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Background: Dyspnoea is a multidimensional experience of breathing discomfort, but its affective dimension is unfrequently assessed in people with chronic obstructive pulmonary disease (COPD). We evaluated the effectiveness of a home-based pulmonary rehabilitation (PR) programme on the physical and affective components of dyspnoea assessed by the Dyspnoea-12 (D-12) questionnaire. We also determined the baseline characteristics that contributed to the change in D-12 scores., Methods: In this retrospective study, 225 people with COPD (age, 65±11 years; forced expiratory volume in 1 s (FEV 1 ), 35±15% of predicted value) were enrolled into a person-centric home-based PR, consisting of a weekly supervised 90 min home session during 8 weeks. D-12 questionnaire, health status, anxiety and depressive symptoms, exercise tolerance and general fatigue were assessed at baseline (M0), at the end of PR programme (M2), and 8 (M8) and 14 months (M14) after M0. Multivariable analysis of covariance (ANCOVA) models were performed to identify the baseline characteristics that contributed to the change in D-12 scores., Results: Both physical and affective components of dyspnoea and all the other outcome measures were improved at M2, M8 and M14 compared with baseline (p<0.05). Baseline body mass index was the only significant independent predictor of the changes in physical dyspnoea score, while the change in the affective dimension of dyspnoea after PR was associated with FEV 1 , anxiety symptoms and exercise tolerance (6 min stepper test). However, since these variables had only a small impact on the changes in D-12 questionnaire scores, results from the ANCOVA analysis should be taken cautiously., Conclusion: Both physical and affective components of dyspnoea were improved, at short term and long term, by 8 weeks of individualised home-based PR. The present results support the importance of assessing dyspnoea as a multidimensional experience during PR, warranting replication by robustly designed randomised and controlled studies., Competing Interests: Competing interests: SG, MK, JH and DS have no conflict of interest to disclose. FM reports grants from AstraZeneca and GlaxoSmithKline, Boehringer Ingelheim, GSK, Sanofi, and Novartis during the conduct of this study, and personal fees from GlaxoSmithKline, Grifols, and Novartis outside the submitted work. J-MG reports non-financial support unrelated to the submitted work from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GlaxoSmithKlein, Novartis, and Roche. CC reports grants from AstraZeneca, Santelys, personal fees from ALK-Abello, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein, Novartis, Sanofi-Regeneron, TEVA and congress supports from ALK-Abello, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKlein, Novartis, Pierre Fabre, Pfizer, Roche, TEVA. OLR reports personal fees and/or non-financial support unrelated to the submitted work from AstraZeneca, Boehringer Ingelheim, Chiesi, Lilly, Novartis, GlaxoSmithKline, MundiPharma, Pfizer, Teva, Santelys, Vertex and Vitalaire., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components., Objective: The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity., Methods: This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m²) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients' adhesion, and satisfaction., Results: A total of 49 patients completed the study. No significant group × time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: -0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: -1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95%) and satisfaction in the TRG were good., Conclusions: In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients' adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care., Trial Registration: ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666., (©François Bughin, Gaspard Bui, Bronia Ayoub, Leo Blervaque, Didier Saey, Antoine Avignon, Jean Frédéric Brun, Nicolas Molinari, Pascal Pomies, Jacques Mercier, Fares Gouzi, Maurice Hayot. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 06.12.2021.)

Background: Long-term effectiveness of pulmonary rehabilitation (PR) is still uncertain in older people with severe chronic obstructive pulmonary disease (COPD). The objective was to compare the effects of home-based PR in people with COPD above and below the age of 70 years., Methods: In this retrospective study, 480 people with COPD were recruited and divided into those ≤70 (n=341) and those >70 years of age (n=139). All participants underwent an 8 weeks of home-based PR, consisting of a weekly supervised 90-minute home session. Six-minute stepper test (6MST), timed-up and go test (TUG), Hospital Anxiety and Depression Scale, and Visual Simplified Respiratory Questionnaire (VSRQ) were assessed at baseline (M0), at 2 (M2), 8 (M8), 14 (M14) months after baseline., Results: The older group was described by fewer current smokers (p <0.001), more long-term oxygen therapy use (p = 0.024), higher prevalence of comorbidities (p<0.001), lower 6MST score and higher TUG score (p<0.001), compared to the younger group. Both groups improved every outcome at M2 compared to baseline. At M2, 88% of people ≤70 years of age and 79% of those above 70 were considered as responders in at least one evaluated parameter (p = 0.013). Both groups maintained the benefits at M14, except for the VSRQ score and the number of responders to this outcome in the older group., Conclusion: Regardless of the age, personalized home-based PR was effective for people with COPD in the short term. Above 70 years, an ageing effect appeared on the long-term effectiveness of quality of life benefit., Competing Interests: Jean-Marie Grosbois reports home-based PR was financially supported by Adair, Aeris Santé, Bastide, France Oxygène, Homeperf, LVL, Medopale, NorOx, Santélys, SOS Oxygène, Sysmed, VitalAire, and ARS Hauts-de-France. The funders played no role in the design, conduct or reporting of this study. OLR reports personal fees and/or non-financial support from AstraZeneca, Boehringer Ingelheim, Chiesi, Lilly and Novartis, non-financial support from GlaxoSmithKline, Mayoli, MSD, Pfizer, PulmonX, Santelys association, Vertex, Vitalaire and Zambon, outside the submitted work. JMG reports personal fees from Astra Zeneca, Boehringer Ingelheim, Chiesi, GSK, and Roche, non-financial support unrelated to the submitted work from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein, Novartis, Vitalaire, and Roche, and received financial support from Adair, Aeris Santé, Bastide, France Oxygène, Homeperf, LVL, Medopale, NorOx, Santélys, SOS Oxygène, Sysmed, VitalAire, and ARS Hauts-de-France for the home-based PR programme. The funders played no role in the design, conduct or reporting of this study. BW reports personal fees and non-financial support unrelated to the submitted work from Boehringer Ingelheim, Vitalaire, and Roche. CC reports personal fees and non-financial support unrelated to the submitted work from ALK-Abello, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein, MEDA Pharma, Medexact, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi, Santélys, and TEVA. The aforementioned authors report no other potential conflicts of interest for this work. None of the other authors have any conflict of interest to disclose., (© 2020 Gephine et al.)

Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability. A thorough patient-centered outcome assessment, including not only measures of lung function, exercise capacity, and health-related quality of life, but also functional capacity and performance in activities of daily life, is imperative for a comprehensive management of chronic obstructive pulmonary disease. This American Thoracic Society Seminar Series is devoted to help clinicians substantiate their choice of functional outcome measures in this population. In Part 1 of this two-part seminar series, we describe the various domains of functional status to elucidate terms and key concepts intertwined with functioning and to demonstrate the clinical relevance of assessing functional capacity in the context of activities of daily living in agreement with the International Classification of Functioning, Disability, and Health. We hope that a better understanding of the various defining components of functional status will be instrumental to healthcare providers to optimize chronic obstructive pulmonary disease evaluation and management, ultimately leading to improved quality of life of patients afflicted by this condition. This first article also serves as an introduction to Part 2 of this seminar series, in which the main functional tests available to assess upper and lower body functional capacity of these patients are discussed.

Background: Training volume is paramount in the magnitude of physiological adaptations following resistance training. However, patients with severe COPD are limited by dyspnea during traditional two-limb low-load/high-repetition resistance training (LLHR-RT), resulting in suboptimal training volumes. During a single exercise session, single-limb LLHR-RT decreases the ventilatory load and enables higher localized training volumes compared with two-limb LLHR-RT.Research Question: Does single-limb LLHR-RT lead to more profound effects compared with two-limb LLHR-RT on exercise capacity (6-min walk distance [6MWD]), health status, muscle function, and limb adaptations in patients with severe COPD?Study Design and Methods: Thirty-three patients (mean age 66 ± 7 years; FEV1 39 ± 10% predicted) were randomized to 8 weeks of single- or two-limb LLHR-RT. Exercise capacity (6MWD), health status, and muscle function were compared between groups. Quadriceps muscle biopsy specimens were collected to examine physiological responses.Results: Single-limb LLHR-RT did not further enhance 6MWD compared with two-limb LLHR-RT (difference, 14 [-12 to 39 m]. However, 73% in the single-limb group exceeded the known minimal clinically important difference of 30 m compared with 25% in the two-limb group (P = .02). Health status and muscle function improved to a similar extent in both groups. During training, single-limb LLHR-RT resulted in a clinically relevant reduction in dyspnea during training compared with two-limb LLHR-RT (-1.75; P = .01), but training volume was not significantly increased (23%; P = .179). Quadriceps muscle citrate synthase activity (19%; P = .03), hydroxyacyl-coenzyme A dehydrogenase protein levels (32%; P < .01), and capillary-to-fiber ratio (41%; P < .01) were increased compared with baseline after pooling muscle biopsy data from all participants.Interpretation: Single-limb LLHR-RT did not further increase mean 6MWD compared with two-limb LLHR-RT, but it reduced exertional dyspnea and enabled more people to reach clinically relevant improvements in 6MWD. Independent of execution strategy, LLHR-RT improved exercise capacity, health status, muscle endurance, and enabled several physiological muscle adaptations, reducing the negative consequences of limb muscle dysfunction in COPD.Clinical Trial Registration: ClinicalTrials.gov; No.: NCT02283580; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exercise-based rehabilitation improves physical function, fatigue and quality of life in patients with thoracic neoplasia. However, the implementation of this intervention is limited because of poor accessibility and adherence. Consequently, telerehabilitation is a promising strategy to improve access and adherence to rehabilitation. OBJECTIVES: To investigate the feasibility, adherence and satisfaction of a home-based telerehabilitation program (TELERP) with real-time physiological parameters acquisition in patients with unresectable thoracic neoplasia receiving chemotherapy and to explore its effects on patients' functional capacity. METHODS: Five patients receiving chemotherapy followed an 8-week TELERP using real-time monitoring combined with interactive exercises. The TELERP included supervised and unsupervised exercise sessions (3 sessions/week). The feasibility of the TELERP, adverse outcomes and adherence were analyzed. Six-minute walking test (6MWT) and timed stair test (TST) were done to assess functional capacity. RESULTS: Five patients with lung cancer (mean age of 62 ± 7 yr; BMI of 24 ± 3 Kg/m2) completed the TELERP. Patients completed 15 supervised and 8.6 ± 2.97 unsupervised exercise sessions, representing 100 and 96% of the prescribed sessions, respectively. Patients trained at moderate and high intensity ≥50% of the time of the cardiopulmonary exercise session. No adverse event occurred. Following the TELERP, TST and 6MWT improved significantly (Δ −3.0 ± 0.19 s, p = 0.05 and Δ 39.8 ± 19.7 m, p = 0.01, respectively). CONCLUSION: These results support the feasibility of a TELERP and suggest that such intervention may contribute to maintain or improve functional capacity for patients with thoracic neoplasia receiving chemotherapy. CONTEXTE: La réadaptation fondée sur l'exercice améliore la fonction physique, la fatigue et la qualité de vie chez les patients atteints de néoplasie thoracique. Toutefois, la mise en oeuvre de cette intervention est limitée en raison d'une faible accessibilité et d'une faible adhésion. Par conséquent, la téléréadaptation est une stratégie prometteuse pour améliorer l'accès à la réadaptation et l'adhésion à celle-ci. OBJECTIFS: Étudier la faisabilité d'un programme de téléréadaptation à domicile (TELERP) avec acquisition de paramètres physiologiques en temps réel destiné à des patients atteints de néoplasie thoracique non résécable recevant de la chimiothérapie, l'adhésion à ce programme et la satisfaction à son égard, et explorer ses effets sur la capacité fonctionnelle des patients. MÉTHODES: Cinq patients recevant de la chimiothérapie ont suivi un TELERP de huit semaines ayant recours à une surveillance en temps réel combinée à des exercices interactifs. Le TELERP comprenait des sessions d'exercices supervisés et non supervisés (trois sessions par semaine). La faisabilité du TELERP, l'adhésion à celui-ci et ses résultats indésirables ont été analysés. Le test de marche de six minutes (6MWT) et le test de l'escalier chronométré (TST) ont été utilisés pour évaluer la capacité fonctionnelle. RÉSULTATS: Cinq patients atteints du cancer du poumon (âge moyen de 62 ± 7 ans; IMC de 24 ± 3 kg/m2) ont suivi le TELERP. Les patients ont fait 15 sessions d'exercices supervisées et 8,6 ± 2,97 sessions d'exercices non supervisées, représentant respectivement 100 % et 96 % des sessions prescrites. Les patients se sont entrainés à une intensité allant de modérée à élevée pendant ≥ 50% de la durée de la session d'exercices cardiopulmonaires. Aucun effet indésirable n'a été observé. Après le TELERP, le TST et le 6MWT s'étaient améliorés de manière significative (Δ -3,0 ± 0,19 s, p = 0,05 et Δ 39,8 ± 19,7 m, p = 0,01, respectivement). CONCLUSION: Ces résultats appuient la faisabilité d'un TELErp et suggèrent qu'une telle intervention peut contribuer à maintenir ou à améliorer la capacité fonctionnelle des patients atteints de néoplasie thoracique recevant de la chimiothérapie. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and an important cause of disability and handicap. For a thorough patient-centered outcome assessment and comprehensive management of the disease, measures of lung function, exercise capacity, and health-related quality of life, but also of functional capacity in activities of daily life, are necessary. In Part 2 of this seminar series, we discuss the main functional tests to assess upper and lower body functional capacity in patients with COPD to help clinicians substantiate their choice of functional outcome measures in COPD. In agreement with the International Classification of Functioning, Disability and Health to assess functional capacity representative of daily life activities, this review focuses on functional tests that include components such as changing and maintaining body positions, walking, moving, and climbing, as well as carrying, moving, and handling objects. We review the validity, reliability, and responsiveness of these tests. With 11 links to the International Classification of Functioning, Disability and Health framework addressing several upper and lower body components of functional activities, the Glittre Activities of Daily Life test seems to be the most promising and comprehensive test to evaluate functional capacity in activities of daily life. The links between functional capacity tests and real participation in daily life, as well as with important clinical outcomes such as morbidity and mortality, need further investigation. More studies are also recommended to document minimal detectable changes, minimal clinically important differences, and normative values for these functional tests. [ABSTRACT FROM AUTHOR]

Background: Pulmonary rehabilitation (PR) has proven effective in improving exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD). In Canada, however, there are insufficient rehabilitation services. New strategies such as telerehabilitation must be deployed to increase accessibility. This study aims to investigate the effect of telerehabilitation on exercise tolerance and quality of life and to document patient satisfaction and adherence. Materials and Methods: Twenty-six patients with moderate to very severe COPD participated in this pre-/postintervention study. They received 15 in-home teletreatment sessions over 8 weeks via videoconference from a service center to their home. Education was provided via self-learning health capsules. Assessments were carried out twice before (T0 and T1; 8 weeks apart) and immediately after the intervention (T2). Primary outcome measures were changes in exercise tolerance (6-min walk test [6MWT] and cycle endurance test [CET]) and quality of life (Chronic Respiratory Questionnaire [CRQ]). Results: There were significant improvements between pre- and postintervention (T2-T1) on the 6MWT (32 m; p <0.001), CET (41 s; p =0.005), and three of four CRQ domains (dyspnea [p <0.001], fatigue [p =0.002], and emotion [p =0.002]). Improvements in the CET and fatigue during the 8-week intervention period were greater than changes over 8 weeks of maturation (T1-T0) (p =0.004 and 0.02, respectively). Participants' satisfaction and adherence rate with telerehabilitation were very high. Conclusions: Using telehealth technology to deliver in-home PR is a feasible and practical solution for patients with moderate to very severe COPD. The telerehabilitation program was associated with beneficial effects on exercise tolerance and quality of life and was well received by users. [ABSTRACT FROM AUTHOR]

Background: Low-load, high-repetitive single-limb resistance training may increase limb muscle function and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD) while minimizing the occurrence of limiting exertional symptoms. Whether high-repetitive single-limb resistance training would perform better than high-repetitive two-limb resistance training is unknown. In addition, the mechanisms underlying possible benefits of high-repetitive resistance training has not been investigated. The aims of this study are to compare single versus two-limb high-repetitive resistance training in patients with COPD and to investigate mechanisms of action of these training modalities. Methods/Design: This trial is a prospective, assessor-blind, randomized controlled trial. The participants are patients with stable severe to very severe COPD who are older than 40 years of age and healthy controls. The intervention is single-limb, high-repetitive, resistance training with elastic bands, three times/week for 8 weeks. The control is two-limb high-repetitive resistance training with elastic bands, three times/week for 8 weeks. The primary outcomes is change in the 6-min walking distance after 8 weeks of single-limb or two-limb high-repetitive resistance training. The secondary outcomes are changes in limb muscle strength and endurance capacity, key protein involved in quadriceps anabolic/catabolic signalization, fiber-type distribution and capillarization, subjective dyspnea and muscle fatigue, muscle oxygenation, cardiorespiratory demand and health-related quality-of-life after 8 weeks of single-limb or two-limb high-repetitive resistance training. The acute effects of single-limb versus two-limb high-repetitive resistance training on contractile fatigue, exercise stimulus (the product of number of repetition and load), subjective dyspnea and muscle fatigue, muscle oxygenation, and cardiorespiratory demand during upper and lower limb exercises will also be investigated in patients with COPD and healthy controls. Randomization will be performed using a random number generator by a person independent of the recruitment process, using 1:1 allocation to the intervention and the control group using random block sizes. Blinding: All outcome assessors will be blinded to group assignment. Discussion: The results of this project will provide important information to help developing and implementing customized exercise training programs for patients with COPD. Trial registration: ClinicalTrials.gov Identifier NCT02283580 Registration date: 4 November 2014. First participant randomized: 10 November 2014. [ABSTRACT FROM AUTHOR]

Patients with chronic obstructive pulmonary disease (COPD) are often caught in a downward spiral that progresses from expiratory flow limitation to poor quality of life and invalidity. Within this downward spiral, exercise tolerance represents a key intermediate outcome. As recently stated by the GOLD initiative, improvement in exercise tolerance is now rec ognized as an important goal of COPD treatment. This objective will be achieved only by a comprehensive understanding of the mechanism of exercise limitation in this disease. The objective of this paper is to review the mechanisms of exercise limitation in COPD and discuss their relative contribution to exercise intolerance in patients suffering from this disease. [ABSTRACT FROM AUTHOR]

Background: In people with chronic obstructive pulmonary disease (COPD), limb-muscle dysfunction is one of the most troublesome systemic manifestations of the disease, which at the functional level is evidenced by reduced strength and endurance of limb muscles. Improving limb-muscle function is an important therapeutic goal of COPD management, for which resistance training is recommended. However, current guidelines for resistance training in COPD mainly focus on improving muscle strength which only reflects one aspect of limb-muscle function and does not address the issue of reduced muscle endurance. The latter is of importance considering that the reduction in limb-muscle endurance often is greater than that of muscle weakness, and also, limb-muscle endurance seems to be closer related to walking capacity as well as arm function than to limb-muscle strength within this group of people. Thus, strategies targeting multiple aspects of the decreased muscle function are warranted to increase the possibility for an optimal effect for the individual patient. Periodized resistance training, which represents a planned variation of resistance training variables (i.e., volume, intensity, frequency, etc.), is one strategy that could be used to target limb-muscle strength as well as limb-muscle endurance within the same exercise regimen.Methods: This is an international, multicenter, randomized controlled trial comparing the effect and feasibility of non-linear periodized resistance training to traditional non-periodized resistance training in people with COPD. Primary outcomes are dynamic limb-muscle strength and endurance. Secondary outcomes include static limb-muscle strength and endurance, functional performance, quality of life, dyspnea, intramuscular adaptations as well as the proportion of responders. Feasibility of the training programs will be assessed and compared on attendance rate, duration, satisfaction, drop-outs as well as occurrence and severity of any adverse events.Discussion: The proposed trial will provide new knowledge to this research area by investigating and comparing the feasibility and effects of non-linear periodized resistance training compared to traditional non-periodized resistance training. If the former strategy produces larger physiological adaptations than non-periodized resistance training, this project may influence the prescription of resistance training in people with COPD.Trial Registration: ClinicalTrials.gov, ID: NCT03518723 . Registered on 13 April 2018. [ABSTRACT FROM AUTHOR]

Background. Once viewed as an irreversible condition, chronic obstructive pulmonary disease (COPD) is now considered as a preventable and treatable disease. The past ten years of research have clearly indicate that dyspnea, exercise tolerance and quality of life can be improved considerably with appropriate therapeutic interventions that include pharmacological and non-pharmacological components. It is also becoming evident that it is the concomitant use of appropriate pharmacotherapy and non-pharmacological approaches, such as exercise training and pulmonary rehabilitation, that offers the best hope for an optimal status. Purpose. The objective of this short paper is to review the rationale of combining pharmacological and non-pharmacological therapeutic approaches to optimize functional status and quality of life in patients with COPD. Principal Findings: Optimal bronchodilation is the mainstay of treatment. Leg fatigue will prevent patients with COPD from obtaining full advantage of bronchodilation. Quadriceps fatigue during cycling exercise is linked to events taking place within the muscle providing a muscular and metabolic basis to explain the observation that some patients with COPD develop contractile fatigue after exercise. Muscle fatigue can be improved with exercise training. Pharmacotherapy and exercise training offer the best hope for an optimal status in COPD Conclusion. Our goals are to stimulate interest in COPD, provide a strong case against the nihilistic approach to this disease to ultimately raise the standard of care to the benefit of the numerous patients afflicted by this condition. [ABSTRACT FROM AUTHOR]