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Background: Pulmonary rehabilitation (PR) has a positive impact on functional status and quality of life in patients with interstitial lung disease (ILD). Objectives: This study investigated the effects of PR in hypercapnic ILD patients receiving nighttime noninvasive positive pressure ventilation (NPPV). Methods: Consecutive ILD patients referred to a specialized inpatient PR center were included. All participated in a PR program. Those with hypercapnia received NPPV (NPPV group; n = 29); the remaining patients served as comparison group (n = 319). Results: PR improved the 6-min walk distance by 64.4 ± 67.1 m versus baseline (p < 0.0001) in NPPV patients and by 43.2 ± 55.1 m (p < 0.0001) in the comparison group (difference 21.1 m, 95% confidence interval 0.5-41.8; p = 0.045). There was no change in total lung capacity during PR in NPPV recipients or the comparison group. Forced vital capacity significantly increased from baseline in the comparison, but not the NPPV group. NPPV recipients were significantly more likely than the comparison group to have improved dyspnea during PR (p = 0.049). There was no improvement in the 36-item Short Form (SF-36) physical component score in the NPPV group after PR, but there was in the comparison group. PR improved the SF-36 mental component score versus baseline in both groups. Conclusion: An individually tailored PR plus nighttime NPPV appears feasible in hypercapnic ILD patients and significantly improves exercise capacity and quality of life.

Cognitive impairment is highly prevalent in patients with COPD and demonstrates multiple detrimental effects on many aspects of patient state and therapeutic outcomes. It is attributed to several overlapping pathophysiological factors, with the most common being the low level of oxygen saturation due to respiratory insufficiency. Despite the impact of cognitive impairment on clinical outcomes, the screening for coexisting cognitive deficits which may interfere with the successful progress of respiratory treatment is yet neglected. There is a special consideration that cognitive deficits should be taken into account when developing respiratory therapy plans. Cognitively impaired patients are likely to require more support and have need of an individualised respiratory care plan which can also be beneficial for their cognitive deficits. Pulmonary rehabilitation as a multidisciplinary approach could be prioritised for COPD patients with cognitive impairment. Educational aims To illustrate the common signs of cognitive impairment and define potential associations between lung and cognitive dysfunction. To illustrate the potential influence of cognitive deficits on the optimal progress of respiratory therapy. To illustrate the importance of cognitive evaluation as part of a comprehensive clinical assessment for patients suspected of suffering cognitive impairment., Cognitive impairment in COPD may affect respiratory treatment and should be considered in therapeutic strategy http://ow.ly/aK3s309RiS9

Background: Pulmonary rehabilitation (PR) in patients awaiting lung transplantation is crucial to ensure a transplant benefit. However, PR in patients with end-stage lung disease treated with noninvasive ventilation (NIV) remains an area of uncertainty. Objectives: The aim of the study was to assess the potential benefit of PR in patients awaiting lung transplantation treated with NIV. Methods: Patients awaiting lung transplantation who underwent comprehensive inpatient PR from 1998 to 2015 were retrospectively analyzed. Success of PR was assessed by comparing admission and discharge. Multivariate regression models were applied to assess the impact of long-term nocturnal NIV on PR success. Results: In total, 1,044 patients were included in the analysis. Thereof, 296 patients (28%) were treated with NIV. PR in patients treated with NIV resulted in a significant increase in 6-min walk distance (6MWD; from 250 ± 117 to 309 ± 116 m; p < 0.0001) and in various items of the Short Form Health Survey (SF)-36 questionnaire. The increase in 6MWD was higher in patients treated with NIV than in patients without NIV (59 ± 63 vs. 48 ± 55 m; p = 0.003). Furthermore, improvements of various lung function variables were higher in patients with NIV. Finally, multivariate generalized regression analysis revealed that NIV therapy was associated with improvement of 6MWD (p = 0.023) while controlling for various baseline characteristics. Conclusions: PR in patients with end-stage lung disease awaiting lung transplantation on nocturnal NIV is feasible and is associated with improvements of exercise capacity and quality of life. Furthermore, despite more advanced lung disease, patients treated with NIV have an increased benefit of PR compared to patients without NIV while awaiting lung transplantation.

Background: Whole-body vibration training (WBVT) has been shown to be a feasible and effective exercise modality in patients directly following lung transplantation (LTx). Aim of this study was to investigate WBVT effects in long-term LTx patients (LTx>1year). Methods: 70 long-term LTx patients (mean duration since LTx: 5.7±4.5 years) participated in this randomized controlled trial. All patients performed a comprehensive pulmonary rehabilitation program of 3-weeks duration including a standardized endurance and strength training program on 5 days per week. On top, patients were randomized into squat training groups 3x/wk performing dynamic squat exercises for 4x2 min either on a side-alternating WBVT platform at high frequencies of 24-26 Hz (WBVT group) or for the same amount on the floor (control group, CON). Results: Patients in both groups reached a significant increase in 6-minute walk distance (WBVT: 44±44m versus CON: 22±34m) which was significantly superior in favor of the WBVT-group (delta: 22m, p=0.027). Also peak cycling work rate increased significantly more in the WBVT group (15±9W versus 10±9W, between-group difference: 5W, p=0.044). Furthermore, LTx patients who performed WBVT showed a significant increase in insulin-like growth factor (+18±49ng/ml) compared to control (-14±51ng/ml, between-group difference: 32ng/ml, p=0.035). Conclusion: Squat training on a vibration platform induced significantly higher improvements in exercise capacity compared to squat training on the floor. Therefore, WBVT seems to be an effective add-on exercise modality also in long-term LTx patients.

Aim: To investigate any relationship between, i)quality of training sessions, ii)improvements in inspiratory muscle function, iii)changes in exercise capacity following well-controlled, high-intensity inspiratory muscle training (IMT), in combination with 3-months of pulmonary rehabilitation. Methods: 169 patients (FEV1 41±16%pred.) with low maximal inspiratory pressure (PImax 51±15%pred) were recruited and randomized into an intervention group (IMT ≥50%PImax) or a control group (IMT ≤10%PImax). Patients participated in daily IMT using a tapered flow resistive loading device. Subgroup analyses were performed by pooling the data of both groups and subsequently dividing it into tertiles based on improvements in PImax after the intervention. Results: Training characteristics (total inspiratory work performed/session, average peak power/session, and IMT intensity) were significantly related to improvements in PImax (Figure 1A-1C). Average training compliance (84±19%) was not associated with change in PImax (p-for-trend=0.129). Larger improvements in PImax were related to larger increases in endurance cycling time (Figure 1D). Conclusion: The quality rather than the number of performed training sessions is strongly associated with improvement in inspiratory muscle strength which in turn relates to improvements in endurance cycling time.

Background: There is only little evidence on the acute effects of non-invasive ventilation (NIV) during exercise in hypercapnic COPD patients. Methods: Fifteen hypercapnic COPD patients (age: 62±7 yrs, FEV1: 18±4 %pred., pCO2: 51±5mmHg) were recruited. Patients underwent a two-day assessment. On the first day an incremental cycling test was performed to determine peak work rate. On the second day patients performed two constant work rate cycling tests (CWRT) at 60% of peak work rate until exhaustion. CWRTs were randomly assigned to 2 conditions; a) with oxygen supplementation (4±2lpm) only, and b) with the same oxygen supplementation plus effective NIV (inspiratory pressure: 25±2 cmH20, expiratory pressure: 6±1 cmH20) including one hour of rest in between. Results: There was a clinically relevant change concerning a longer cycle endurance time with the use of NIV (627±384 sec versus 506±291 sec, p=0.34). Furthermore, NIV limited CO2 retention. At isotime (the shortest test between the two experimental conditions in a given subject) CO2 increased from 50.7±6.8mmHg up to 55.7±6.9mmHg without NIV and from 45.1±5.8mmHg to 49.9±5.8mmHg with NIV (p=0.019). Furthermore, oxygen saturation at isotime tended to be higher with NIV (96.0±4.5% versus 92.5±5.9%, p=0.081). Dyspnea rated on the Borg scale was significantly lower at the end of the CWRT with NIV (3.2±1.9 pts versus 5.3±1.5 pts, p=0.006). Conclusion: NIV during exercise in hypercapnic COPD patients prevented CO2 retention and reduced dyspnea. This might provide the basis for a feasible and safe endurance training program in this specific cohort of patients with very advanced COPD.

Background: Cognitive impairment (CI) is a prevalent extrapulmonary manifestation in COPD. Potential disturbances in cerebral circulation and oxygen delivery due to reduced ventilatory efficiency and ventilatory drive may be associated with higher rates of CI. We assessed cerebral tissue oxygen index (TOI) and cerebral hemodynamics at exertion in COPD patient with and without CI. Method: 52 COPD patients (aged: 68±8yrs; FEV1: 45±14%; 40%women) underwent a comprehensive cognitive assessment. Patients were assigned to “CI” and “non-CI” groups according to Montreal Cognitive Assessment (MoCA) cutoff score ≤25points. Patients performed cycle endurance test (CET) at 75% of peak work rate while transcutaneous carbon-dioxide partial-pressure (TCPCO2), cerebral tissue oxygen index (TOI) and hemoglobin responses were recorded by SenTec and Portalite systems, respectively. Results: 23 patients (44%) presented evidences of CI (MoCA≤25) with also lower scores in other cognitive tests (all p Conclusion: COPD patients have the capacity to autoregulate cerebral cortex blood flow in response to hypercapnia and hypoxemia, at least during exercise, and thus to normalize cerebral tissue oxygenation. These findings suggest that exercise is safe and can be beneficial regarding to cognitive function in COPD.

Background: Chronic respiratory failure can be associated with CO2 retention and hypercapnia during exercise in COPD patients. A continuously monitoring of transcutaneous CO2 levels (TcPCO2) may be useful to screen CO2 trends and to identify patients with exercise-induced hypercapnia (EIH). Objective: The aim of this study was to investigate the accuracy of the SenTec Digital Monitoring System (SDMS, SenTec AG, Therwil, Switzerland) during the 6-minute walk test (6MWT) in COPD patients. Methods: 10 COPD patients were enrolled in this prospective, pilot study. Capillary blood gases (CBG) from the earlobe were taken by the same investigator pre-6MWT and directly following 6MWT withTcPCO2 levels recorded simultaneously. To ensure a valid comparison between CBG and TcPCO2, values were taken at the same time point. An independent person set digital markers in the SenTec device concurrently with the taking of the CBG. Results: The agreement of PCO2 recording between CBG and SenTec device showed a very strong intra-class correlation coefficient for pre-walk (ICC=0.98, 95%CI: 0.93-0.99) and post-walk (ICC=0.98, 95CI: 0.73-0.99) values of the 6MWT (see Figure). Conclusion: Transcutaneously measured PCO2 values by the SDMS during 6MWT were highly accurate. The strong correlation with CBG and the continuous, non-invasive method could be advantageous to detect patients with EIH during the 6MWT.

Background: Cognitive impairment (CI) is a prevalent extrapulmonary manifestation in COPD. We assessed the prevalence and the determinants of CI in COPD. Method: 52 COPD patients (aged: 68±8yrs; FEV 1 : 45±14%; 40%women) underwent a comprehensive cognitive assessment. Patients were assigned to “CI” and “non-CI” groups according to Montreal Cognitive Assessment (MoCA) cutoff score ≤25points. Clinical data including medical history, respiratory function, health/ mood status evaluation by Saint-George respiratory questionnaire (SGRQ) and hospital anxiety-depression scale (HADS) were collected. Patients performed six-minute walk test (6MWT) and cycle endurance test (CET) at 75% of peak work rate. Results: 23 patients (44%) presented evidences of CI (MoCA≤25) with also lower scores in the other cognitive tests (all p 1 %, health and mood status (SGRQ, HADS), and exercise capacity (6MWD: 359 ±85m vs 380 ±116m, p=0.48; CET: 616 ±329sec vs 551 ±370sec, p=0.51) but greater oxygen desaturation during the CET (SpO 2 nadir: 92.3 ±2.9% vs 89.9 ±3.9%, p=0.014). Certain threshold of SpO 2 nadir (≤90%) increased the risk for CI after adjustment for oxygen-use (p=0.026). Conclusion: CI is highly prevalent in patients with COPD and affects several cognitive domains. It is associated with the years of education and the oxygen desaturation during the CET, however, it seems that is not associated with exercise capacity in COPD patients.

Background: Inspiratory muscle dysfunction occurs in patients with chronic obstructive pulmonary disease (COPD) and is associated with dyspnea and decreased exercise capacity. Aim of this study was to investigate additional benefits of adding inspiratory muscle training (IMT) to a general exercise training program during pulmonary rehabilitation (PR) in COPD patients with inspiratory muscle weakness. Methods: 70 COPD patients (FEV1: 39±13%pred., PImax: 51±14 cmH2O) participated in this randomized controlled trial. All patients performed a 3-week comprehensive inpatient PR including standardized endurance and strength training. On top, patients performed supervised IMT on 7 days/wk randomized into an intervention group and a Sham-IMT group (initial IMT pressure: 61±15% of PImax and 13±8% of PImax, respectively) Results: At 3 weeks, PImax improved significantly more in the IMT group (IMT: 18±12cmH2O vs. 6±11cmH2O, p Conclusion: A complementary inspiratory muscle training on top of a general exercise training program in COPD patients with inspiratory muscle weakness significantly improved inspiratory muscle function. However, these benefits did not transfer into further improvements of functional exercise capacity.

Hintergrund: Bislang gibt es nur wenig Evidenz bezüglich der akuten Auswirkungen einer nicht invasiven Beatmung (NIV) während körperlichen Trainings bei hyperkapnischen COPD Patienten. Methodik: 15 hyperkapnische COPD Patienten (Alter: 62±7J, FEV1: 18±4%Soll, pCO2: 51±5[zum vollständigen Text gelangen Sie über die oben angegebene URL], 25. Jahreskongress der Deutschen Interdisziplinären Gesellschaft für Außerklinische Beatmung (DIGAB) e.V.

Die Langzeit-Sauerstoff-Therapie (LTOT) fuhrt bei Patienten mit chronisch respiratorischer Insuffizienz nachweislich zur Prognoseverbesserung. Pathogenetisch sind eine Verbesserung der Oxygenierung, eine Abnahme des pulmonal-arteriellen Drucks sowie eine Abnahme der Atemarbeit von Bedeutung. Aufgrund der Vielfalt und grosen Unterschiedlichkeit der LTOT-Systeme ist eine individuelle Einstellung des Patienten auf die Langzeit-Sauerstoff-Therapie notwendig. Zu berucksichtigen sind dabei insbesondere Mobilitatsaspekte. Bei den Applikationsgeraten ist zu unterscheiden zwischen stationaren/mobilen Flussigsauerstoffsystemen sowie stationaren/mobilen Konzentratoren. Die Sauerstofftitration sollte individuell, bezogen auf eine Ruhe- und eine Belastungsphase (z. B. 6-Minuten-Gehtest) sowie den Schlaf, vorgenommen werden. Der Einsatz von Spar- bzw. Demandventilen ist kritisch zu prufen. Er ist nur aufgrund arztlicher Verordnung gerechtfertigt und bedarf engmaschiger Kontrollen.

Die fruher weitverbreitete Meinung, Patienten mit einer chronisch obstruktiven Atemwegs- und Lungenkrankheit sollten sich korperlich schonen, gilt inzwischen als obsolet. Stattdessen sollte moglichst fruhzeitig eine multimodale pneumologische Rehabilitation durchgefuhrt werden. Anschliesend sollten die Patienten dauerhaft gezielt Lungensport betreiben oder zumindest korperlich aktiv bleiben. Die Evidenz der pneumologischen Rehabilitation ist vor allem fur die COPD gesichert. Hier stellt sich nicht mehr die Frage ob, sondern allenfalls wie und unter welchen Bedingungen sie angewendet werden sollte. Studien konnten zeigen, dass die Rehabilitation vergleichbar gut wie eine medikamentose Therapie wirkt, zum Teil sogar besser. Selbst bei einer Exazerbation wird heute empfohlen, moglichst rasch mit einem speziellen Krafttraining zu beginnen. Neue Trainingsformen verbessern die Mobilitat auch bei korperlich stark eingeschrankten COPD-Patienten. Fur Patienten mit Asthma und Lungenfibrose liegen weniger Studien vor, die pneumologische Rehabilitation wird aber auch hier empfohlen.

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPD-related fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.

Background Several studies have shown that whole-body vibration training (WBVT) improves exercise capacity in patients with severe COPD. The aim of this study was to investigate the determinants of improved exercise capacity following WBVT. Methods Seventy-four COPD patients (FEV1: 34 ± 9%predicted) were recruited during a 3-week inpatient pulmonary rehabilitation (PR) program. Conventional endurance and strength exercises were supplemented with self-paced dynamic squat training sessions (4bouts*2min, 3times/wk). Patients were randomly allocated to either a WBVT-group performing squat training on a side-alternating vibration platform (Galileo) at a high intensity (24–26 Hz) or a control group performing squat training without WBVT. Results Patients in the WBVT group significantly improved postural balance in several domains compared to the control-group (i.e. tandem stance: WBVT +20% (95%CI 14 to 26) vs. control −10% (95%CI 6 to 15), p Conclusions Implementation of WBVT improves postural balance performance and muscle power output. The neuromuscular adaptation related to improved balance performance may be an important mechanism of the improvement in exercise capacity after WBVT especially in COPD patients with impaired balance performance and low exercise capacity.

Background: Pulmonary rehabilitation (PR) following lung transplantation (LTx) has been shown to be effective with regard to exercise capacity and health-related quality of life (HRQL). However, outcome data is limited with respect to LTx as a population. Differences concerning the effects of PR in patients with single LTx (SLTx) or double LTx (DLTx) have not been studied yet. Objectives: The aim was to compare possible differences concerning PR outcomes between SLTx and DLTx. Methods: In a retrospective analysis (period: 1997-2016), data from 722 patients with either chronic obstructive pulmonary disease (COPD; SLTx: n = 129, FEV1 51 ± 17% pred.; DLTx: n = 204, FEV1 74 ± 20% pred.) or interstitial lung disease (ILD; SLTx: n = 135, FVC 58 ± 18% pred.; DLTx: n = 254, FVC 63 ± 18% pred.) after LTx were included. All patients underwent a specialized inpatient PR program. The data of the 6-minute walk distance (6MWD) and HRQL (physical [PCS] and mental [MCS] component summary of the SF- 36 questionnaire) were analyzed. Results: Independently from the procedure and pretransplant diagnosis, patients significantly (p < 0.05) improved the 6MWD without any differences between SLTx and DLTx (COPD: SLTx: +109 ± 68 m, DLTx: +117 ± 82 m; ILD: SLTx: +115 ± 80 m, DLTx: +132 ± 77 m). The PCS (COPD: SLTx: +9 ± 9 points, DLTx: +7 ± 9 points; ILD: SLTx: +6 ± 9 points, DLTx: +9 ± 9 points) and MCS (COPD: SLTx: +8 ± 15 points, DLTx: +7 ± 15 points; ILD: SLTx: +10 ± 13 points, DLTx: +8 ± 12 points) also improved significantly without any group differences. Conclusions: LTx patients with a pretransplant diagnosis of COPD or ILD all benefitted significantly and with clinical relevance with regard to exercise capacity and HRQL from an inpatient PR performed within 1 year postoperatively. PR outcomes were similar regardless of SLTx or DLTx.

Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted) were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. The next day, six bouts of repeated squat exercises were performed in random order for one, two or three minutes either with or without WBVT while metabolic demands were simultaneously measured. Squat exercises with or without WBVT induced comparable ventilatory efficiency (minute ventilation (VE)/carbon dioxide production (V′CO2): 38.0±4.4 with WBVT versus 37.4±4.1 without, p=0.236). Oxygen uptake after 3 min of squat exercises increased from 339±40 mL·min−1 to 1060±160 mL·min−1 with WBVT and 988±124 mL min−1 without WBV (p=0.093). However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068), heart rate (109±13 bpm versus 110±15 bpm, p=0.513) or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279). Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD compared to squat exercises without WBVT. Bearing in mind the small sample size, WBVT might be a feasible and safe exercise modality even in patients with severe COPD., Whole-body vibration training is a feasible and safe exercise modality even in patients with severe COPD http://ow.ly/FNK5307VSPC

Background: Carbon dioxide pressure (pCO2) can be reliably measured transcutaneously and may be of clinical relevance in COPD. Retention of CO2 and exercise-induced hypercapnia (EIH) has been scarcely studied as disease marker in COPD. The aims of this study were (1) to study pCO2 response during the 6MWT and (2) to compare clinical characteristics amongst patients with and without CO2 retention and those with and without EIH during the 6MWT. Methods: Sixty-two COPD patients (age: 63±8years, FEV1: 33±10%pred) participated in study. Transcutaneous carbon dioxide pressure (tcpCO2) was measured continuously during the 6MWT by the use of SenTec device. Measurements where repeated after 1 week and data from the longest 6MWT were analyzed. Results: Half of the patients (50%) had CO2 retention (ΔtcpCO2 >4mmHg from baseline) while the rest preserved or reduced tcpCO2 levels. Nineteen patients (31%) exhibited EIH (tcpCO2 >45mmHg) during the 6MWT. Physiological characteristics of CO2 retainers were similar with non-retainers but patients with EIH were characterized by higher resting tcpCO2 levels within the normal range, lower inspiratory pressures (Pimax), lower BMI, more severe FEV1 and higher dyspnoea at rest compared to non-EIH. The determinants of pCO2 retention were pre-walk dyspnoea and FEV1 while pre-walk dyspnoea and baseline pCO2 levels were crucial for EIH. Conclusions: The pCO2 response to 6MWT is highly heterogeneous in COPD. CO2 retention is related to more pre-walk dyspnoea and worse FEV1 while EIH is associated with more pre-walk dyspnoea and higher baseline PaCO2 levels. Monitoring of pCO2 changes during 6MWT might help to identify patients who need special attention regarding to EIH.

Background Most endurance training programs rely on continuous or interval cycling. Objective Aim of this study was to determine the feasibility of these training modalities during treadmill walking. Methods 42 COPD patients (FEV 1 : 37±14% pred.) were enrolled in this prospective, randomized 4-arm study. Patients were randomized to one of four treadmill walking programs (a 15 sessions). Training modalities consisted of 2 constant walking speed groups (MIC group walking speed [WS]: 60% from mean baseline 6-minute walking test [6MWT] speed/ HIT group WS: 120% from mean 6MWT speed for 1 min alternating with 1 min of rest) and 2 symptom orientated groups (MIC-Borg group [BG]/ HIT-BG) where WS was adjusted to dyspnea scores of 4-6 on a 10 point Borg scale (BS). Total walking time was increased from 10 up to 32 minutes in all groups. Dyspnea, leg fatigue, heart rate (HR) and oxygen saturation (SpO 2 ) were recorded during each session. Results Levels of dyspnea (BS: MIC: 4.3±1.4 vs. MIC-BG: 4.1±1.1, p=n.s. and HIT: 3.6±1.0 vs. HIT-BG: 3.7±0.9, p=n.s.) and leg fatigue (BS: MIC: 2.6±1.7 vs. MIC-BG: 3.2±1.2, p=n.s. and HIT: 2.5±1.4 vs. HIT-BG: 1.7±1.0 p=n.s.) were comparable during exercise. Also mean SpO 2 and HR were comparable. MIC-BG had markedly, but not significantly less unintended breaks (n) during training than MIC group (0.8±2 vs. 13±20) and trained at a higher walking speed (p=0.02) than predicted. In all groups no adverse events were observed. Conclusion It seems that all 4 treadmill-based walking training modalities are feasible and safe for patients with severe COPD.

Background There is growing evidence that patients with idiopathic pulmonary fibrosis (IPF) benefit from pulmonary rehabilitation (PR) in terms of exercise capacity and health related quality of life (HRQL). However, the effects of PR on mental aspects of HRQL are still unknown. Objective The aim of our study was to investigate (a) short-term effects of an inpatient PR and (2) sustainability after 3 months in IPF patients. Methods 33 IPF patients were randomized into a PR group (PRG) receiving 3 weeks of inpatient PR (n=18, 68±9y, FVC: 73±17%pred.) and a control group (CG) with usual care (n=15, 65±10y; FVC: 72±21%pred.). Data were collected at the begin of the study [T1], after 6 weeks of usual care (CG) or following PR (PRG)[T2], and at 3 months follow-up (n=24)[T3]. Results From T1 to T2, PRG but not CG improved significantly in HADS scores (anxiety: -1.5±2.7pts., depression: -1.7±2.3pts.), mental score of SF36 questionnaire (6.1±7.9pts.), and CRQ categories of mastery (0.7±1.2pts.), fatigue (0.9±1.5pts.) and emotion (0.9±1.1pts.). CRQ dyspnea score worsened significantly in CG (-0.5±0.7pts.). At T3, PRG improved clinically relevant in all CRQ domains (>0.5pts.) and HADS scores (each >1.0pts.) compared to CG. 6-minute walking distance (6MWD) increased from T1 to T2 in PRG (+60±94m, p Conclusion PR improves anxiety and depression, HRQL and 6MWD in IPF patients. The benefit of PR was sustained after 3 months to a clinical relevant extent regarding HRQL, symptoms of anxiety and depression but not 6MWD.

Background: There are several studies that have shown that whole body vibration training (WBVT) is able to improve exercise capacity in patients with COPD. However, the underlying mechanisms remain unknown. Objective: To evaluate the effect of WBVT on balance and muscle power in patients with severe COPD. Methods: Fifty patients (age: 63±7 ys, FEV 1 : 35±10 %pred.) were recruited during a 3-week inpatient pulmonary rehabilitation program (PR). On top of conventional endurance and strength training patients performed dynamic squat training sessions (4x2min, 3x/wk) randomized into a WBVT-group performing squat training on a vibration platform or a control group (CON) exercising on the floor. To assess balance patients were asked to stand still for 10 sec in different static positions (Romberg stand, tandem stand, 1-leg stand with open and closed eyes). Muscle power tests consisted of 2-leg jumps, 5-repetition sit-to-stand test (STST) as well as the 1-min STST. All tests were performed on a force measurement platform pre and post PR. Results: After PR the WBVT-group could improve balance significantly more in 2 out of 4 domains compared to the CON-group (tandem stand: WBVT +10% vs. CON -14%, p=0.008 and 1-leg stand: WBVT +6% vs. CON -9%). Also some measures of muscle power like jump height (WBVT: +26% vs. CON: +1%, p=0.010) and the 5-STST (WBVT: -5.2±5.1sec vs. CON: -2.4±0.9sec) improved significantly more in the WBVT-group. Conclusion: This is the first study that investigated potential mechanisms of the beneficial effect of WBVT. It was found that neuromuscular adaptations like improvements in balance and muscle power may explain some of these positive effects.

Aim: With this large, multi-center, randomized controlled trial we aimed to examine the effects of a well-controlled, high-intensity inspiratory muscle training (IMT) program in a combination with a 3-month pulmonary rehabilitation (PR) on functional exercise capacity in COPD patients with inspiratory muscle weakness. Methods: Patients with reduced maximal inspiratory pressure (PImax 2 O or Results: While most baseline characteristic of patients were comparable between groups, the intervention group was more impaired in some pulmonary function characteristics and limb muscle strength. Conclusion: Inclusions will be completed by September 2016 and preliminary results of between group comparisons will be presented then.

The acute effect of supplemental oxygen during exercise has been shown to differ largely among patients with COPD. It is unknown what factors influence oxygen response.In a randomized, single-blind fashion, 124 patients with COPD underwent one 6-min walk test on supplemental oxygen (6MWTOxygen supplementation resulted in an increase in the 6-min walk distance in the total cohort (27 ± 42 meters; P .001) and in the subgroups of HYX (37 ± 40 meters; P .001) and EIH (28 ± 44 meters; P .001) but not in the NOX subgroup (15 ± 43 meters; P = .065). Forty-two percent of patients with HYX and 47% of patients with EIH improved their 6-min walk distance to a clinically relevant extent (≥ 30 meters) by using oxygen. These oxygen responders were characterized by significantly lower 6-min walk distance using room air compared with patients without a relevant response (306 ± 106 meters vs 358 ± 113 meters; P .05). Although oxygen saturation was significantly higher during 6MWTIn contrast to patients with NOX, patients with HYX and EIH generally benefit from supplemental oxygen by increasing exercise capacity. However, less than one-half of patients reached the threshold of clinically relevant improvements. These oxygen responders were characterized by significantly lower exercise capacity levels.ClinicalTrials.gov; No.: NCT00886639; URL: www.clinicaltrials.gov.

People with chronic obstructive pulmonary disease (COPD) are affected by somatic as well as psychological symptoms such as anxiety and depression and reduced quality of life. Protective psychological factors exist which enable people to adapt successfully to disease, but research about these factors in COPD is sparse. The aim of this study was to investigate whether sense of coherence (SOC), resilience and social support are potential protective factors and thus associated with reduced levels of symptoms of anxiety and depression and lower perceived disability in people with COPD. An online study was conducted in which n = 531 participants with COPD completed questionnaires assessing protective psychological factors, anxiety and depressive symptoms (Hospital Anxiety and Depression Scale) and disease-specific disability (COPD Disability Index). Regression analyses were conducted. SOC and resilience contributed significantly to reduced levels of symptoms of anxiety and depression and to lower disease-specific disability after controlling for confounding variables and disease severity. Symptoms of anxiety and depression were most strongly predicted by SOC. This study’s results indicated that SOC and resilience could represent helpful individual resources due to their protective potential helping people adjust to COPD. Limitations and implications of this study are discussed.

The two-minute walk test (2MWT) is less well validated than the well-known six-minute walk test (6MWT) as a field walking test in patients with chronic obstructive pulmonary disease (COPD). The primary objective of this study was to compare the accuracy of the 2MWT to the 6MWT in detecting exercise-induced oxygen desaturation in patients with severe COPD. Twenty-six patients with COPD (age: 61 ± 10 years, forced expired volume in one second: 37 ± 10%) that were normoxemic at rest performed a 2MWT and a 6MWT under normal ambient conditions on two consecutive days in random order. Oxygen saturation, total walking distance, heart rate, breathing frequency, dyspnea, and leg fatigue were evaluated. Average walking distances were 150 m (95% confidence interval (95% CI): 134–165 m) and 397 m (95% CI: 347–447 m) for the 2MWT and 6MWT, respectively ( r = 0.80, p < 0.0001). The difference in minimum oxygen saturation during the 2MWT (83%, 95% CI: 81–86%) and 6MWT (mean 82%, 95% CI: 80–84%) was not statistically different and the data strongly correlated between the groups ( r = 0.81, p < 0.0001). Other measurements from the 6MWT, including heart rate, breathing rate, and levels of perceived exertion were also comparable in 2MWT. The 2MWT showed comparable validity in detecting exercise-induced oxygen desaturation in patients with severe COPD compared to the 6MWT.

Interval (IT) and continuous training (CT) represent well-established exercise modalities in patients with moderate to severe chronic obstructive pulmonary disease (COPD). However, their effects and feasibility in patients with end-stage COPD remain unclear.Sixty patients (53 ± 6 years, 53% women) being evaluated for lung transplantation where randomly assigned either to IT (n = 30, cycling at 100% peak work rate for 30 seconds alternating with 30 seconds of rest) or CT (n = 30, cycling at 60% of peak work rate) during a 3-week inpatient rehabilitation program. Both exercise protocols yielded an equivalent amount of total work. Patients had a mean forced expiratory volume at 1 second (FEV(1)) of 25% ± 8% of predicted value.Patients in both groups achieved similar clinically relevant improvements in 6-minute walking distance of 35 ± 29 meters for IT and 36 ± 43 meters for CT, with a between-group difference of 0.3 meters (95% confidence interval, -18.2 to 18.8). Changes in lung function parameters were not significant. Perceived intensity of dyspnea was significantly (p0.05) lower in IT (Borg 6.2 ± 1.8) compared with CT (Borg 7.1 ± 1.7). Patients required a median of 5 unintended breaks (interquartile range, 2-28) during IT exercise and 29 (interquartile range, 6-68) during CT (p0.001).IT is associated with a lower intensity of dyspnea during exercise and fewer unintended breaks but achieves similar improvements in exercise capacity compared with CT in pre-lung transplant COPD patients.

Ziel der vorliegenden Studie ist die Analyse von krankheitsbezogenen Angsten im Zusammenhang mit Depressivitat bei COPD-Patienten. Sowohl Angst als auch Depressivitat sind ein haufiges komorbides Phanomen bei COPD. Beides kann einen erheblichen Einfluss auf den Verlauf und das Erleben der Erkrankung haben. Bislang wurden in Studien lediglich allgemeine – nicht aber COPD-assoziierte – Angste erfasst. An der Studie nahmen insgesamt 96 COPD-Patienten (GOLD III/IV) teil. Die MANOVA ergab, dass COPD-Patienten mit auffalligen Depressivitatswerten starkere krankheitsbezogene Angste berichten als Patienten mit unauffalligen Depressivitatswerten. Sie leiden unter groserer Angst vor sozialer Ausgrenzung, Angst vor Dyspnoe, Angst vor korperlicher Aktivitat und Progredienzangst. Es ergaben sich keine Unterschiede zwischen den beiden Vergleichsgruppen in den medizinisch-objektiven Parametern (FEV 1 % des Solls; 6-Minuten-Gehtest). Insgesamt belegt unsere Studie die hohe Relevanz der Erfassung krankheitsspezifischer Angste bei COPD-Patienten im Zusammenhang mit Depressivitat. Die rechtzeitige Identifikation und angemessene Behandlung von COPD-bezogenen Angsten und Depressivitat hat eine grose Bedeutung fur den Krankheitsverlauf.

Zahlreiche Studien zeigen eine hohe Komorbiditat der COPD mit psychischen Beschwerden. Angesichts der realen Bedrohung durch die Erkrankung treten bei den Betroffenen auch krankheitsbezogene Angste (Progredienz, End-of-Life) auf. Diese konnen die Lebensqualitat beeintrachtigen und den Krankheitsverlauf verschlechtern. Es existieren wenige Studien, die krankheitsbezogene Angste bei COPD untersuchen. Ziel der Studie war es, Zusammenhange zwischen krankheitsbezogenen Angsten, psychischer Symptomatik und Lebensqualitat zu erfassen sowie deskriptive Erkenntnisse zu krankheitsbezogenen Angsten und End-of-Life-Care zu berichten. An der Untersuchung nahmen 132 COPD-Patienten teil. Es zeigten sich keine Unterschiede im Ausmas der krankheitsbezogenen Angste zwischen verschiedenen COPD-Stadien. Es ergaben sich signifikante Korrelationen der End-of-Life-Angste zu Progredienzangst, Depressivitat und psychischer Lebensqualitat. Deskriptive Analysen zeigten, dass bezuglich der Kommunikation von End-of-Life-Aspekten erheblicher Verbesserungsbedarf besteht. Unsere Ergebnisse unterstreichen die grose Bedeutung krankheitsbezogener und End-of-Life-Angste bei COPD.

Summary Introduction Objective of this study was to validate an activity monitor (DynaPort MoveMonitor [MM], McRoberts, The Hague, The Netherlands) against night-vision video analysis during sleep. Methods Twenty patients (65 ± 11 years old, mean body-mass-index: 27 ± 6 kg/m 2 ) with different chronic lung diseases were recruited to participate in this validation study. Patients performed a polysomnography measurement during one single night while wearing the MM. The activity monitor data of the MM were then validated against the analysis of the night-vision video by an independent investigator. In total, four different lying positions (supine, left, right and prone), sitting upright, out of bed as well as large, medium, small and sitting transitions were classified. Results A mean duration of 7.6 ± 0.9 h per night of video and MM classification was available for analysis. In total, 702 different postures were registered on the video from which 678 postures (96.6%) were detected correctly by the MM compared to the video classification. These results yielded a total degree of sensitivity of 93.9% and specificity 94.9% in detecting postures during the night. In total, 682 transitions (394 small, 189 medium, 15 large and 84 sitting transitions) were detected of which 482 were also detected by the MM. The MM detected 70% of the transitions correctly (51.0% small, 97.4% medium, 100% large and 97.6% sitting transitions). Conclusion The MM is an activity monitor showing a high degree of sensitivity and specificity to detect different nocturnal postures as well as medium and large sized transitions in patients with chronic respiratory disorders.

The study aimed to construct a questionnaire for COPD specific anxiety. Anxiety is a prevalent comorbid complication in COPD; however, assessment has focused on anxiety questionnaires in general and not on COPD related fears. Ninety-six patients with COPD (GOLD III/IV) participated in the study. Results of a principal component analysis with Varimax-rotation suggested 5 factors, jointly explaining 64.7% of variance. These factors depict: fear of social isolation, dyspnea related fear, fear of movement, fear of progression of disease, anxiety in relationships, and fear of LTOT. Satisfying internal consistencies (a=0.77-0.89) resulted for all factors. Validity analyses confirmed discriminant and convergent associations, as well as correlations with functional tests. Overall, the COPD-Anxiety-Questionnaire constitutes a reliable and valid measure to assess COPD-related fears. Moreover, it enables the early identification of COPD patients suffering from disease related anxiety.

Noninvasive positive pressure ventilation (NIPPV) has been shown to improve exercise tolerance and health-related quality of life in patients with advanced COPD. This study tested the feasibility of nocturnal NIPPV as an additional tool in a hospital-based pulmonary rehabilitation program. This prospective observational trial included forty COPD patients in GOLD stage IV. NIPPV was successfully introduced and accepted during sleep by all patients. All patients received pressure support ventilation for 7.9+/-0.5h per day with an inspiratory support of 17.5+/-4.4 cmH(2)O, and an expiratory pressure of 4.5+/-0.9 cmH(2)O. The outcome of pulmonary rehabilitation in patients receiving nocturnal NIPPV was compared with the results of forty matched control patients who underwent the same program. Rehabilitation with nocturnal NIPPV resulted in the 6-minute walk test and in the longest non-stop walk distance in improvements of 82 and 89 m, respectively, while patients without nocturnal ventilatory support improved by 50 and 51 m (p0.04 and p0.03 between groups, respectively). Further significant improvements were found for FEV(1), lung hyperinflation, and blood gases in the NIPPV treated, but not in the control subjects. Health-related quality of life, assessed by the SF-36 questionnaire, improved moderately or largely in patients receiving NIPPV in the categories role-physical, vitality, social function, and mental health. Control subjects improved moderately in vitality only. In conclusion, nocturnal NIPPV is feasible and enhances the effects of pulmonary rehabilitation in advanced stage COPD.

The use of non-invasive ventilation (NIV) to improve physical activity in COPD patients has been addressed in several clinical investigations in the past. In general, NIV can be applied directly during exercise, but also intermittently when used for long-term treatment thereby aiming at improving physical activity during spontaneous breathing. There is increasing evidence that NIV enhances exercise capacity in COPD patients with a reduction of exercise-induced dyspnea when applied during exertion. Furthermore, physical training has been shown to produce positive results when training was performed under NIV-aided conditions. However, the results regarding tolerance of NIV, exercise ability and dyspnea are individually different. In most studies where NIV was applied during exercise, patients had no indication for long-term NIV, and patients were ventilated with low inspiratory pressures, which produced varying results. In contrast, the use of higher inspiratory pressures in hypercapnic COPD patients was more effective in enhancing exercise capacity. The intermittent application of NIV also positively affects exercise capacity in COPD patients, although different results were achieved with different ventilator strategies, mainly with a variety of inspiratory pressure levels. Different ventilation modes were used for NIV to aid exercise and for the intermittent approach in addition to different settings: CPAP, pressure support ventilation, proportional assist ventilation and controlled NIV. Therefore, it is still unclear how to define the best technique for NIV to be used in order to enhance exercise capability in COPD patients. Future studies are needed to define which subgroup of patients benefit from NIV in view of its effects on exercise. Further studies should also be aimed at clarifying which mode and which ventilator settings are most beneficial in improving exercise capability in COPD patients.

Background A large proportion of COPD patients do not achieve the recommended level of physical activity. It is suggested that feedback on the level of activity by using an activity monitoring device (PAM) increases awareness and may stimulate patients to increase their physical activity in daily life. Our objective was to assess the validity and usability of a simple and low-cost physical activity monitor (Polar A300™) when compared with the validated and established Bodymedia-SenseWear™ (SWA) device. Methods To assess the diagnostic equivalent, two different PAM devices were used in parallel in 20 COPD patients GOLD I to IV during 3 consecutive days of daily life. Both systems were compared in terms of steps, calories burned, daily activity time and metabolic equivalents using linear regression analysis and Bland-Altman plots. Practical usability was examined by a 16-item-questionnaire. Results High correlations of both devices were observed with regard to the sensed step count (r = 0.96; p < 0.01) and calories burned (r = 0.74; p < 0.01), and a lower correlation of daily activity (r = 0.25; p < 0.01) was found. Data analysis over 3 days showed that 90% of the steps (95% CI -4223 to 1887), 100% of the calories (95% CI -2798 to 1887), 90% of the daily activity data (95% CI -12.32, 4065) and 95% of the MET (95% CI -3.11 to 2.75) were within the limits of agreement. A favorable usability (system-, information- and interface quality) of the A300™ device was shown (p < 0.01). Conclusion The A300™ device with easy practical usability was shown not to be inferior for assessment of physical activity time, step count and calorie consumption in COPD patients when compared with the SWA. It is suggested to consider widespread available devices as commonly used for monitoring recreational sporting activities also in patients for assessment of physical activity in daily life.

Nach wie vor wird die Vocal Cord Dysfunction als Ursache von nicht behandelbaren Atemnotsymptomen unterschatzt. Dies kann in Einzelfallen zu tragischen Verlaufen fuhren. Als Schlussel zur Diagnose ist die gezielte Anamnese anzusehen, die eine zielfuhrende Diagnostik ermoglicht. Der endgultige diagnostische Beweis kann sich mitunter schwierig gestalten. Insbesondere die Kombination von VCD-Beschwerden mit einem gleichzeitig bestehenden Asthma bronchiale bietet selbst fur den Experten ein oft verwirrendes klinisches Bild. VCD-Atemnotanfalle sind nicht elektiv auslosbar und diagnostisch wegen der raschen Selbstlimitierung oft nicht oder nur unzureichend zu beweisen. Die Lungenfunktion bietet selten hinweisgebende Befunde. Daher muss die Diagnose unter Einbeziehung der Anamnese mitunter klinisch im Sinne ausreichender Wahrscheinlichkeit gestellt werden. Der moglichst exakten Schilderung der Dyspnoe durch den Patienten kommt dabei zentrale Bedeutung zu, kann doch nur er selbst die Charakteristik der Atemnot exakt beschreiben. Therapeutisch kommen differenzierte multimodale Verfahren zum Einsatz. Wichtig ist es v. a. die Patienten genau uber ihr Krankheitsbild zu informieren.

Die positive Wirkung pneumologischer Rehabilitation (PR) ist fur haufig auftretende chronische Erkrankungen der Atmungsorgane, wie z. B. der COPD, wissenschaftlich bereits gut belegt. In den letzten Jahren sind zunehmend auch seltene Lungenerkrankungen in den Fokus der Rehabilitationsforschung geruckt. Studien zeigen, dass eine Rehabilitation mit korperlichem Training auch fur diese Patienten einen positiven Effekt hat und sowohl die korperliche Leistungsfahigkeit als auch die Lebensqualitat verbessern kann. Um den Erfolg zu optimieren, sollten einzelne Module der PR modifiziert und auf die krankheitsspezifischen, individuellen Bedurfnisse des Patienten angepasst werden.

Background: The Oxymizer ® device is a special oxygen nasal cannula that provides a higher luminal diameter in combination with an incorporated oxygen reservoir. In the past we found that Oxymizer® was beneficial in hypoxemic COPD patients by increasing oxygenation during exercise. Objective: Aim of this prospective cross-over study was to investigate the effects of an Oxymizer® in comparison to a conventional nasal cannula (CNC) during exercise in hypoxemic patients with pulmonary fibrosis. Methods: 24 patients with pulmonary fibrosis (m:f=:15:9; VC=54±22%pred.; DLCO=20±12mmol/kg/min; PaO 2 =54,90±7,3mmHg; PaCO 2 =40,5±5,5mmHg, peak work rate [PWR]=74±21Watt) were recruited during pulmonary rehabilitation. After an initial incremental cycle test, patients performed 4 constant cycling work rate tests (CWRT) at 70% of their PWR (twice with Oxymizer ® and twice with CNC in random order). Results: Endurance time (581sec.[351-1142] vs. 498sec.[303-796], p=0.009) and oxygen saturation during exercise (90%[87-93] vs. 88%[85-91], p=0.002) were significantly higher by using Oxymizer® compared to CNC. No significant differences were found between Oxymizer® and CNC regarding PaCO2 (37.8mmHg [33.5-41.0] vs. 37.6mmHg [33.3-41.5], p=n.s.) and perceived dyspnea rated on the modified Borg scale (7.5pts. [7-8] vs. 7.5pts. [6-8], p=n.s.). Discussion: This study showed that oxygen delivery via Oxymizer ® is superior to CNC in patients with pulmonary fibrosis with regard to a longer endurance time and although a better oxygenation during exercise. Oxymizer ® seems to be a simple and useful device in hypoxemic patients with pulmonary fibrosis.

Background: In a former study we have shown that squat exercises during whole body vibration training (WBVT) seem to be superior in improving exercise capacity in patients with COPD in comparison to squat exercises on the floor. However, cardiorespiratory capacity during WBVT remains unknown. Objective: To quantify differences in oxygen uptake and symptoms during squat exercises with and without WBVT in patients with severe COPD. Methods: Eight patients (age: 64±5 ys, FEV1: 42±2 %pred.) performed an assessment on two consecutive days. Day 1: incremental, symptom-limited spiroergometry on a bicycle. Day 2: six short bouts of external paced squatting exercises (10 repetitions per minute) for 1, 2 or 3 minutes on the floor and on a WBVT-platform (Galileo®) respectively. All squat exercises were performed in random order using mobile spiroergometry. Results: Oxygen uptake (%VO2peak) was significantly (p

Background: Exercise training improves exercise capacity in patients with chronic obstructive pulmonary diseases (COPD). In a retrospective analysis, we found that COPD patients (PiMM) showed higher improvements of exercise capacity following training intervention than Alpha-1 antitrypsin deficiency patients (A1ATD, PiZZ). Objective: We investigated if this different change in exercise capacity is reflected by different skeletal muscle adaptations. Methods: 6 A1ATD (PiZZ, age: 57±7y, FEV1: 38±6%pred., Prolastin®: n=6) and 10 COPD patients (PiMM, age: 62±7y, FEV1: 28±4%pred.) prospectively performed a 3-week training therapy. Before and after, each patient underwent muscle biopsy (m.vastus lateralis) and peak work rate (PWR) test. Results: Prospective data showed that exercise capacity improved in both groups, however the improvement was smaller in A1ATD patients (PWR: A1ATD:+10±11Watt, p

Background: Supplemental oxygen (O 2 ) improves exercise capacity, oxygenation and dyspnea in patients with hypoxemic chronic obstructive pulmonary disease (COPD). Evidence regarding the effect of O 2 in normoxemic COPD patients or comparing its effects in normoxemic and hypoxemic patients is still scarce. Objective: The aim of our study was to investigate the effect of O 2 in patients with (LTOT) and without indication for long term oxygen therapy (nonLTOT). Methods: 124 COPD patients underwent two 6-minute walking tests (day 2+3) after a pretest (day 1). One test was performed using O 2 and the other using compressed room air in randomized order and a single-blinded fashion. Results: O 2 resulted in a significant increase in 6MWD (+26m, p 2 seems to be the individual level of exercise performance (6MWD) at baseline (r=-0.337, p Comparing LTOT- and nonLTOT-patients, we found that LTOT-patients benefit more from O 2 regarding the walking distance (+33m vs. +15m, p 2 -level (+7.0 vs. +3.4 percentage points, p 2 only when suffering from severe airflow obstruction (r=-0.257, p Discussion: O 2 improves 6MWD, oxygenation and dyspnea in normoxemic and hypoxemic COPD-patients. However, these short-term effects were more pronounced in patients with indication for LTOT than in those without. NonLTOT-patients suffering from severe airflow obstruction or severe exercise-induced dyspnea seem to show a relevant benefit from O 2 .

Background Careful patient selection is the prerequisite to raise transplant benefit. In lung transplant (LT) candidates, the effect of body mass index (BMI) on postoperative outcome remains controversial, possibly due to the inaccuracy of BMI in discriminating between fat and muscle mass. We therefore hypothesized that assessment of body composition by muscle mass measures is more accurate than by BMI regarding postoperative outcome. Methods All LT recipients from 2011 to 2014 were included and retrospectively analyzed. Lean psoas area (LPA) was assessed from pretransplant computed tomography scans, and associations with postoperative outcomes were investigated. Results Included were 103 consecutive LT recipients with a mean pre-LT BMI of 22.0 ± 4.0 kg/m 2 and a mean LPA of 22.3 ± 8.3 cm 2 . LPA was inversely associated with length of mechanical ventilation ( p = 0.03), requirement of tracheostomy ( p = 0.035), and length of stay in the intensive care unit ( p = 0.02), while controlling for underlying disease, BMI, sex, age, and procedure; in contrast, BMI was not ( p = 0.25, p = 0.54, and p = 0.42, respectively.). Multiple regression analysis revealed that the 6-minute walk distance at the end of pulmonary rehabilitation was significantly associated with LPA ( p = 0.02). Conclusions LPA can easily be assessed in LT candidates as part of pretransplant evaluation and was significantly associated with short-term outcome, whereas BMI was not. Assessment of LPA may provide additional information on body composition beyond BMI. However, the clinical utility has to be further evaluated.

In recent years, several studies have shown that whole body vibration training (WBVT) may be a beneficial training mode in a variety of chronic diseases and conditions such as osteoporosis, fibromyalgia, multiple sclerosis, or chronic low back pain. However, a systematic review on the effects of WBVT in patients with chronic obstructive pulmonary disease (COPD) has not been performed yet. An extensive literature search was performed using various electronic databases (PubMed, Embase, LILACS, and PEDro). They were searched from inception until September 20, 2014, using key words like “COPD” and “whole body vibration training.” A total of 91 studies could be identified and were screened for relevance by two independent reviewers. Six studies were included in a qualitative analysis. Trials studied either the effects of WBVT versus an inactive control group, versus sham WBVT, during an acute COPD exacerbation or as a modality on top of conventional endurance and strength training. All randomized trials reported a significantly superior benefit on exercise capacity (6-minute walking distance) in favor of the WBVT group. Although there are only few studies available, there is some preliminary evidence that WBVT may be an effective exercise modality to improve functional exercise capacity in patients with COPD.

Background In recent years, some studies have shown that whole-body vibration training (WBVT) may be a beneficial training mode in patients with chronic obstructive pulmonary disease (COPD). However, the effects of WBVT in patients after lung transplantation (LTx) have not yet been investigated. Methods Eighty-three LTx patients (56 ± 7 years of age, 51% male, 10 ± 12 weeks post-LTx, forced expiratory volume in 1 second [FEV 1 ] 68 ± 20 percent predicted [% pred], baseline 6-minute walk distance [6MWD] 350 ± 120 meters) admitted to a 4-week inpatient multidisciplinary program of pulmonary rehabilitation (PR) performed supervised endurance and strength training on 5 days per week. In addition, patients were randomly assigned to 1 of 2 supervised intervention groups on 3 days/week: (1) 4 × 2 minutes of bilateral dynamic squat exercises on a side-alternating vibration platform at 24 to 26 Hz (WBVT); and (2) a control group (CON) with the same amount of exercise time on the floor. Results Seventy patients completed the study (WBVT: n = 34; CON: n = 36). Improvement in 6MWD was significantly ( p = 0.029) higher in the WBVT group (83.5 meters [95% CI 65.4 to 101.7]) compared with the CON group (55.2 m [95% CI 37.5 to 72.8]). Also, peak work rate increased significantly ( p = 0.042) more in the WBVT group (16.8 W [95% CI 13.5 to 20.5]) than in the CON group (12.6 W [95% CI 9.0 to 16.1]). No adverse events related to the intervention occurred during the study. Conclusions A complementary WBVT on top of conventional endurance and strength training seems to be a feasible and safe exercise modality in patients after LTx. Furthermore, it may even enhance the benefits of a comprehensive PR on exercise capacity.