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Purpose: We aimed to elicit patients' views of research priorities related to pulmonary rehabilitation (PR). Method:We used a modified nominal group technique in which participants with chronic lung conditions who had completed PR attended one of five meetings during which they generated ideas, discussed them with the group, and prioritized their top three topics. Afterward, they completed member checking and satisfaction questionnaires. Results:Fourteen participants (mean age 71 years) prioritized 25 topics, which included music as a motivator, education about the reason for various assessments and exercises, and ongoing patient assessment and follow-up. Most participants "totally agreed" that the summarized topics matched what they thought was important in PR research (75%) and that the meeting was a positive experience (100%). Participants indicated that the findings of this study accurately reflected their priorities. Conclusions:Individuals who have completed PR may have questions about programme components including assessment, treatment, and strategies for promoting motivation. To inform future research projects and identify knowledge translation needs, we will distribute a questionnaire to a larger sample of former PR patients to further prioritize the 25 topics identified in the meetings. Objectif : connaître les points de vue des patients sur les priorités de la recherche en réadaptation pulmonaire (RP). Méthodologie : les chercheurs ont utilisé une technique de groupe nominale modifiée selon laquelle les participants atteints d'une pneumopathie chronique qui ont effectué une RP ont assisté à l'une des cinq rencontres pour générer des idées, en parler en groupe et prioriser leurs trois thèmes principaux. Ils ont ensuite rempli les questionnaires de vérification et de satisfaction des membres. Résultats : quatorze participants (d'un âge moyen de 71 ans) ont priorisé 25 thèmes, qui incluaient la musique comme élément motivateur, l'éducation sur la raison des diverses évaluations et des divers exercices ainsi que l'évaluation et le suivi continus des patients. La plupart des participants étaient « totalement d'accord » avec le fait que les thèmes résumés correspondaient à ce qu'ils considéraient comme important en recherche sur la RP (75 %) et que la rencontre était une expérience positive (100 %). Les participants ont indiqué que les résultats de cette étude étaient un reflet exact de leurs priorités. Conclusions : les personnes qui ont effectué la RP peuvent avoir des questions sur les éléments du programme, y compris l'évaluation, le traitement et les stratégies pour promouvoir la motivation. Afin d'éclairer les projets de recherche et de déterminer les besoins en application des connaissances, les chercheurs distribueront un questionnaire à un plus grand échantillon d'anciens patients en RP afin de mieux prioriser les 25 thèmes établis pendant les rencontres. [ABSTRACT FROM AUTHOR]

Motivators and barriers to exercise participation in women with coronary artery disease remain poorly understood. With evidence suggesting that women with coronary artery disease are less likely to adhere to exercise during cardiac rehabilitation and are more likely to drop out, it is important to understand these factors in order to optimize cardiac rehabilitation programs for women. We contribute to the discussion by presenting findings from a qualitative study using two focus groups with nine women with coronary artery disease sharing their experiences with attending cardiac rehabilitation and exercising in this setting, in addition to their perceived motivators and barriers to performing aerobic interval training. Focus group transcripts were analysed using a deductive thematic approach with Bandura's Social Cognitive Theory as the guiding conceptual framework. Four themes were identified regarding the attitudes and experiences of attending and exercising at cardiac rehabilitation, while five themes capturing the motivators and barriers for these women to perform aerobic interval training were identified for the first time. These novel themes encompassed the daunting nature of it, the physical discomfort associated with it, and conversely, the potential sense of enjoyment and accomplishment that it could bring. This study demonstrates the complexity of implementation of aerobic interval training into clinical practice, and suggests that further research is warranted to explore this domain. Despite challenges in feasibility of conducting a randomised controlled trial in female patients with coronary artery disease examining the effects of aerobic interval training versus moderate-intensity continuous exercise on aerobic exercise capacity, there was a significant per protocol treatment effect of 0.95 ml·kg−1·min−1 in favour of aerobic interval training. The cardiac rehabilitation environment provides key facilitators and perceived benefits for exercising and attending cardiac rehabilitation for women, and thus emphasises the need for improving referral and enrolment processes specifically for women into cardiac rehabilitation programs. Aerobic interval training may elicit feelings of fear and physical discomfort, or may be precluded by comorbid conditions, therefore, judicious consideration must be taken in examining the suitability of implementation into clinical practice for each female patient. [ABSTRACT FROM AUTHOR]

Nonadherence to exercise is a main cause of reduced function for older adults with chronic disease following completion of rehabilitation. This quantitative study used a questionnaire to evaluate the barriers and facilitators to community-based exercise following rehabilitation, from the perspectives of older adults with chronic diseases and their healthcare professionals (HCPs). Questionnaires were administered one-on-one to 83 older adults and 35 HCPs. Those with chronic disease perceived cost (43%), travel time (43%), and physical symptoms (39%) as primary barriers to program participation, with similar perceptions across all chronic conditions. Access to a case manager (82%), a supported transition following rehabilitation (78%), and a condition-specific program (78%) were the primary facilitators. Significant between group differences were found between HCPs and older adults with chronic disease across all barriers (p < .001), with a greater number of HCPs perceiving barriers to exercise participation. There were no between-group differences in the perception of factors that facilitate participation in exercise. [ABSTRACT FROM AUTHOR]

Background: Aerobic exercise is used in the rehabilitation setting in people with interstitial lung disease (ILD), however little is known about interval exercise as a training strategy. The aim of this study was to compare the cardiorespiratory responses and preferences of a single bout of interval exercise with continuous exercise in individuals with advanced ILD. Methods: Peak work (Wpeak) was obtained from a cardiopulmonary exercise test (CPET). The total volume of prescribed exercise was matched between a bout of interval cycling (alternating 30 seconds at 100% of Wpeak: 30 seconds total rest × 20 min) and continuous cycling (50% of Wpeak × 20 min). Results: Nine lung transplant candidates with ILD were included: 4 men; 62 (6) years; forced vital capacity (FVC) 60% of predicted; and all using supplemental oxygen. Eight (89%) participants reported a preference for interval exercise and one reported no preference (p =.01). One participant required two unintended breaks during continuous exercise. There were no large differences between interval and continuous exercise although some trends emerged. Interval exercise resulted in a lower peak heart rate (124 (12) vs. 132 (15), p =.04) and a trend toward less oxygen desaturation (drop of 8 (4)% vs. 11 (5)%, p =.05) and lower end-exercise Borg leg fatigue (3.8 (2) vs. 4.4 (2), p =.05). End-exercise dyspnea was similar between both exercise modes. Conclusions: Interval exercise was well tolerated and preferred by participants with advanced ILD. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of this study was to investigate the strength of the relationships between self-efficacy and (i) functional exercise capacity and (ii) physical activity in chronic obstructive pulmonary disease (COPD), and whether self-efficacy assessment type (i.e., COPD symptoms, exercise-task, exercise-barrier, general, falls) and physical activity assessment type (i.e., self-report vs. objective) are moderators. A systematic search of COPD and self-efficacy concepts was conducted using eight databases from inception to 23 January 2019. Studies were included if they provided correlation coefficients of the relationship between self-efficacy and functional exercise capacity or physical activity, were conducted in adults diagnosed with COPD, and were published in English-language journals. A total of 14 correlation coefficients were included in the self-efficacy and functional exercise capacity meta-analysis, and 16 in the self-efficacy and physical activity meta-analysis. Data were screened, reviewed, and extracted independently by two reviewers, with discrepancies resolved by a third reviewer. Stronger self-efficacy was associated with better functional exercise capacity (weighted r = 0.38, 95%CI [0.25, 0.50]), and greater physical activity (weighted r = 0.25, 95%CI [0.17, 0.34]). Exercise-task self-efficacy had the strongest relationship to functional exercise capacity (weighted r = 0.64, 95% CI [0.51, 0.73]). For physical activity, the type of self-efficacy most strongly related was inconclusive. In COPD, self-efficacy has a relationship to functional exercise capacity and physical activity, the strength of which is influenced by the choice of self-efficacy measure. An understanding of these relationships will assist clinicians in selecting the self-efficacy measure most closely related to the outcome of interest. [ABSTRACT FROM AUTHOR]

To systematically review randomized controlled trials that compared the effectiveness of different types of exercise on the symptom of fatigue in individuals with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, EMcare, PsychINFO, and Cochrane library were searched from inception to October 2018. Studies were included if individuals with COPD were randomized into two or more physical exercise interventions that reported fatigue. Of the 395 full-texts reviewed, 17 studies were included. Fifteen studies reported the impact of exercise on health-related quality of life with fatigue as a subdomain. Reduction in fatigue was observed following endurance, resistance, or a combination of both exercises. There was no significant difference between continuous and interval training (n = 3 studies, pooled standardized mean difference (SMD) = -0.17, 95% CI = -0.47, 0.12, p = 0.25) or between endurance and resistance training (n = 3 studies, SMD = -0.35, 95% CI = -0.72, 0.01, p = 0.07) on fatigue in people with COPD. Fatigue reduction is not usually a primary outcome of exercise interventions, but it is frequently a secondary domain. The type of exercise did not influence the impact of exercise on fatigue, which was reduced in endurance, resistance, or a combination of both exercises, enabling clinicians to personalize training to match targeted outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The effectiveness of self-guided Internet-based lifestyle counseling (e-counseling) varies, depending on treatment protocol. Two dominant procedures in e-counseling are expert- and user-driven. The influence of these procedures on hypertension management remains unclear. The objective was to assess whether blood pressure improved with expert-driven or user-driven e-counseling over control intervention in patients with hypertension over a 4-month period.Study Design: This study used a three-parallel group, double-blind randomized controlled design.Setting/participants: In Toronto, Canada, 128 participants (aged 35-74 years) with hypertension were recruited. Participants were recruited using online and poster advertisements. Data collection took place between June 2012 and June 2014. Data were analyzed from October 2014 to December 2016.Intervention: Controls received a weekly e-mail newsletter regarding hypertension management. The expert-driven group was prescribed a weekly exercise and diet plan (e.g., increase 1,000 steps/day this week). The user-driven group received weekly e-mail, which allowed participants to choose their intervention goals (e.g., [1] feel more confident to change my lifestyle, or [2] self-help tips for exercise or a heart healthy diet).Main Outcome Measures: Primary outcome was systolic blood pressure measured at baseline and 4-month follow-up. Secondary outcomes included cholesterol, 10-year Framingham cardiovascular risk, daily steps, and dietary habits.Results: Expert-driven groups showed a greater systolic blood pressure decrease than controls at follow-up (expert-driven versus control: -7.5 mmHg, 95% CI= -12.5, -2.6, p=0.01). Systolic blood pressure reduction did not significantly differ between user- and expert-driven. Expert-driven compared with controls also showed a significant improvement in pulse pressure, cholesterol, and Framingham risk score. The expert-driven intervention was significantly more effective than both user-driven and control groups in increasing daily steps and fruit intake.Conclusions: It may be advisable to incorporate an expert-driven e-counseling protocol in order to accommodate participants with greater motivation to change their lifestyle behaviors, but more studies are needed.Trial Registration: This study is registered at www.clinicaltrials.gov NCT03111836. [ABSTRACT FROM AUTHOR]

To inform recommendations for the exercise component of a healthy lifestyle intervention for adults with obesity and treated obstructive sleep apnoea (OSA), we investigated the total energy expenditure (EE) and cardiorespiratory response to weight-supported (cycling) and unsupported (walking) exercise. Individuals with treated OSA and a body mass index (BMI) > 30 kg/m² performed an incremental cardiopulmonary exercise test on a cycle ergometer and a treadmill to determine the peak oxygen uptake (...O2pk). Participants subsequently completed two endurance tests on each modality, matched at 80% and 60% of the highest ...O2pk determined by the incremental tests, to intolerance. The cardiorespiratory response was measured and total EE was estimated from the ...O2. Sixteen participants completed all six tests: mean [SD] age 57 [13] years and median [IQ range] BMI 33.3 [30.8-35.3] kg/m². Total EE during treadmill walking was greater than cycling at both high (158 [101] vs. 29 [15] kcal; p < 0.001) and moderate (178 [100] vs. 85 [59] kcal; p = 0.002) intensities, respectively, with similar cardiorespiratory responses and pattern of EE during rest, exercise and recovery. Contrary to current guidelines, walking might be the preferred training modality to achieve the combination of weight loss and increased cardiorespiratory fitness in adults with obesity and treated OSA. [ABSTRACT FROM AUTHOR]

Background. The World Health Organization recognizes participation in meaningful life roles as a key component of health. However, the evidence base for interventions to improve participation remains inconclusive. In particular, whether exercise interventions improve participation in life roles is unclear. Purpose. The aim of this review was to evaluate the effect of physical exercise interventions on participation in life roles in older adults residing in the community. Data sources. The PubMed, Embase, CINAHL, Cochrane, and PEDro databases were searched from inception through March 2015. Study selection. Randomized controlled trials comparing the effects of an exercise intervention to usual care on participation in life roles in adults who were 60 years of age or older were included in this review. Data extraction. Teams of 2 investigators independently extracted data on participation. Methodological quality was appraised using the Cochrane tool for assessing the risk of bias. The protocol was registered with Prospero (CRD42014014880). Data synthesis. Eighteen randomized controlled trials with a total of 2,315 participants met the inclusion criteria. Standardized mean differences (SMDs) with 95% CIs were calculated using a random-effects model. A meta-analysis of 16 studies showed no overall effect of the exercise interventions on participation (SMD = 0.03; 95% CI = -0.10 to 0.16). Subgroup analysis showed that exercise interventions lasting 12 months or more had a small positive effect on participation (SMD = 0.15; 95% CI = 0.02 to 0.28). Limitations. Limitations included variability in definitions and measures of participation. Conclusions. In general, exercise interventions do not improve participation in life roles in older adults. The results do not support the implicit assumption that exercise-based interventions associated with improved function/activity also result in improved participation. Investigation of complex interventions that go beyond exercise to address participation in life roles for older adults is warranted. [ABSTRACT FROM AUTHOR]

Background Despite well-established improvements following rehabilitation, functional gains often diminish following discharge. Objective To explore the attitudes of older adults with HF and COPD, who have completed rehabilitation, toward community-based exercise maintenance. Methods Semi-structured interviews were conducted with 11 individuals with HF or COPD. Results Deductive thematic analysis uncovered three themes: 1) transitioning to community exercise is challenging, highlighting participants' struggle with unstructured maintenance and a lack of appropriate programs; 2) a structured, group-based program tailored to functional ability facilitates adherence, describing participants views on the importance of routine, and accountability; and 3) “We are all there for the same purpose” – participant support for integrated exercise, including the benefit of multiple perspectives and sustainability. Conclusions A motivating program leader and access to appropriate facilities are key features to support adherence to prescribed activity. Tailored programs can be delivered consecutively to older adults with HF and COPD. [ABSTRACT FROM AUTHOR]

Purpose: To describe patient perspectives of aerobic exercise during inpatient stroke rehabilitation, including their self-efficacy and beliefs towards exercise, as well as their perceptions of barriers. Method: A survey was conducted at three Canadian rehabilitation centres to evaluate individuals' (N = 33) self-efficacy and outcome expectations for exercise. In addition, patient perceptions of other people recovering from stroke, social support, and aerobic exercise as part of rehabilitation were assessed. Results: Thirty-two people completed the survey. Of these, 97% were willing to participate in aerobic exercise 5.9 ± 8.8 days after admission to inpatient rehabilitation. While outcome expectations for exercise were high, participants reported lower self-efficacy for exercise. Patients reported barriers related to the ability to perform exercise (other health problems (i.e., arthritis), not being able to follow instructions and physical impairments) more often than safety concerns (fear of falling). The lack of support from a spouse and family were commonly identified, as was a lack of information on how to perform aerobic exercise. Conclusion: Patients with stroke are willing to participate in aerobic exercise within a week after admission to inpatient rehabilitation. However, they perceive a lack of ability to perform aerobic exercise, social support from family and information as barriers. Implications for rehabilitation: Aerobic exercise is recognized as part of comprehensive stroke rehabilitation. There is a need to better understand patient perspectives to develop and implement more effective interventions early after stroke. Patients lack confidence in their ability to overcome barriers early after stroke. Patients are concerned with their ability to perform exercise, fall risk, lack of support from a spouse and family, and limited information on aerobic exercise. There is a need to reinforce education with practical experience in structured aerobic exercise programs that show patients and caregivers how to manage disability and complex health needs. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that exercise training for hemodialysis patients positively improves morbidity and mortality outcomes, yet exercise programs remain rare and are not systematically incorporated into care. We developed a research-based film, Fit for Dialysis, designed to introduce, motivate, and sustain exercise for wellness amongst older hemodialysis patients, and exercise counseling and support by nephrologists, nurses, and family caregivers. The objective of this clinical trial is to determine whether and in what ways Fit for Dialysis improves outcomes and influences knowledge/attitudes regarding the importance of exercise for wellness in the context of end-stage renal disease.Methods/design: This 2-site parallel intervention trial will recruit 60 older hemodialysis patients from two urban hospitals. The trial will compare the film + a 16-week exercise program in one hospital, with a 16-week exercise-only program in another hospital. Physical fitness and activity measures will be performed at baseline, 8 and 16 weeks, and 12 weeks after the end of the program. These include the 2-min Walk Test, Grip Strength, Duke Activity Status Index, and the Timed Up-and-Go Test, as well as wearing a pedometer for one week. Throughout the 16-week exercise program, and at 12 weeks after, we will record patients' exercise using the Godin Leisure-time Exercise Questionnaire. Patients will also keep a diary of the exercise that they do at home on non-dialysis days. Qualitative interviews, conducted at baseline, 8, and 16 weeks, will explore the impact of Fit for Dialysis on the knowledge/attitudes of patients, family caregivers, and nephrology staff regarding exercise for wellness, and in what ways the film is effective in educating, motivating, or sustaining patient exercise during dialysis, at home, and in the community.Discussion: This research will determine for whom Fit for Dialysis is effective, why, and under what conditions. If Fit for Dialysis is proven beneficial to patients, nephrology staff and family caregivers, research-based film as a model to support exercise promotion and adherence could be used to support the National Kidney Foundation's guideline recommendation (NKF-KDOQI) that exercise be incorporated into the care and treatment of dialysis patients.Trial Registration: NCT02754271 (ClinicalTrials.gov), retroactively registered on April 21, 2016. [ABSTRACT FROM AUTHOR]

Background and Objective: Cardiac rehabilitation programs (CRPs) are common for cardiac patients; however, most individuals post transient ischemic attack (TIA) receive no rehabilitation despite similar pathologies. The objective of this study is to determine effects of cardiac rehabilitation (CR) on cardiovascular fitness (peak oxygen uptake [VO2peak]) and 6-minute walk distance (6MWD) post TIA. Secondary outcomes included other clinical and process indicators.Methods: Eighty-five people post TIA (mean age 67.5 ± 10.7, 47% female) were referred to CR (2006-2014). The retro-TIA cohort included 65 consecutively enrolled individuals who were evaluated retrospectively. To collect additional measures, the pro-TIA cohort included 20 participants who were followed prospectively with a 3-month nonintervention period followed by 6-months of CR with 6MWD, cognition, depression score, and anthropometrics measured at each time point. Baseline, 6-month cardiopulmonary exercise test results, depression score, and anthropometrics were examined separately for both cohorts.Results: Among all participants, 62% completed CR with 72.8 ± 17.7% attendance to prescheduled classes. CR resulted in improvements in VO2peak for both cohorts (both, P < .02). In the retro-TIA cohort, there were improvements in resting heart rate and body mass index, with reductions in the proportion of people with obesity and abdominal obesity (all, P < .04). In the pro-TIA cohort, compared to the stable baseline period there was a significant improvement with the CR intervention in the depression score (Δ1.1 ± 4.3 and Δ-3.3 ± 3.9, respectively; P = .04) but not in 6MWD (Δ4.8 ± 42 m and Δ61.0 ± 73.5 m, respectively; P = .06). For all participants, regression analysis revealed a higher depression score (β = 1.10, P = .02), male sex (β = 4.932, P = .02), and less social support (β = 4.085, P = .04) as predictors of dropout.Conclusions: A CRP is feasible and effective for improving cardiovascular health. Strategies to promote adherence in men, in those with depressive symptoms, and in those with less social support require investigation. [ABSTRACT FROM AUTHOR]

Background: The cardiopulmonary exercise test (CPET) is an established method for determining target exercise training intensity (ventilatory threshold [VAT]) and cardiovascular risk; unfortunately, CPET is not readily accessible to people post stroke. The objective of this study was to determine the utility of the 6-minute walk test (6MWT) as a less resource-intensive alternative to CPET for prescribing exercise intensity to people post stroke with motor impairments.Methods: Sixty participants (male, 71.7%; 13.5 ± 22.5 [mean ± standard deviation] months post stroke; age 64.5 ± 12.5 years, with a Chedoke-McMaster Stroke Assessment score of 4.9 ± .9 of the leg) underwent 6MWT, CPET, balance, strength, and cognition assessments.Results: 6MWT heart rate (hr) was significantly lower than VAT-hr (92.3 ± 14.8 beats⋅min(-1) versus 99.8 ± 15.7 beats⋅min(-1), respectively, P < .001; correlation r = .7, P < .001). Bland-Altman analysis revealed that the 6MWT underestimated the VAT-hr by 7.7 ± 11.5%. The 95% confidence interval of the mean bias was large (14.8% and -30.3%), reflecting poor agreement, with 71.7% (n = 43) of the participants unable to reach a walking intensity at or above the VAT-hr. Lower oxygen uptake at the VAT (β = .655, P = .004), higher 6MWT-hr (β = 1.07, P = .01), and better balance (β = 1.128, P = .04) were associated with greater utility of the 6MWT for prescribing exercise.Conclusions: The 6MWT-hr was not interchangeable with the target training VAT-hr determined by CPET. However, in combination with CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness. Future studies to develop a less resource-intensive, multimodal alternative to the CPET for prescribing exercise are needed. A modality that minimizes the effect of stroke deficits, specifically poor balance, should be included. [ABSTRACT FROM AUTHOR]

Aerobic exercise is recognized as part of comprehensive stroke rehabilitation in best-practice and clinical guidelines, yet many individuals remain physically inactive during their hospitalization. The purpose of this study was to identify the perspectives of physiotherapists on aerobic exercise prescription and implementation at in-patient stroke rehabilitation centers with and without a structured aerobic exercise program. A survey was conducted at three Canadian rehabilitation centers to evaluate physiotherapist perceptions of individuals recovering from stroke, the practice environment, and their training on aerobic exercise in stroke. Physiotherapists at centers without a structured aerobic exercise program (n= 10) reported the lack of necessary resources and therapeutic support staff and the individuals’ physical impairment as the greatest barriers. In contrast, physiotherapists at the center with a structured aerobic exercise program (n= 6) reported therapy selection (insufficient time in a single physiotherapy session) and concern for the individuals’ cardiovascular risk and cognitive impairment as the greatest barriers. Both groups of physiotherapists indicated that fatigue was a barrier. Only physiotherapists at the center with a structured aerobic exercise program had received continuing education on aerobic exercise in stroke. The lack of resources at rehabilitation centers without a structured aerobic exercise program needs to be addressed. There remains a need for continuing education on aerobic training in stroke, specifically on assessment and prescription using a standardized approach. [ABSTRACT FROM PUBLISHER]

Background: Balance deficits and an increased fall risk are well documented in individuals with COPD. Despite evidence that balance training programs can improve performance on clinical balance tests, their minimal clinically important difference (MCID) is unknown. The aim of this study was to determine the MCID of the Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), and Activities-Specific Balance Confidence (ABC) scale in patients with COPD undergoing pulmonary rehabilitation.Methods: We performed a secondary analysis of data from two studies of balance training in COPD (n = 55). The MCID for each balance measure was estimated using the following anchor and distribution-based approaches: (1) mean change scores on a patient-reported global change in balance scale, (2) optimal cut-point from receiver operating characteristic curves (ROCs), and (3) the minimal detectable change with 95% confidence (MDC95).Results: Data from 55 patients with COPD (mean age, 71.2 ± 7.1 y; mean FEV1, 39.2 ± 15.8% predicted) were used in the analysis. The smallest estimate of MCID was from the ROC method. Anchor-based estimates of the MCID ranged from 3.5 to 7.1 for the BBS, 10.2 to 17.4 for the BESTest, and 14.2 to 18.5 for the ABC scale; their MDC95 values were 5.0, 13.1, and 18.9, respectively.Conclusions: Among patients with COPD undergoing pulmonary rehabilitation, a change of 5 to 7 points for the BBS, 13 to 17 points for the BESTest, and 19 points for the ABC scale is required to be both perceptible to patients and beyond measurement error. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the impact of a physical activity (PA)-focused behavioural intervention during and after pulmonary rehabilitation (PR) on PA levels (primary aim), health-related outcomes and self-efficacy (secondary aims) of patients with COPD. Thirty-two patients were randomly assigned to an experimental group (EG) or control group (CG). The EG received a PA-focused behavioural intervention during PR (3 months) and follow-up support (3 months). The CG received PR (3 months). Daily PA was collected: number of steps; time spent in moderate-to-vigorous PA (MVPA), total PA and sedentary activities (SA). Secondary outcomes comprised exercise capacity, muscle strength, health-related quality of life (HRQOL) and self-efficacy. Measures were collected at baseline, 3 and 6 months. Compared with the CG, the EG improved the number of steps (p = 0.006) and time spent in MVPA (p = 0.007), total PA (p = 0.014) and SA (p = 0.018) at 3 months. Differences were maintained after follow-up support (0.025 ≤ p ≤ 0.040), except for SA (p = 0.781). Exercise capacity, muscle strength and HRQOL were increased at 3 and 6 months (p ≤ 0.002) with no between-group differences (0.148 ≤ p ≤ 0.987). No changes were observed in self-efficacy (p = 0.899). A PA-focused behavioural intervention during and after PR may improve patients’ PA levels. Further research is warranted to assess the sustainability of the findings. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the effect of distractive auditory stimulus (DAS) in the form of music on exercise capacity, symptoms and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD). Topics discussed include the findings which suggest that DAS may reduce symptoms of dyspnea and fatigue when applied during exercise training, but would not for overall dyspnea management.

Objective To identify patient characteristics that influence physiotherapist's decisions on enrollment and attendance in a structured aerobic exercise program early after stroke. Design Retrospective chart review. Setting Rehabilitation hospital. Participants Consecutive sample of people (N=345) admitted to inpatient stroke rehabilitation over a 2-year period. Interventions Not applicable. Main Outcome Measures Patient demographic characteristics, preexisting medical conditions, and poststroke outcome variables (neurological deficit, physical impairment, balance control, and functional mobility and independence) were compared between individuals enrolled and not enrolled in a structured aerobic exercise program. The rate of attendance was calculated for the enrolled group. Results One hundred twenty-nine patients (38%) were enrolled in the structured aerobic exercise program. Patients who were older ( P =.0093) and had cardiac disease ( P =.012), cardioembolic sources ( P =.0094), and arthritis ( P =.031) were less likely to be enrolled in the structured aerobic exercise program. Poststroke outcome variables were not associated with enrollment. Among those enrolled, the rate of attendance was positively correlated with the FIM cognitive rating ( r =.27; P =.0031). Conclusions Enrollment in structured aerobic exercise programs during inpatient stroke rehabilitation can be limited by safety concerns related to patients' cardiovascular and musculoskeletal status. Barriers associated with the perception of cardiovascular risk factors should be confronted because they do not preclude participation in cardiac rehabilitation. In addition, poststroke deficits do not limit participation in adapted aerobic exercise early after stroke. It is likely that the characteristics of the structured aerobic exercise program were integral to accommodate the breadth of poststroke deficits encountered in this study. Future research investigating physiotherapist and practice environment factors that influence the decision to prescribe and implement aerobic exercise is warranted. [ABSTRACT FROM AUTHOR]

Background. Aerobic activity positively affects patients recovering from stroke and is part of best practice guidelines, yet this evidence has not been translated to routine practice. Objective. The objective of this study was to evaluate the feasibility of a model of care that integrated aerobic training in an inpatient rehabilitation setting for patients in the subacute stage of stroke recovery. Key elements of the program were personalized training prescription based on submaximal test results and supervision within a group setting. Design. This was a prospective cohort study. Methods. Participants (N = 78) completed submaximal exercise testing prior to enrollment, and the test results were used by their treating physical therapists for exercise prescription. Feasibility was evaluated using enrollment, class attendance, adherence to prescription, and participant perceptions. Results. Overall, 31 patients (40%) were referred to and completed the exercise program. Cardiac comorbidities were the main reason for nonreferral to the fitness group. Program attendance was 77%; scheduling conflicts were the primary barrier to participation. The majority of participants (63%) achieved 20 minutes of continuous exercise by the end of the program. No adverse events were reported, all participants felt they benefited from the program, and 80% of the participants expressed interest in continuing to exercise regularly after discharge. Limitations. Cardiac comorbidities prevented enrollment in the program for 27% of the admitted patients, and strategies for inclusion in exercise programs in this population should be explored. Conclusions. This individualized exercise program within a group delivery model was feasible; however, ensuring adequate aerobic targets were met was a challenge, and future work should focus on how best to include individuals with cardiac comorbidities. [ABSTRACT FROM AUTHOR]

This study aimed at investigating whether providing feedback on physical activity (PA) levels to patients with chronic obstructive pulmonary disease (COPD) is feasible and enhances daily PA during pulmonary rehabilitation (PR). Patients with COPD participated in a 12-week PR program. Daily PA was measured using activity monitors on weeks 1, 7, and 12, and feedback was given in the following weeks on the number of steps, time spent in sedentary, light, and moderate-to-vigorous intensity activities, and time spent standing, sitting, and lying. Compliance with PA monitoring was collected. Two focus groups were conducted to obtain patients’ perspectives on the use of activity monitors and on the feedback given. Differences in PA data were also assessed. Sixteen patients (65.63 ± 10.57 years; forced expiratory volume in one second (FEV1) 70.31 ± 22.74% predicted) completed the study. From those, only eleven participants used the activity monitors during all monitoring days. Participants identified several problems regarding the use of activity monitors and monitoring duration. Daily steps ( p = 0.026) and standing time ( p = 0.030) were improved from week 1 to week 7; however, the former declined from week 7 to week 12. Findings suggest that using feedback to improve PA during PR is feasible and results in improved daily steps and standing time on week 7. The subsequent decline suggests that additional strategies may be needed to stimulate/maintain PA improvements. Further research with more robust designs is needed to investigate the impact of feedback on patients’ daily PA. [ABSTRACT FROM PUBLISHER]

The article discusses a study that determined incremental shuttle walk test (ISWT) measurement properties for assessing peak exercise capacity of patients with chronic diseases. ISWT studies on validity, reliability and responsivenes were conducted on patients with cardiac disease and chronic obstructive pulmonary disease (COPD) for peak consumption of oxygen. Results showed the responsiveness of ISWT to bronchodilator administration and pulmonary rehabilitation.

The aim of the present study was to describe the perspectives of individuals with chronic obstructive pulmonary disease (COPD) who participated in a minimally supervised maintenance exercise intervention and identify the barriers and facilitators associated with participation. The intervention was delivered in a community center and was designed to maintain exercise capacity and quality of life following discharge from pulmonary rehabilitation. This study utilized qualitative focus groups (FGs) involving individuals with COPD (n = 12) who had been attending the maintenance community program for at least 6 months. All individuals who met the inclusion criteria for the FGs consented to participate. Four themes were identified: (1) issues around attendance; (2) perceived benefits of the program; (3) perceived burdens of the program; and (4) recommendations for program improvement. Participants expressed more benefits than barriers, stating that their experience of improved function and quality of life facilitated their attendance. Barriers included exacerbations, fatigue, access to transportation, and weather. Participants endorsed the benefits of a community-based maintenance exercise program after pulmonary rehabilitation. Minimally supervised community-based programs with access to a case manager may provide a useful approach to enhancing adherence to exercise. [ABSTRACT FROM PUBLISHER]

Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD). This systematic review identified which outcomes, outcome measures and instruments have been used to assess single free-living PA-related intensity in people with COPD and compared the intensity level (light, moderate, vigorous) obtained by different outcome measures. PubMed, Scopus, Web of Science, Cochrane Library and EBSCO were searched for original studies of COPD and assessing single free-living PA-related intensity were included. Agreement was calculated as the number of agreements between 2 measures [same intensity level]/ number of comparisons using both measures*100. We included 43 studies (1282 people with COPD, mean age 66 years, 65% men, 49% FEV 1%pred) and identified 13 outcomes, 46 outcome measures and 22 instruments. The most-reported outcomes, outcome measures and instruments were dyspnoea with the Borg scale 0–10; cardiac function, via heart rate (HR) using HR monitors; and pulmonary gas exchange, namely oxygen consumption (VO 2), using portable gas analysers, respectively. The most frequently assessed PAs were walking and lifting, changing or moving weights/objects. Agreement between the outcome measures ranged from 0 (%VO 2peak vs metabolic equivalent of task [MET];%HR peak vs Fatigue Borg; MET vs walking speed) to 100% (%HR reserve vs dyspnoea Borg; fatigue and exertion Borg vs walking speed).%VO 2peak/reserve elicited the highest intensity. Hence, Borg scores,%HR reserve and MET may underestimate PA-related intensity. Various methodologies are used to assess single free-living PA-related intensity and yield different intensity levels for the same PA. Future studies, further exploring the agreement between the different outcome measures of PA-related intensity and discussing their advantages, disadvantages and applicability in real-world settings, are urgent. These would guide future worldwide recommendations on how to assess single free-living PA-related intensity in COPD, which is essential to optimise PA interventions and ensure patient safety. [ABSTRACT FROM AUTHOR]

Background: Rating of perceived exertion (RPE) is used to monitor or prescribe workload of exercise, but its utility among individuals with a stroke remains in question. Objective: To examine the validity of RPE at multiple percentages of peak aerobic capacity (Vo2peak) in individuals in the subacute stage of stroke recovery. Methods: Thirty-seven patients with stroke in the subacute stage of recovery from an inpatient rehabilitation institute completed a graded maximal exercise test on a semi-recumbent cycle ergometer. Respiratory gas exchange was monitored for analysis of Vo2, while heart rate and RPE (Borg CR10 Scale) were measured at the end of each minute. RPE was compared with expected ranges when at 60%, 70%, and 80% of Vo2peak. Post hoc analyses were performed to determine whether patient characteristics differed between participants who fell within and outside the expected RPE range at 80% of Vo2peak. Results: Median (interquartile range) RPE at 60%, 70%, and 80% Vo2peak were 3.0 (3.0-3.5), 3.0 (3.0-5.0), and 4.75 (3.0-5.75), respectively; 76.2%, 69.0%, and 38.9% of participants fell into the expected RPE range at each intensity. Patient characteristics were similar between participants who fell within and outside the expected RPE range at 80% Vo2peak. Conclusion: RPE appears to be a reasonable indicator of exercise intensity after stroke at moderate (60%-70% Vo2peak) but not high-intensity exercise (80% Vo2peak). This conclusion is based on the high degree of between-subject variability in RPE at 80% Vo2peak. Future research should identify whether RPE can be adapted to accurately capture exertion during high-intensity exercise after stroke. [ABSTRACT FROM AUTHOR]

The article discusses a systematic review which determine the effect of supervised exercise programs after primary pulmonary rehabilitation (PR) on exercise capacity and health-related quality of life (HRQL) in individuals with chronic obstructive pulmonary disease (COPD). It concluded that supervised exercise programs after primary PR appear to be more effective than usual care for preserving exercise capacity in the medium term but not in the long term.

Summary: Background: The original method for determining endurance shuttle walk test (ESWT) speed involves components that are time consuming for clinicians. We sought to determine: (i) whether components described in the original method for determining ESWT speed held true and; (ii) the agreement between speeds derived using the original method and that equivalent to 85% of the peak speed achieved during the incremental shuttle walk test (ISWT). Methods: Patients with chronic obstructive pulmonary disease (COPD) performed two ISWTs and one ESWT on separate days, wearing a calibrated portable gas analysis unit. A retrospective analysis of these data allowed us to determine whether: (i) the peak rate of oxygen uptake () can be accurately estimated from the incremental shuttle walk distance (ISWD) and; (ii) ESWTs performed at a speed derived using the original method elicited 85% of . Agreement between walks speeds was determined using Bland–Altman analysis. Results: Twenty-two participants (FEV1 48 ± 13% predicted, age 66 ± 8 yr) completed the study. The estimated from the ISWD was less than that measured during the ISWT (mean difference −4.4; 95% confidence interval (CI), −6.0 to −2.9 ml· kg−1·min−1). The ESWT and ISWT elicited similar (mean difference −0.2; 95% CI, −1.5 to 1.2 ml·kg−1·min−1). The mean difference (±limits of agreement) between ESWT speeds was 0.15 (±0.34) km·h−1. Conclusions: Components of the original method for determining the ESWT speed did not hold true in our sample. ESWT speed can be derived by calculating 85% of the peak speed achieved during the ISWT. [ABSTRACT FROM AUTHOR]

Introduction: Our goal was to compare behavioral- and information-based interventions aimed at increasing prescription of inspiratory muscle training (IMT) for people with chronic obstructive pulmonary disease (COPD) by interdisciplinary teams during pulmonary rehabilitation (PR). Methods: Six hospital PR programs were randomly assigned to a behavioral- or information-based intervention. Both interventions provided evidence supporting IMT and its prescription details. However, the behavioral-based intervention focused on barriers and challenges to IMT prescription informed by a nationwide survey and the theory of planned behavior (TPB). It included hands-on practice and content, in part, was driven by learners' questions. In contrast, the information-based intervention delivered information in a typical didactic education session followed by a demonstration and question period. It was supplemented with evidence-based research articles. The primary outcome was the change in prescription rate of IMT for COPD patients by determining the difference during the 6 months preceding compared to the 6 months during the interventions. Results: Sixty-one health professionals and 488 COPD outpatients within 6 PR programs participated. No COPD patients were prescribed IMT at any of the sites during the 6-month preintervention phase. The behavioral-based intervention resulted in an IMT prescription rate of 10.2% to people with COPD, whereas the information-based intervention resulted in no IMT prescriptions. Discussion: A behavioral-based intervention that is based on TPB and addresses challenges identified by health professionals is more effective than a traditional lecture approach to increase health professionals' prescription of IMT for patients with COPD. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective: Field and laboratory-based tests are used to measure exercise capacity in people with COPD. A comparison of the cardiorespiratory responses to field tests, referenced to a laboratory test, is needed to appreciate the relative physiological demands. We sought to compare peak and submaximal cardiorespiratory responses to the 6-min walk test, incremental shuttle walk test and endurance shuttle walk test with a ramp cycle ergometer test (CET) in patients with COPD. Methods: Twenty-four participants (FEV1 50 ± 14%; 66.5 ± 7.7 years; 15 men) completed four sessions, separated by ≥24 h. During an individual session, participants completed either two 6-min walk tests, incremental shuttle walk tests, endurance shuttle walk tests using standardized protocols, or a single CET, wearing a portable gas analysis unit (Cosmed K4b2) which included measures of heart rate and arterial oxygen saturation (SpO2). Results: Between tests, no difference was observed in the peak rate of oxygen uptake ( F3,69 = 1.2; P = 0.31), end-test heart rate ( F2,50 = 0.6; P = 0.58) or tidal volume ( F3,69 = 1.5; P = 0.21). Compared with all walking tests, the CET elicited a higher peak rate of carbon dioxide output (1173 ± 350 mL/min; F3,62 = 4.8; P = 0.006), minute ventilation (48 ± 17 L/min; F3,69 = 10.2; P < 0.001) and a higher end-test SpO2 (95 ± 4%; F3,63 = 24.9; P < 0.001). Conclusions: In patients with moderate COPD, field walking tests elicited a similar peak rate of oxygen uptake and heart rate as a CET, demonstrating that both self- and externally paced walking tests progress to high intensities. [ABSTRACT FROM AUTHOR]

The article discusses a study which focused on the measurement of arm exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The types of arm exercise tests used in this study included arm ergometry, ring shifts, dowel lifts, proprioceptive neuromuscular facilitation and activities of daily living. The clinical characteristics of COPD include airway obstruction, systemic inflammation and skeletal muscle dysfunction.

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Background and objective. In spite of the challenges, engaging in exercise programs very early after stroke may positively influence aerobic capacity and stroke-related outcomes, including walking ability. The objective of this study was to evaluate the feasibility of adding aerobic cycle ergometer training to conventional rehabilitation early after stroke and to determine effects on aerobic capacity, walking ability, and health-related quality of life. Methods. A prospective matched control design was used. All participants performed a graded maximal exercise test on a semi-recumbent cycle ergometer, spatiotemporal gait assessments, 6-Minute Walk Test, and Stroke Impact Scale. The Exercise group added 30 minutes of aerobic cycle ergometry to conventional inpatient rehabilitation 3 days/week until discharge; the Control group received conventional rehabilitation only. Results. All Exercise participants (n = 23) completed the training without adverse effects. In the 18 matched pairs, both groups demonstrated improvements over time with a trend toward greater aerobic benefit in the Exercise group with 13% and 23% increases in peak VO2 and work rate respectively, compared to 8% and 16% in the Control group (group-time interaction P = .71 and .62). A similar trend toward improved 6-Minute Walk Test distance (Exercise 53% vs Controls 23%, P = .23) was observed. Conclusion. Early aerobic training can be safely implemented without deleterious effects on stroke rehabilitation. A trend toward greater improvement in aerobic capacity and walking capacity suggests that such training may have an early beneficial effect and should be considered for inclusion in rehabilitation programs. [ABSTRACT FROM AUTHOR]

In light of the demonstrated importance of fitness programs after stroke, the current study set out to determine the availability and characteristics of fitness programs for individuals after stroke in the Greater Toronto Area (GTA). A questionnaire was distributed to 784 fitness programs in the GTA requesting information on the facility, program characteristics, and barriers to and willingness in offering specific programs for individuals post stroke. Of the 213 respondents, 146 (69%) reported that individuals with a chronic disability participated in their activities, 39 (18%) did not allow individuals with disabilities to participate, and 28 (13%) were unaware if individuals with disabilities accessed their facilities. Sixty-two facilities (29%) offered specific fitness programs for individuals with a chronic disability including 26 (12%) that offered exercise programs for people who have had a stroke. The study identified that a small percentage of fitness programs surveyed in GTA have fitness programs for individuals post-stroke. Since the occurrence of stroke is expected to increase as the population ages, the need for community fitness programs for individuals post-stroke will continue to rise. Many facilities expressed interest in offering specific fitness programs for individuals post-stroke; therefore, barriers must be addressed to facilitate the development of these programs. Études à l’appui, les programmes de conditionnement physique sont importants pour les patients en réadaptation consécutive à un accident cérébrovasculaire. Le but de cette étude est de répertorier les programmes de conditionnement physique dans la région métropolitaine de Toronto (GTA) et d’en présenter les caractéristiques. Nous avons envoyé un questionnaire à 784 organismes offrant des programmes de conditionnement physique dans cette région pour connaître les caractéristiques de leur programme et de leurs installations, leurs obstacles et leur intention concernant l’élaboration de programmes spécifiques de conditionnement physique à l’intention de cette clientèle. Sur les 213 répondants, 146 (69 %) indiquent que leur clientèle inclut des individus présentant une incapacité chronique, 39 (18 %) ne permettent pas la participation à des individus présentant une incapacité et 28 (13 %) ne savent pas si des individus présentant une incapacité sont des clients de leur organisme. Parmi les 62 organismes (29 %) offrant des programmes spécifiques de conditionnement physique à l’intention d’une clientèle présentant une incapacité chronique, 26 organismes (12 %) proposent des programmes conçus spécifiquement pour des individus en réadaptation consécutive à un accident cérébrovasculaire. D’après les résultats de cette étude, il y a un faible pourcentage d’organismes dans la région métropolitaine de Toronto offrant des programmes de conditionnement physique à l’intention de la clientèle des accidentés cérébrovasculaires. Avec le vieillissement de la population, on s’attend à une augmentation de l’incidence des accidents cérébrovasculaires et à un accroissement du besoin d’offrir des programmes de conditionnement physique à l’intention de cette clientèle. Plusieurs organismes ont manifesté le désir d’offrir des programmes spécifiques de conditionnement physique à l’intention de cette clientèle ; on doit donc travailler à éliminer les obstacles à l’élaboration de ces programmes, [ABSTRACT FROM AUTHOR]

Cardiorespiratory fitness, along with sensorimotor recovery, is important for optimal function after stroke. Development of exercises that simultaneously address aerobic training and increase paretic limb involvement may improve outcomes and maximize productivity of therapy sessions. This case series assessed the feasibility of and characterized the cardiorespiratory and sensorimotor demands of adapted aerobic cycle ergometer activities hypothesized to increase paretic limb use. Mechanically loaded and electromyographic (EMG) feedback pedaling were compared to traditional pedaling in three poststroke case studies and a healthy control group. Submaximal oxygen uptake (Vo2), heart rate, perceived rate of exertion (RPE), and EMG of four leg muscles were assessed. Mechanically loaded ergometry increased RPE and altered muscle activity in healthy participants, while participants with stroke did not consistently increase paretic limb activation. EMG feedback pedaling increased target limb activity in healthy participants and decreased nonparetic activity in stroke participants. This paper highlights the challenges involved in adapting training tasks for individuals who are not able to walk at training intensities. Further work is necessary to refine adapted tasks for optimal effectiveness, and consideration of additional methods that permit differential interlimb loading may have additional value. [ABSTRACT FROM AUTHOR]

The article presents a study of acute exacerbations of COPD in patients following pulmonary rehabilitation. The study involved a six-month study of sixty subjects who completed pulmonary rehabilitation and were followed up until acute exacerbation of COPD occurred. The research results indicate that patients with lower functional exercise capacity are more likely to experience acute exacerbation of COPD following pulmonary rehabilitation.

Abstract: Brooks D, Davis AM, Naglie G. Validity of 3 physical performance measures in inpatient geriatric rehabilitation. Objective: To evaluate the construct validity and the responsiveness of 3 measures of physical performance measures as outcome measures for frail older persons. Design: Pre-post design with measures at admission and discharge. Setting: Three inpatient geriatric rehabilitation programs. Participants: Fifty-two subjects (35 women, 17 men; age, 80±8y). Interventions: Not applicable. Main Outcome Measures: Physical performance measures were Timed Up & Go (TUG) test, two-minute walk test (2MWT), and functional reach. Functional status was measured with the FIM instrument and the Modified Barthel Index. Results: The TUG and 2MWT scores differed significantly in groups of patients using different ambulatory aids (P=.006), whereas no such difference was observed for the functional reach (P=.40). The correlations between the TUG test and FIM and between the 2MWT and FIM were –.59 and .59 (P<.001), respectively, at admission, and –.42 and .47 (P≤.04), respectively, at admission and discharge. The correlations between functional reach and the FIM were not significant (P≥.09). Standardized response means were 1.1 for the TUG, 0.7 for the 2MWT, and 0.5 for functional reach. Conclusions: The TUG test and 2MWT are valid and responsive outcome measures in older persons participating in geriatric rehabilitation. Functional reach was a moderately responsive outcome measure but did not consistently reflect ambulatory or functional status. [Copyright &y& Elsevier]

The purpose of this systematic review was to determine the effect of inspiratory muscle training (IMT) (alone or combined with exercise and/or pulmonary rehabilitation) compared to other rehabilitation interventions such as: exercise, education, other breathing techniques or exercise and/or pulmonary rehabilitation among adults with chronic obstructive pulmonary disease (COPD). A systematic review of the literature on IMT and COPD was conducted according to the Cochrane Collaboration protocol. Inclusion criteria for the review included randomized controlled trials, published in English, comparing IMT or combined IMT and exercise/pulmonary rehabilitation with other rehabilitation interventions such as general exercise, education, other breathing techniques or exercise/pulmonary rehabilitation among adults with COPD. 274 articles were retrieved, and 16 met the inclusion criteria. Seven meta-analyses were performed that compared targeted or threshold IMT to exercise (n = 3) or to education (n = 4). Results showed significant improvements in inspiratory muscle strength and endurance, and in the dyspnea scale on a quality of life measure, for participants in the IMT versus education group. In other instances where meta-analyses could not be performed, a qualitative review was performed. IMT results in improved inspiratory muscle strength and endurance compared to education. Further trials are required to investigate the effect of IMT (or combined IMT) compared to other rehabilitation inventions for outcomes such as dyspnea, exercise tolerance, and quality of life. [ABSTRACT FROM AUTHOR]

Study objectives: This study was conducted to examine the short-term effects of using a rollator on functional exercise capacity among individuals with COPD and to characterize which individuals benefit most from its use. Design: Repeated-measures randomized crossover design using the 6-min walk test (6MWT) as the primary outcome measure. Setting: Respiratory rehabilitation center. Patients: Forty stable subjects who had received a diagnosis of COPD. Interventions: Two 6MWTs were performed on each study day. One 6MWT was performed unaided, and the other was performed with a rollator. The order was randomized on the first day and reversed on the second day. Results: Use of the rollator was associated with a significant reduction in dyspnea (p < 0.001) and duration of rest (reduction for the total group, 19 s; and reduction for those who walked < 300 m unaided, 40 s; p = 0.001) during the 6MWT. For subjects who walked < 300 m unaided, there was also a significant improvement in distance walked (p = 0.02). No changes were found for the measures of cardiorespiratory function or gait (p > 0.05). The requirement to rest during an unaided 6MWT was a significant predictor of improved functional exercise capacity with the use of the rollator (p < 0.005). The majority of subjects whose unaided 6MWT distance was < 300 m preferred using the rollator to walking unaided. Conclusions: Use of a rollator was effective in improving functional exercise capacity by reducing dyspnea and rest duration among stable individuals with severe COPD. Individuals who walked < 300 m and individuals who required a rest during an unaided 6MWT benefited the most from using a rollator in terms of reduced dyspnea, reduced rest time, and improved distance walked. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. A growing body of evidence shows that individuals with COPD have important deficits in balance control that may be associated with an increased risk of falls. Pulmonary rehabilitation (PR) is a key therapeutic intervention for individuals with COPD; however, current international guidelines do not include balance training and fall prevention strategies. Objective: The primary aim of this trial is to determine the effects of PR with balance training compared to PR with no balance training on the 12-month rate of falls in individuals with COPD. Secondary aims are to determine the effects of the intervention on balance, balance confidence, and functional lower body strength, and to estimate the cost-effectiveness of the program. Methods: A total of 400 individuals from nine PR centers across Canada, Europe, and Australia will be recruited to participate in a randomized controlled trial. Individuals with COPD who have a self-reported decline in balance, a fall in the last 2 years, or recent near fall will be randomly assigned to an intervention or control group. The intervention group will undergo tailored balance training in addition to PR and will receive a personalized home-based balance program. The control group will receive usual PR and a home program that does not include balance training. All participants will receive monthly phone calls to provide support and collect health care utilization and loss of productivity data. Both groups will receive home visits at 3, 6, and 9 months to ensure proper technique and progression of home exercise programs. The primary outcome will be incidence of falls at 12-month follow-up. Falls will be measured using a standardized definition and recorded using monthly self-report fall diary calendars. Participants will be asked to record falls and time spent performing their home exercise program on the fall diary calendars. Completed calendars will be returned to the research centers in prepaid envelopes each month. Secondary measures collected by a blinded assessor at baseline (pre-PR), post-PR, and 12- month follow-up will include clinical measures of balance, balance confidence, functional lower body strength, and health status. The cost-effectiveness of the intervention group compared with the control group will be evaluated using the incremental cost per number of falls averted and the incremental cost per quality-adjusted life years gained. Results: Recruitment for the study began in January 2017 and is anticipated to be complete by December 2019. Results are expected to be available in 2020. Conclusions: Findings from this study will improve our understanding of the effectiveness and resource uses of tailored balance training for reducing falls in individuals with COPD. If effective, the intervention represents an opportunity to inform international guidelines and health policy for PR in individuals with COPD who are at risk of falling. [ABSTRACT FROM AUTHOR]

Abstract: Physical activity is an integral component of stroke prevention. Although approximately 80% of strokes are due to cerebral ischemia, the mechanisms linking physical activity to the incidence of and recovery from ischemic stroke are not completely understood. This review summarizes evidence from human and animal studies regarding physical activity in the prevention of overt and covert ischemic stroke and associated injury. In cohort studies, people who are physically active have reduced rates of overt ischemic stroke and ischemic stroke mortality. However, few human studies have examined physical activity and the incidence of covert stroke. Evidence from animal models of ischemic stroke indicates that physical activity reduces injury after ischemic stroke by reducing infarct size and apoptotic cell death. Accordingly, physical activity may reduce the magnitude of injury from ischemic stroke so that there are fewer or less severe symptoms. Future research should investigate physical activity and incidence of covert stroke prospectively, ascertain the optimal dose and type of exercise to prevent ischemic injury, and identify the underlying neuroprotective mechanisms. [Copyright &y& Elsevier]

Abstract: Neuromuscular dyscontrol during gait following stroke may be further compromised by increased susceptibility to fatigue. Our purpose was to examine how extended effortful activity affected spatio-temporal gait parameters after stroke. The influence of sub-maximal exercise was assessed among 26 stroke survivors who performed the Six-Minute Walk Test with distance recorded every 2min. Walking distance decreased 5.8 (S.D. 6.9)m in the second 2-min interval and another 2.3 (S.D. 9.9)m in the final 2min (p =0.0005). Secondly, we evaluated spatio-temporal gait parameters prior to and immediately following a standardized maximal exercise test on a cycle ergometer in 36 stroke survivors. In contrast to the expected reduction in walking speed, maximal exercise led to a 5.5 (S.D. 11.5)cm/s increase in preferred gait speed (p =0.007) and a 4.5 (S.D. 7.7)steps/min increase in cadence (p =0.0004), but did not affect gait symmetry. Subsequent division of participants by preferred pedaling cadence revealed that individuals with lower preferred cadence had the greatest increase in preferred speed, cadence and paretic leg step length (p <0.01). These unexpected results suggest that potential fatigue-induced effects on gait may have been masked by immediate positive influences of movement rate on walking speed. Such activity-specific effects may have clinical applications for stroke patients and other populations with gait deviations. [Copyright &y& Elsevier]

Objective: To determine the association between self-efficacy and health-related quality of life (HRQoL) in people with Chronic Obstructive Pulmonary Disease (COPD) and the moderating effect of self-efficacy type (exercise task, exercise barrier, COPD symptom, general) and HRQoL type (generic, COPD specific).Methods: Databases were searched systematically from inception to January 2019. Methodological quality was assessed, and a meta-analysis was conducted following PRISMA guidelines (PROSPERO protocol: CRD42018114846).Results: Across 31 coefficients, there was a positive relationship between self-efficacy and HRQoL (r = 0.38, 95 %CI [0.32, 0.45]). Exercise barrier self-efficacy had the strongest relationship to HRQoL (r = 0.42, 95 % CI [0.30, 0.52]), followed by COPD symptoms (r = 0.41, 95 % CI [0.33, 0.49]), exercise tasks (r = 0.40, 95 % CI [0.29, 0.50]), and general self-efficacy (r = 0.21, 95 % CI [0.14, 0.28]). Generic HRQoL had a similar relationship to self-efficacy (r = 0.38, 95 % CI [0.28, 0.47]) as COPD specific HRQoL (r = 0.38, 95 % CI [0.30, 0.46]).Conclusion: There is a moderate positive relationship between self-efficacy and HRQoL in COPD, with the relationship stronger for exercise and COPD symptoms than general self-efficacy. [ABSTRACT FROM AUTHOR]