes in patients with scheduled lung resection.MethodsA systematic search of randomised trials was conducted by two authors. Meta-analysis was performed, and the effect of exercise training was estimated by risk ratios (RR) and mean differences, with their CIs. Clinical usefulness was estimated according to minimal important difference values (MID).ResultsFourteen studies involving 791 participants were included. Compared with usual care, exercise training reduced overall POC (10 studies, 617 participants, RR 0.58, 95% CI 0.45 to 0.75) and clinically relevant POC (4 studies, 302 participants, Clavien-Dindo score ≥2 RR 0.42, 95% CI 0.25 to 0.69). The estimate of the effect of exercise training on mortality was very imprecise (6 studies, 456 participants, RR 0.66, 95% CI 0.20 to 2.22). The main risks of bias were a lack of participant blinding and selective reporting. Exercise training appeared to improve exercise capacity, pulmonary function and also quality of life and depression, although the clinical usefulness of the changes was unclear. The quality of the evidence was graded for each outcome.ConclusionPreoperative exercise training leads to a worthwhile reduction in postoperative complications. These estimates were both accurate and large enough to make recommendations for clinical practice.

No abstract available

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is responsible for the current pandemic and results in a large number of hospitalizations. This highly contagious disease causes severe acute respiratory infection; thus, many patients require management in intensive care. At a time when there is a high influx of patients with COVID-19 in Intensive Care Units (ICU) all over the world, there is little literature concerning the physiotherapy management of these patients. This article provides information based on the latest evidence to help physiotherapists optimize care, to protect patients and care providers in the ICU, and for follow-up care.

BACKGROUND: Oxygen uptake (V̇O2) kinetics have been shown to be slowed in adolescents with cystic fibrosis (CF) during heavy-intensity cycling and maximal exercise testing. OBJECTIVES: This study investigated V̇O2 kinetics in adolescents with CF compared to control adolescents (CON) during a treadmill-walking exercise. METHODS: Eight adolescents with CF and mild-to-moderate pulmonary obstruction (5 girls; 13.1 ± 2.5 years; FEV1 67.8 ± 21.4%) and 18 CON adolescents (10 girls; 13.8 ± 1.8 years) were recruited. Pulmonary gas exchange and ventilation were measured during a single transition of 10 min of treadmill walking and a 5 min seated recovery period. Participant's walking speed was determined during a one-minute self-paced walking task along a 50-m corridor. A six-parameter, non-linear regression model was used to describe the changes in V̇O2 function during the treadmill walking and recovery, with monoexponential curve fitting used to describe the mean response time (MRT1) at the onset of exercise, and the half-life (T1/2V̇O2) at the offset of exercise. V̇O2 baseline and amplitude, minute ventilation and respiratory equivalents were recorded. RESULTS: V̇O2 kinetics were slower in CF group compared to CON group during the treadmill walking with a greater MRT1 (32 ± 14 s vs 21 ± 16 s; p = .04, effect size = 0.75). The T1/2V̇O2 was prolonged during recovery in CF group compared to CON group (86 ± 24 s vs 56 ± 22 s; p = .04, effect size = 1.31). The mean VE/V̇CO2 during exercise was the only parameter significantly greater in CF group compared to CON group (32.9 ± 2.3 vs 29.0 ± 2.4; p < .01, effect size = 1.66). CONCLUSION: V̇O2 kinetics were found to be slowed in adolescents with CF during treadmill walking.

TO THE EDITOR, Chronic respiratory diseases (CRD) progressively lead to physical inactivity and worsening dyspnoea, and cause disability and mortality. [...]

Accurate testing of muscle function is essential in individuals with cystic fibrosis (CF). A literature search was conducted in MEDLINE, CENTRAL, CINAHL, PEDro, ScienceDirect and Web of Science according to PRISMA and COSMIN guidelines from inception to September 2019 to investigate the clinimetric properties of muscle tests in individuals with CF. The search identified 37 studies (1310 individuals) and 34 different muscle tests. Maximal inspiratory pressure, inspiratory work capacity and quadriceps strength measured by computerised dynamometry were identified as reliable tests of muscle function. The one-minute sit-to-stand test was found to have high reliability but its validity to measure quadriceps strength is unknown. The clinimetric properties of other routinely used tests have not been reported in people with CF. Very different measurement procedures were identified. Inspiratory muscle and quadriceps testing can be considered as reliable but high-quality studies evaluating tests of other muscles function (e.g. muscle endurance) are lacking.

BackgroundThoracic surgery is the optimal treatment for early-stage lung cancer, but there is a high risk of postoperative morbidity. Therefore, it is necessary to evaluate patients’ preoperative general condition and cardiorespiratory capacity to determine the risk of postoperative complications. The objective of this study was to assess whether the stair-climbing test could be used in the preoperative evaluation of lung resection patients to predict postoperative morbidity following thoracic surgery.MethodsWe performed a systematic review and a meta-analysis on the association between stair-climbing test result and morbidity/mortality after thoracic surgery. We analysed all articles published until May 2020 in the following databases: Pubmed/Medline, Pedro, The Cochrane library, Embase and CINAHL. The risk of bias was assessed using the Quality in Prognosis Studies tool. This meta-analysis is registered as PROSPERO CRD42019121348.Results13 articles were included in the systematic review for a total of 2038 patients and 6 in the meta-analysis. There were multiple test evaluation criteria: rise time, height, desaturation and heart rate change. For the meta-analysis, we were able to pool data on the height of rise at a variable threshold: risk ratio 2.34 (95% CI 1.59 to 3.43) with I²=53% (p=0.06). The threshold for occurrence of complications was estimated at a 10 m climb.ConclusionsOur results indicate that the stair-climbing test could be used as a first-line functional screening test to predict postoperative morbidity following thoracic surgery and that patients with a poor test result (

Purpose Cognitive dysfunction is a common impairment associated with COPD. However, little is known about 1) its prevalence among those subjects referred for pulmonary rehabilitation (PR), 2) how it may affect the benefit of PR, 3) whether PR improves cognitive function and 4) whether cognitive dysfunction affects the usability of telehealth technology usually used to deliver in-home PR. Patients and Methods Fifty-six subjects with stable COPD (54% females, mean age 62 years (SD 9) and median FEV1 0.9 L (IQR 0.7 to 1.1)) participated in this multicenter observational study and performed 24 sessions of PR. The Montreal Cognitive Assessment tool (MoCA) was used to assess the occurrence of mild cognitive dysfunction (using a screening cutoff

Rationale Several studies have evaluated the effect of nasal high flow (NHF) to enhance exercise performance and tolerance in patients with COPD, however results are disparate. Objective The aim of this systematic review and meta-analysis was to assess the effect of NHF as an adjuvant to exercise training on functional exercise capacity in patients with COPD. Method An electronic search was carried out in the following databases: Pubmed, CENTRAL, PEDro, ScienceDirect, Web of Science, OpenGrey, ClinicalTrials.gov, European Respiratory Society and American Thoracic Society databases. Two authors independently selected relevant randomized trials (parallel group or cross-over design), extracted data, assessed the risk of bias and rated the quality of the evidence. Results Eleven studies were included, involving 408 participants (8 full papers and 3 conference abstracts). Most studies had a high risk of bias or other methodological limitations. The use of NHF during a single session increased functional exercise capacity (SMD 0.36 (95% CI 0.03 to 0.69) p=0.03, heterogeneity (I² 83 %)). When conference abstracts were included in the pooled analysis, the estimated effect did not change (p=0.006). The use of NHF throughout a pulmonary rehabilitation programme (parallel group RCTs) increased functional exercise capacity at 4 to 12 weeks compared with those who trained without NHF (SMD 0.34 (95% CI 0.00 to 0.68) p=0.05, heterogeneity (I² 18%)). Conclusion There is very low to low quality evidence that NHF improves functional exercise capacity. Patient responses to NHF therapy were highly variable and heterogeneous, with benefits ranging from clinically trivial to worthwhile. Registration (www.crd.york.ac.uk/prospero: CRD42021221550).

Riassunto Le patologie respiratorie ostruttive sono un importante campo di intervento del fisioterapista nel campo della pneumologia. La broncopneumopatia cronica ostruttiva (BPCO), la fibrosi cistica, la dilatazione dei bronchi (esclusa la fibrosi cistica) o, ancora, l’asma fanno, cosi, parte delle patologie per le quali il fisioterapista occupa un posto fondamentale nell’implementazione delle diverse terapie accanto agli altri professionisti sanitari che gravitano intorno a questi pazienti. La riabilitazione respiratoria costituisce, attualmente, un trattamento di riferimento per questi disturbi ventilatori ostruttivi ed e suddivisa in diverse aree di intervento: svezzamento dal fumo, riqualificazione allo sforzo (con o senza adiuvanti), promozione dell’attivita fisica, ginnastica ed educazione terapeutica (assunzione di trattamenti, supporto nutrizionale). Il fisioterapista occupa un posto importante in queste diverse modalita e puo anche proporre altre terapie specifiche in funzione della natura del disturbo ostruttivo, come il disingombro bronchiale nella fibrosi cistica o gli esercizi respiratori nell’asma. Attraverso questi interventi, il fisioterapista contribuisce all’aumento delle capacita di sforzo dei pazienti e al miglioramento della loro qualita di vita.

There is a growing body of evidence supporting the use of nasal high flow (NHF) to treat acute respiratory failure, particularly in Chronic Obstructive Pulmonary Disease (COPD) patients. Conversely, there are sparse data evaluating its effects in stable COPD patients.We identified randomized controlled trial comparing the effects of delivering air or oxygen

Background and objective We hypothesized that by reducing respiratory work and improving gas exchange, nasal high flow (NHF) would improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) following respiratory exacerbation. Methods This was a monocentric, randomized, controlled crossover study. Patients with severe to very severe COPD carried out two high-intensity constant work-rate exercise tests (CWRET) with and without NHF on two consecutive days. The primary outcome was the mean difference in endurance time between both conditions. The secondary aims included vastus lateralis oxygenation (StO2 ), dyspnoea, leg discomfort, maximal inspiratory pressure (MIP), transcutaneous CO2 pressure (PtcCO2 ), respiratory rate (RR), heart rate (HR) and pulsed O2 saturation (SpO2 ), as well as the patients' opinions of the device. Results A total of 19 patients were included (mean forced expiratory volume in 1 s = 28.7 ± 10.8%, age = 62.1 ± 9.1 years). No significant differences in endurance time during the CWRET were found between the two test conditions (-66.58 (95% CI: -155.9 to 22.7) s, P = 0.12). StO2 , PtCO2 and HR were reduced at the end of the exercise with NHF (-2.1% (95% CI: -4.3 to -0.0); -1.3 mm Hg (95% CI: -2.5 to -0.2); -2.7 bpm (95% CI: -5.0 to -0.5), respectively, P ≤ 0.05). No significant differences were found for any of the other secondary outcomes. Half of the patients evaluated the device as being moderately to very uncomfortable. Conclusion NHF during exercise did not increase endurance time in patients with COPD following exacerbation. Clinical trial registration NCT03058081 at clinicaltrials.gov.

Early diagnosis of COPD exacerbations is vital. Exacerbations are characterised by an increase in dyspnoea that could be affect physical capacity. Changes in the physical capacity of patien...

We previously showed that functional electrical stimulation during cycle ergometry (FES-cycling) increased oxygen consumption (VO2), indicating that metabolism during exercise was increased. Howeve...

Questions: Can people referred to pulmonary rehabilitation easily learn to use a system for remote transmission of oximetry data? Do they consider remote transmission of oximetry data to be satisfactory? Are the transmitted data valid compared with locally stored data? Design: Multicentre, prospective, observational study. Participants: One hundred and five adults with chronic respiratory disease who were referred to pulmonary rehabilitation. Intervention: At an initial session, participants were taught to record and transmit their oximetry data to a remote server. At subsequent testing session(s), participants were requested to independently activate and use the oximetry monitoring system for a period of exercise on a cycle ergometer, until autonomy with the system was demonstrated. A subgroup of five participants undertook five 45-minute training sessions to generate a dataset to assess whether the transmitted data were valid compared with the locally stored data. Outcome measures: Outcome measures included the number of sessions needed to become autonomous, participant satisfaction with the system, and measures of the validity of the transmitted data. Results: Participants became autonomous quickly: 86% at the first testing session and 100% within three testing sessions. At least 98% of participants agreed that the system was easy to use and they would be willing to use it throughout pulmonary rehabilitation. The system transmitted usable data from 98% (95% CI 96 to 100) of sessions and introduced minimal artefact. Mean absolute differences were 0.365 beats/minute for heart rate and 0.133% for oxyhaemoglobin saturation. For heart rate, exact agreement was 72% (SD 9) and similar agreement (within 3 beats/minute) was 99% (SD 1). For oxyhaemoglobin saturation, exact agreement was 87% (SD 3) and similar agreement (within 3%) was 100% (SD 0). Conclusion: The telemonitoring system used in this study was sufficiently valid and acceptable for use in at-home pulmonary rehabilitation by people with chronic respiratory disease. Study registration: ClinicalTrials.gov NCT03295474 and NCT03004716 (subgroup study). Key words: Pulmonary rehabilitation, Telemonitoring, Telerehabilitation, Exercise, Physical therapy

Objective The aim of this pilot study was to assess physical fitness and its relationship with functional dyspnea in survivors of COVID-19 6 months after their discharge from the hospital. Methods Data collected routinely from people referred for cardiopulmonary exercise testing (CPET) following hospitalization for COVID-19 were retrospectively analyzed. Persistent dyspnea was assessed using the modified Medical Research Council dyspnea scale. Results Twenty-three people with persistent symptoms were referred for CPET. Mean modified Medical Research Council dyspnea score was 1 (SD = 1) and was significantly associated with peak oxygen uptake (VO2peak; %) (rho = −0.49). At 6 months, those hospitalized in the general ward had a relatively preserved VO2peak (87% [SD = 20]), whereas those who had been in the intensive care unit had a moderately reduced VO2peak (77% [SD = 15]). Of note, the results of the CPET revealed that, in all individuals, respiratory equivalents were high, power-to-weight ratios were low, and those who had been in the intensive care unit had a relatively low ventilatory efficiency (mean VE/VCO2 slope = 34 [SD = 5]). Analysis of each individual showed that none had a breathing reserve 90%. Conclusion At 6 months, persistent dyspnea was associated with reduced physical fitness. This study offers initial insights into the mid-term physical fitness of people who required hospitalization for COVID-19. It also provides novel pathophysiological clues about the underlaying mechanism of the physical limitations associated with persistent dyspnea. Those with persistent dyspnea should be offered a tailored rehabilitation intervention, which should probably include muscle reconditioning, breathing retraining, and perhaps respiratory muscle training. Impact This study is the first, to our knowledge, to show that a persistent breathing disorder (in addition to muscle deconditioning) can explain persistent symptoms 6 months after hospitalization for COVID-19 infection and suggests that a specific rehabilitation intervention is warranted.

Background Few studies have evaluated muscle strength in COVID-19 ICU survivors. We aimed to report the incidence of limb and respiratory muscle weakness in COVID-19 ICU survivors. Method We performed a cross sectional study in two ICU tertiary Hospital Settings. COVID-19 ICU survivors were screened and respiratory and limb muscle strength were measured at the time of extubation. An ICU mobility scale was performed at ICU discharge and walking capacity was self-evaluated by patients 30 days after weaning from mechanical ventilation. Results Twenty-three patients were included. Sixteen (69%) had limb muscle weakness and 6 (26%) had overlap limb and respiratory muscle weakness. Amount of physiotherapy was not associated with muscle strength. 44% of patients with limb weakness were unable to walk 100 m 30 days after weaning. Conclusion The large majority of COVID-19 ICU survivors developed ICU acquired limb muscle weakness. 44% of patients with limb weakness still had severely limited function one-month post weaning.

Background Little interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to investigate the relationship between MEP and critical outcomes. Methods This work was a secondary analysis of a prospective, observational study of adult patients who required mechanical ventilation for ≥ 24 h in an 18-bed ICU. MEP was assessed before extubation after a successful, spontaneous breathing trial. The relationships between MEP and extubation failure, and short-term (30 days) mortality, were investigated. Univariate logistic regressions were computed to investigate the relationship between MEP values and critical outcomes. Two multivariate analyses, with and without maximal inspiratory pressure (MIP), both adjusted using principal component analysis, were undertaken. Unadjusted and adjusted ROC curves were computed to compare the respective ability of MEP, MIP and the combination of both measures to discriminate patients with and without extubation failure or premature death. Results One hundred and twenty-four patients were included. Median age was 66 years (IQR 18) and median mechanical ventilation duration was 7 days (IQR 6). Extubation failure rate was 15% (18/124 patients) and the rate for 30-day mortality was 11% (14/124 patient). Higher MEP values were significantly associated with a lower risk of extubation failure in the univariate analysis [OR 0.96 95% CI (0.93–0.98)], but not with short-term mortality. MEP was independently linked with extubation failure when MIP was not included in the multivariate model, but not when it was included, despite limited collinearity between these variables. This study was not able to differentiate the respective abilities of MEP, MIP, and their combination to discriminate patients with extubation failure or premature death (adjusted AUC for the combination of MEP and MIP: 0.825 and 0.650 for extubation failure and premature death, respectively). Conclusions MEP is related to extubation failure. But, the results did not support its use as a substitute for MIP, since the relationship between MEP and critical outcomes was no longer significant when MIP was included. The use of MIP and MEP measurements combined did not reach higher discriminative capacities for critical outcomes that MEP or MIP alone. Trial Registration This study was retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1 (NCT02363231) in 13 February 2015

BACKGROUND: Maximal oxygen consumption (V(˙) O(2max)) is the most frequently used variable to determine postoperative risk in patients with non-small cell lung cancer (NSCLC), however patients frequently cannot provide the necessary maximum effort to ensure the validity of the V(˙) O(2) measurements. The aim of this observational study was to assess exercise-limiting factors and the rate of achievement of the currently recommended maximality criteria in patients with NSCLC who had been routinely referred for cardiopulmonary exercise testing (CPET) to assess their postoperative risk. METHODS: Patient data, including peak exercise variables and markers used to designate the exercise test as maximal, were retrospectively analysed from 203 preoperative CPET assessments that were performed at Rouen University Hospital from January 2014 until July 2019. RESULTS: Ventilatory limitation was the most common physiological cause of exercise cessation. A total of 62 patients (or 30.5%) achieved either one, or no, markers of maximality. The mean duration of the incremental phase (after the 3-minute warm-up) was 5.1±2 minutes. CONCLUSIONS: About 30% of the patients in this study did not generate maximum effort during CPET. As a result, it is likely that their V(˙) O(2peak) was underestimated and that their post-operative risk was overestimated. It is therefore important to incorporate strategies to verify V(˙) O(2peak) results for patients with (values) close to the risk threshold.

Introduction: TBM can be treated by noninvasive positive airway stenting with the use of portable continuous positive airway pressure (CPAP) devices. CPAP improves exercise tolerance. However, the level of EPAP can be challenging to determine. Our aim was to determine if the level of EPAP required to stent the trachea was correlated to the improvement in exercise capacity. Methods: We retrospectively reviewed the recordings of bronchoscopy performed for the clinical management of patients with TBM referred for CPAP initiation. During the bronchoscopy, the EPAP level was titrated by 5cmH2O increments from 5cmH2O to 20cmH2O. We measured: the decrease in lumen area (DLA) from inspiration to expiration, the angulation α between the posterior and the lateral wall during expiration as well as the anteroposterior distance (apD). These measurements were made during tidal breathing. They were compared to the improvement in the 6-minute walking distance (6MWD) achieved with CPAP. Results: Our cohort consisted of 16 patients. The use of portable CPAP improved by 33m [11 – 53] when compared to self-ventilation (p=0.01). At 5cmH2O, the EPAP did not change the DLA nor the α angle or the apD. At 10cmH2O and above a significant improvement was seen in all these parameters (p Conclusion: Our results suggest that a significant level of EPAP is required to improve the exercise capacity of patients with TBM.

Introduction: TBM is defined by a 50% reduction of the trachea lumen during expiration. However, no data supports this threshold and it may not reflect exercise limitation. The aim of our study was to assess whether endoscopic morphometric parameters could predict exercise limitation in these patients. Methods: We reviewed all the endoscopic recordings of patients referred in our center for the clinical management of TBM between January 2017 and January 2019. For each patient, we measured: the decrease in lumen area (DLA) from inspiration to expiration, the angulation α between the posterior and the lateral wall during expiration as well as the anteroposterior distance (apD). These measurements were made during tidal breathing (TB) and during forced vital capacity maneuvers (FVC). These measurements were compared to the 6-minute walking distance (6MWD) whilst self-venting. Results: We included 16 patients. The DLA was 24±8% during TB and 38±10% during FVC (p Conclusion: The 50% expiratory collapse commonly used to diagnose TBM is poorly correlated to exercise limitation. Airway collapse during TB is correlated to the 6MWD and therefore may be a more relevant marker of the burden of the disease.

Pulmonary rehabilitation (PR) is an evidence-based intervention to manage symptoms related to chronic obstructive respiratory diseases (CORD). Paradoxically, few people with CORD actually engage in PR, and of those, up to one-third do not complete the program. Additionally, some of those who complete the program do not achieve worthwhile benefits. Therefore, the main challenge for the next decades is to offer PR to as many people (that would potentially benefit from it) as possible. This raises questions about factors influencing participation, completion, and responsiveness to PR programs. Among these factors, urinary incontinence (UI) is highly prevalent among people with CORD (much more than in the general population) and may worsen during PR exercise sessions. Paradoxically, UI is poorly explored in routine and scarcely assessed in research, and none of the actual guidelines about PR mention it. However, its potential influence on engagement, completion, and response to PR is of real concern. Therefore, the aim of this perspective is to describe the mechanisms of UI, particularly in the context of CORD, as well as to highlight its prevalence among people with CORD, their burden, and how it could affect a PR approach based on sustained and regular physical activity.

Background Peak oxygen uptake (V˙O2peak) measured by a cardiopulmonary exercise test (CPX) is the gold‐standard for predicting surgical risk in patients with non‐small cell lung cancer (NSCLC). The 3‐minute chair rise test (3CRT) is a simple test requiring minimal resources. This study aimed to determine the ability of 3CRT to predict V˙O2peak in patients with NSCLC. Methods Retrospective data from CPX and 3CRT carried out in 36 patients with NSCLC between March 2018 and February 2019 were included. A multivariate analysis was undertaken to derive a predictive V˙O2peak equation based on performance on the 3CRT. In addition, sensitivity‐specificity analysis was carried out to estimate a threshold 3CRT value for the prediction of V˙O2peak ≥ 15 mL/kg/minute. Results The following equation was obtained: V˙O2peak predicted = (0.04765 × FEV1) ‐ (0.207 59 × BMI) ‐ (0.115 89 × age) + (0.386 09 × vertical distance) + 16.628 69; r2 = 0.75, P, Cardiopulmonary exercise test can stratify surgical risk. Prediction of the peak oxygen uptake (V˙O2peak) value from the 3CRT yields an unacceptable level of error. Reach 49 chair rises or more during the 3CRT predict a V˙O2peak ≥ 15 ml/kg/min.

La méthode retenue pour cette réponse rapide est basée sur une synthèse des données probantes disponibles les plus pertinentes, les recommandations nationales et internationales, ainsi que sur une consultation des parties prenantes. Ce document a été élaboré collégialement entre la HAS, le Conseil national de l’ordre des masseurs-kinésithérapeutes et les référents des CNP et sociétés savantes : CMK, GKR-SPLF, SFP, SKR. Validation par le collège de la HAS en date du 16 avril 2020.

Objective To evaluate the effect of quadriceps functional electrical stimulation (FES)-cycling on exertional oxygen uptake ( V ˙ o 2 ) compared with placebo FES-cycling in patients with chronic obstructive pulmonary disease (COPD). Design A randomized, single-blind, placebo-controlled crossover trial. Setting Pulmonary rehabilitation department. Participants Consecutive patients (N=23) with COPD Global Initiative for Chronic Obstructive Lung Disease stage 2, 3, or 4 (mean forced expiratory volume during the first second, 1.4±0.4L [50.3% predicted]) who had recently begun a respiratory rehabilitation program. Intervention Two consecutive 30-minute sessions were carried out at a constant load with active and placebo FES-cycling. Main Outcome Measures The primary outcome was mean V ˙ o 2 during the 30-minute exercise session. The secondary outcomes were respiratory gas exchange and hemodynamic parameters averaged over the 30-minute endurance session. Lactate values, dyspnea, and perceived muscle fatigue were evaluated at the end of the sessions. Results FES-cycling increased the physiological response more than the placebo, with a greater V ˙ o 2 achieved of 36.6mL/min (95% confidence interval [CI], 8.9–64.3mL/min) ( P =.01). There was also a greater increase in lactate after FES-cycling (+1.5mmol/L [95% CI, .05–2.9mmol/L]; P =.01). FES-cycling did not change dyspnea or muscle fatigue compared with the placebo condition. Conclusions FES-cycling effectively increased exercise intensity in patients with COPD. Further studies should evaluate longer-term FES-cycling rehabilitation programs.

Background Assessment of maximum respiratory pressures is a common practice in intensive care because it can predict the success of weaning from ventilation. However, the reliability of measurements through an intubation catheter has not been compared with standard measurements. The aim of this study was to compare maximum respiratory pressures measured through an intubation catheter with the same measurements using a standard mouthpiece in extubated patients. Methods A prospective observational study was carried out in adults who had been under ventilation for at least 24 h and for whom extubation was planned. Maximal respiratory pressure measurements were carried out before and 24 h following extubation. Results Ninety patients were included in the analyses (median age: 61.5 years, median SAPS2 score: 42.5 and median duration of ventilation: 7 days). Maximum respiratory pressures measured through the intubation catheter were as reliable as measurements through a standard mouthpiece (difference in maximal inspiratory pressure: mean bias = − 2.43 ± 14.43 cmH2O and difference in maximal expiratory pressure: mean bias = 1.54 ± 23.2 cmH2O). Conclusion Maximum respiratory pressures measured through an intubation catheter were reliable and similar to standard measures. Clinical trial registration Retrospectively Registered in ClinicalTrials.gov (NCT02363231).

Purpose Diaphragm paresis (DP) is characterized by abnormalities of respiratory muscle function. However, the impact of DP on exercise capacity is not well known. This study was performed to assess exercise tolerance in patients with DP and to determine whether inspiratory muscle function was related to exercise capacity, ventilatory pattern and cardiovascular function during exercise. Methods This retrospective study included patients with DP who underwent both diaphragmatic force measurements, and cardiopulmonary exercise testing (CPET). Results Fourteen patients were included. Dyspnea was the main symptom limiting exertion (86%). Exercise capacity was slightly reduced (median VO2peak: 80% [74.5%–90.5%]), mostly due to ventilatory limitation. Diaphragm and overall inspiratory muscle function were correlated with exercise ventilation. Moreover, overall inspiratory muscle function was related with oxygen consumption (r = 0.61) and maximal workload (r = 0.68). Conclusions DP decreases aerobic capacity due to ventilatory limitation. Diaphragm function is correlated with exercise ventilation whereas overall inspiratory muscle function is correlated with both exercise capacity and ventilation suggesting the importance of the accessory inspiratory muscles during exercise for patients with DP. Further larger prospective studies are needed to confirm these results.

Pulmonary rehabilitation (PR) improves outcomes in patients with chronic obstructive pulmonary disease (COPD). Optimal assessment includes cardiopulmonary exercise testing (CPET), but consultations are limited. Field tests could be used to individualize PR instead of CPET. The six-minute stepper test (6MST) is easy to set up and its sensitivity and reproducibility have previously been reported in patients with COPD. The aim of this study was to develop a prediction equation to set intensity in patients attending PR, based on the 6MST. The following relationships were analyzed: mean heart rate (HR) during the first (HR1-3) and last (HR4-6) 3 minutes of the 6MST and HR at the ventilatory threshold (HRvt) from CPET; step count at the end of the 6MST and workload at the Ventilatory threshold (VT) (Wvt); and forced expiratory volume in 1 second and step count during the 6MST. This retrospective study included patients with COPD referred for PR who underwent CPET, pulmonary function evaluations and the 6MST. Twenty-four patients were included. Prediction equations were HRvt = 0.7887 × HR1-3 + 20.83 and HRvt = 0.6180 × HR4-6 + 30.77. There was a strong correlation between HR1-3 and HR4-6 and HRvt (r = 0.69, p < 0.001 and r = 0.57, p < 0.01 respectively). A significant correlation was also found between step count and LogWvt (r = 0.63, p < 0.01). The prediction equation was LogWvt = 0.001722 × step count + 1.248. The 6MST could be used to individualize aerobic training in patients with COPD. Further prospective studies are needed to confirm these results.

In this randomised, crossover trial, 22 patients with severe chronic obstructive pulmonary disease climbed six flights of stairs (108 steps) twice, under two test conditions: (1) energy conservation technique (ECT): participants were asked to rest for at least 5 seconds every three steps and (2) control condition: participants climbed the stairs at their own pace. Significant lower dyspnoea (primary outcome), leg discomfort, minute ventilation and capillary blood lactate under the ECT condition were found, with no change in total task time.Clinical trial registrationNCT03564028

Introduction: EDAC is a rare condition for which treatment options are sparse. Pneumatic airway stenting using CPAP is a non invasive treatment approach. Using portable CPAP devices with built-in battery during exercise may help to improve breathlessness in patients with EDAC. The aim of our study was to assess the improvement in exercise capacity in patients with EDAC. Methods: Retrospective monocentric study including patients referred for suspicion of EDAC between 01/2017 and 02/2019 that underwent bronchoscopy that confirmed EDAC. Results: Out of the 30 patients referred, 27 had EDAC. Patients had a mean age of 65±11 with a BMI of 28±6kg/m2. EDAC was idiopathic in 4 patients and secondary to COPD (n:10), obesity (n:8), asthma (n:4) and lung transplantation (n:1). At rest, mMRC dyspnea scale was 3.2±1.0. Health-related quality of life assessed by the severe respiratory insufficiency questionnaire was low: 46±17. Daytime arterial blood gases were: pH: 7.42±0.06, PaCO2: 5.4±1.4kPa, PaO2: 11.0±4.0kPa. Lung function tests results were: FEV1:1.5±0.7L (63±34%), FVC: 2.3±0.7L (77±27%), FEV1/FVC:69±23%. Tracheal lumen reduction was estimated at 36±23% at rest. Level of positive expiratory pressure requires to counterbalance expiratory collapse was 13±4cmH2O. Distance achieved on the 6 minute-walking test (6MWT) on room air was 280m [158 – 346] (52±27%). Distance improved significantly with CPAP: +32m [8 – 53] (p:0.003). Dyspnea (Borg scale) at the end of 6MWT did not improve significantly: -1.5 [-2 – 3] (p:0.405). Conclusion: Portable CPAP improves exercise capacity in patients with EDAC and may enhance benefits of pulmonary rehabilitation in those patients.

Objective Cardiopulmonary exercise testing (CPET) for patients awaiting lung resection for non–small cell lung cancer (NSCLC) has developed considerably in recent years. Pulmonary rehabilitation before surgery (prehabilitation) improves postoperative risk factors such as forced expiratory volume in 1 second and peak oxygen consumption (VO2peak). Ventilatory inefficiency assessed according to the linear regression of the ratio between the increase in minute ventilation and the expired carbon dioxide flow during CPET (VE/VCO2 slope) >35, is a high-risk factor for postoperative complications. Our objective was to assess the effect of prehabilitation on VE/VCO2 slope, and its relationship with VO2peak. Methods This retrospective cohort study was performed between January 1, 2014 and December 31, 2017 at Rouen University Hospital. One hundred fifty-two patients with NSCLC awaiting lung surgery who underwent CPET were screened. A total of 50 patients who underwent CPET before and after prehabilitation were included. Results VE/VCO2 slope did not change significantly after prehabilitation (median, 37.1 [25th-75th percentile, 33.8-43.4] vs median, 35.4 [25th-75th percentile, 31.1-40.5]; P = .09), whereas VO2peak increased significantly (from a median of 13.2 [25th-75th percentile, 11.9-14.7] to a median of 14.8 [25th-75th percentile, 13.1-16.4] mL/kg/min). The number of patients with a high risk of postoperative complications (ie, VE/VCO2 slope >35) did not change significantly after prehabilitation. Cardiorespiratory parameters improved significantly more in patients who underwent at least 15 sessions of ambulatory prehabilitation. Conclusions VE/VCO2 slope, a known predictor of favorable surgical outcomes in patients with NSCLC, did not change with the prehabilitation program used in this study, despite clear improvements in VO2peak and other CPET measures. Larger, prospective studies are needed to confirm the results of this study.

Muscle group III (Aδ fibres) and IV (C fibres) sensory afferents are involved in the cardiorespiratory adaptation to exercise [1, 2]. Their inhibition with intrathecal fentanyl in the dorsal horn of spinal cord to block their cortical projections decreases high intensity constant workload endurance performance in healthy athlete subjects because of a blunted cardiorespiratory response to exercise. In this condition with high metabolic demand, any decrease in ventilation or hemodynamics would compromise performance because of a nearly maximal solicitation without any possibility for a compensatory strategy. At the opposite, Gagnon et al . have published that the use of spinal anesthesia with fentanyl with the goal of inhibiting muscle group III and IV fibres in COPD patients improved dyspnea and endurance capacity [3]. This improvement was due to the blunted ventilatory response to exercise which improved physiological dead space, ventilatory efficiency and in turn, dyspnea. Moreover, at this relatively lower external workload compared with healthy subjects, cardiac output and peripheral oxygen extraction were not maximal and any mitigation in cardiac output (if any) would be overcome by an increase in peripheral muscle oxygen extraction [3]. High frequency (HF) or low frequency (LF) transcutaneous electrical nerve stimulation (TENS) is a less invasive alternative that also activate opioid receptors, especially those located in the dorsal horn of the spinal cord [1, 4, 5]. This approach deserves to be studied during exercise and over a course of pulmonary rehabilitation in these patients. We performed a randomised double-blind study (clinicaltrials.gov; [NCT03312322][1]) aimed to assess whether either HF or LF lumbar TENS could improve endurance exercise capacity in patients with COPD. Secondary objectives were to assess the influence of lumbar TENS on perceived exertion, ventilatory pattern and muscle oxygenation. We hypothesised that endurance capacity would be improved with lumbar TENS due to a blunted response in exercise ventilation which would contribute to improve ventilatory efficacy and reduce exercise dyspnoea. On the other hand, we hypothesised that any mitigation in cardiac output (if any) would be compensated by an increase in peripheral muscular oxygen extraction. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Bonnevie has nothing to disclose. Conflict of interest: Dr. Gravier has nothing to disclose. Conflict of interest: Dr. Prieur has nothing to disclose. Conflict of interest: Dr. Combret has nothing to disclose. Conflict of interest: Dr. Debeaumont has nothing to disclose. Conflict of interest: Dr. Patout reports grants from B&D Electromedical, personal fees from ResMed , personal fees from Philips Respironics, grants and non-financial support from Fisher & Paykel, non-financial support from MSD, non-financial support from Asten, grants from ADIR Association, during the conduct of the study. Conflict of interest: Dr. Lamia has nothing to disclose. Conflict of interest: Dr. Muir has nothing to disclose. Conflict of interest: Dr. Medrinal has nothing to disclose. Conflict of interest: Dr. Cuvelier has nothing to disclose. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03312322&atom=%2Ferj%2Fearly%2F2019%2F09%2F02%2F13993003.00784-2019.atom

Tristan Bonnevie,1,2 Mathilde Allingham,3 Guillaume Prieur,1,4 Yann Combret,5,6 David Debeaumont,7 Maxime Patout,1,8 Antoine Cuvelier,1,8 Catherine Viacroze,8 Jean-François Muir,1,2,8 Clement Medrinal,1,4 Francis-Edouard Gravier1,2 1Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France; 2ADIR Association, Rouen University Hospital, Rouen, France; 3Rouen University Hospital, School of Physiotherapy, Rouen, France; 4Intensive Care Unit Department, Le Havre Hospital, Hôpital Jacques Monod, Montivilliers, France; 5Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium; 6Physiotherapy Department, Le Havre Hospital, Le Havre, France; 7Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France; 8Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France Purpose: There are many barriers to pulmonary rehabilitation, including a limited access to evaluation centers. To cope with these difficulties, field tests are often used to prescribe endurance training. As field tests are related to muscle strength, they could also be used to prescribe strength training and increase the access to pulmonary rehabilitation in rural area. However, their validity for this purpose has never been studied.Patients and methods: The relationship between the 6-minute stepper test (6MST), 6-minute walk test, maximal workload achieved during cardiopulmonary exercise testing (Wpeak), and one repetition maximum (1RM) was assessed in 35 patients with COPD through a retrospective chart review to derive predictive equation of the 1RM from these tests. The effectiveness of these equations to prescribe strength training at 70% of the 1RM was assessed in an independent cross-validation group of 34 patients with COPD.Results: There was a moderate relationship between the 6MST, Wpeak and the 1RM (r=0.44 and r=0.41, respectively, both P≤0.01). Whatever the test, the prescription of strength training using the estimated 1RM compared with the measured 1RM resulted in a mean absolute difference and a mean bias of about 30 kg.Conclusion: The use of the 6MST and Wpeak for the prescription of strength training would result in a clinically not acceptable error. Therefore, they should not be used as a substitute for the 1RM to prescribe strength training. Keywords: six-minute stepper test, strength training, COPD, pulmonary rehabilitation &nbsp

Background Functional exercise capacity assessment is recommended in children with cystic fibrosis (CF). The six-minute walk test (6MWT) is a valid evaluation of exercise capacity but can be technically complex. Inversely, the sit-to-stand test (STST) is a simple method to evaluate exercise capacity, and is validated in healthy children and adults with CF. This study aimed to evaluate STST measurement properties in children and adolescents with CF. Methods In this multicenter study, children with CF (6 to 18 years) performed two iterations of both the STST and the 6MWT in a randomized order. Criterion validity was determined by assessing correlations between STST repetitions and 6MWT distance (6MWD). Intra-rater reliability, test-retest repeatability, mean bias and limits of agreement were also assessed. Relationships with other outcomes (i.e. respiratory and quadriceps muscle strength) and cardio-respiratory responses were analysed for both tests. Results Thirty-six children with CF were included (mean age 12.0 ±3.5 years and FEV1 95.8 ±25.0%). On average, 39.6 ±10.5 repetitions were performed during the STST and mean 6MWD was 596.0 ±102.6 meters. STST number of repetitions was significantly correlated with 6MWD (r = 0.48; pSTST = 0.91 (95%CI 0.76–0.96) and ICC6MWT = 0.94 (95%CI 0.85–0.97)), and a significant test-retest learning effect. The number of STST repetitions was not correlated with quadriceps or respiratory muscle strength test, and the STST induced fewer cardio-respiratory responses than the 6MWT. Conclusions The STST is an easy-to-use functional test with moderate criterion validity when compared to the 6MWT in children with CF, probably because both tests measure different components of functional exercise capacity. The STST is useful when the 6MWT is unfeasible, however further investigations are required to explore the clinical implications of STST results in children with CF. Clinical trial registration NCT03069625.

Dos Santos et al conducted a thorough randomised controlled trial with high methodological quality, in which they attempted to evaluate whether mobilisation and respiratory techniques shorten the drainage period and length of hospital stay in patients with pleural effusion. Their second objective was to evaluate whether such a strategy combined with continuous positive airway pressure (CPAP) could further improve the benefits. [...]

Resume Introduction La rehabilitation respiratoire est aujourd’hui incontournable dans le traitement des patients atteints de bronchopneumopathie chronique obstructive (BPCO). Certains patients presentent cependant une limitation respiratoire telle qu’il est parfois impossible d’atteindre un niveau de reentrainement suffisant pour obtenir des benefices physiologiques. Etat des connaissances Chez les patients atteints de BPCO, la modification des debits ainsi que des facteurs biomecaniques induits par la distension limitent l’adaptation ventilatoire a l’effort. Le recours a une ventilation non invasive (VNI) a ete evalue chez les patients obstructifs lors de l’effort. Les auteurs rapportent des effets positifs sur la charge de travail des muscles respiratoires ainsi que les parametres physiologiques et la dyspnee. Les donnees restent insuffisantes pour permettre de determiner un quelconque effet de la VNI au terme d’un programme complet de rehabilitation respiratoire. Perspectives Au regard de son caractere chronophage, il s’avere necessaire de mettre en evidence les criteres permettant de cibler les patients « repondeurs ». Conclusions L’utilisation de la VNI lors du reentrainement a l’effort vise a s’affranchir de la dyspnee afin de permettre une sollicitation musculaire plus importante. A ce jour, il apparait necessaire de poursuivre les evaluations au cours de la rehabilitation respiratoire.

Resume L’hospitalisation en reanimation et l’alitement des patients qui en decoule entrainent une complication majeure nommee : « Neuro-myopathie acquise en reanimation ». En plus de l’atteinte musculaire peripherique, le diaphragme est egalement atteint. Plusieurs facteurs sont associes dans cette atteinte mais l’alitement et l’inactivite physique sont principalement decrits. Les kinesitherapeutes sont en premiere ligne pour lutter contre cette complication via la rehabilitation precoce. Niveau de preuve Non adapte.

Noninvasive ventilation (NIV) during exercise has been suggested to sustain higher training intensity but the type of NIV interface, patient-ventilator asynchronies (PVA) or technological limitation of the ventilator may interfere with exercise. We assessed whether these parameters affect endurance exercise capacity in severe COPD patients. In total, 21 patients with severe COPD not eligible to home NIV performed three constant workload tests. The first test was carried out on spontaneous breathing (SB) and the following ones with NIV and a nasal or oronasal mask in a randomized order. PVA and indicators of ventilator performance were assessed through a comprehensive analysis of the flow pressure tracing raw data from the ventilator. The time limit was significantly reduced with both masks (406 s (197&ndash, 666), 240 s (131&ndash, 385) and 189 s (115&ndash, 545), p &lt, 0.01 for tests in SB, with oronasal and nasal mask, respectively). There were few PVA with an oronasal mask (median: 3.4% (1.7&ndash, 5.2)) but the ventilator reached its maximal generating capacity (median flowmax: 208.0 L/s (189.5&ndash, 224.8) while inspiratory pressure dropped throughout exercise (from 10.1 (9.4&ndash, 11.4) to 8.8 cmH2O (8.6&ndash, 10.8), p &lt, 0.01). PVA were more frequent with nasal mask (median: 12.8% (3.2&ndash, 31.6), p &lt, 0.01). Particularly, the proportion of patients with ineffective efforts &gt, 10% was significantly higher with nasal interface (0% versus 33.3%, p &lt, 0.01). NIV did not effectively improve endurance capacity in COPD patients not acclimated to home NIV. This was due to a technological limitation of the ventilator for the oronasal mask and the consequence either of an insufficient pressure support or a technological limitation for the nasal mask.