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Background: Oxygen uptake (V̇O2) and heart rate (HR) kinetics during a constant work-rate test (CWRT) are used to evaluate the response to exercise in healthy subjects as well as subjects with various pathologies. Objectives: This study aimed to explore the feasibility of these measures and their responsiveness to a prehabilitation program in patients with non-small cell lung cancer (NSCLC). Method: This study is preregistered (NCT04041297) ancillary analysis of a subgroup of individuals with NSCLC included in the Preo-Dens study (NCT03936764). Thirty individuals performed a moderate-CWRT before and after a 15-session prehabilitation program between July 2019 and April 2021. V̇O2 and HR on-kinetics were extracted from the first 240 s of breath-by-breath data using Box-Jenkins transfer functions. Results: Pre/post V̇O2 on-kinetic feature values were reliable for 25/30 participants, and pre/post HR kinetic feature values were reliable for 19/30. V̇O2 time constant (τ) and mean response time reduced from pre-post prehabilitation (mean difference −7.8 s; 95% CI: −14.6 to −1.0, and −8.4 s; 95% CI: −14.7 to −2.0, respectively). For HR on-kinetics, τ did not change from pre-post prehabilitation (median difference −4.0 s; 95% CI: −36.0 to +11.0). V̇O2 and HR response amplitudes reduced significatively from pre-post prehabilitation (mean difference −38.6 mL/min; 95% CI: −73.3 to −3.9, and −3.1 beats/min; 95% CI: −6.4 to −0.2, respectively). Conclusion: V̇O2 on-kinetic analysis during moderate-CWRT is feasible in individuals with scheduled NSCLC resection, and results are responsive to prehabilitation. These results support a true speeding of the adaptation of aerobic metabolism after a 15-session prehabilitation program.

International audience; Question: In people with non-small cell lung cancer, what is the effect of condensing 15 prehabilitation sessions into a 3-week regimen compared with a 5-week regimen?Design: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of the primary outcome.Participants: People with diagnosed or suspected non-small cell lung cancer and moderate-to-high risk of postoperative complications. Intervention: Fifteen supervised prehabilitation sessions delivered with either a dense regimen of five sessions/week for 3 weeks (experimental group) or a non-dense regimen of three sessions/week for 5 weeks (control group).Outcome measures: The primary outcome was the change in cardiorespiratory fitness measured by the V̇O2peak in ml/kg/min. The secondary outcomes were the change in other variables of interest measured during cardiopulmonary exercise testing, non-invasive nutritional markers, quadriceps maximal voluntary isometric contractions, maximal inspiratory pressure, quality of life, adherence and postoperative complications.Results: Changes with the experimental regimen were similar to or better than changes with the control regimen for: V̇O2peak (MD 1.2 ml/kg/min, 95% CI −0.1 to 2.6); V̇E/V̇CO2 slope (MD −3.6 points, 95% CI −8.7 to 1.5); and work rate at ventilatory threshold (MD 3.7 W, 95% CI −5.6 to 13.0). The two regimens had similar effects on: peak work rate (MD 1.3 W, 95% CI −6.4 to 9.0), V̇O2 at ventilatory threshold (MD 0.0 ml/kg/min, 95% CI −1.4 to 1.4); body mass index (MD −0.2 kg/m2, 95% CI −0.5 to 0.1); and maximal inspiratory pressure (MD −0.7 cmH2O, 95% CI −9.8 to 8.4). The relative effect was uncertain for quadriceps maximal voluntary isometric contractions, quality of life and complications.Conclusion: Condensing prehabilitation sessions led to similar or better improvement in cardiorespiratory fitness and did not decrease adherence or increase adverse events. This could increase the number of patients who can be referred for prehabilitation, despite short presurgical periods. Trial registration: NCT03936764.

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

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

No abstract available

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

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

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

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

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

Context: Inadequate feeding is a frequent reason for hospital referring in children with bronchiolitis and leads to prolonged hospitalization in 26% of the cases. The main objective was to identify the factors associated with the time to recover adequate nutrition in infants hospitalized for bronchiolitis. Method: We conducted a single-center retrospective study including infants less than 12 months hospitalized for bronchiolitis at Le Havre Hospital (France) between September 2018 and February 2021. A multivariate logistic regression model was computed to investigate the factors associated with (1) the time to recover adequate feeding (LOFR), and (2) the hospital length of stay (LOS). Results: 268 infants were included to assess the LOFR and 478 infants to assess the LOS. The median age was 3.2 months (1.6-5.4) and the sex ratio M/F was 11/20. The use of accessory muscles, nutritional support, and RR ≥ 70/min or < 30/min or apnea are associated (OR=1.5), from virtually no association (OR=1.0) to a significant positive association (OR=2.6) with the LOFR. Intense use of accessory muscles (OR=3.9; 95%CI 1.6-10.4) and “severe” clinical condition (OR=2.8; 95%CI 1.7-4. 8) at admission, O2 supplementation (OR=2.0; 95%CI 1.3-3.1) were significantly related to prolonged LOS in the multivariate analysis. Conclusion: The clinical severity on admission may be related to the LOFR, ranging from none to significant. Other known factors and the new clinical severity scale proposed by the latest French guidelines appeared to be related to the LOS in this work. Further studies are needed to highlight these factors.

Studies have reported persistent symptoms in patients hospitalized for COVID-19 up to 6 months post-discharge; however, sequalae beyond 6 months are unknown. This study aimed to investigate the clinical status of COVID-19 patients one year after hospital discharge and describe the factors related to poor outcomes. We conducted a single-center, prospective, cohort study of patients in Le Havre hospital (France) between 1 March 2020 and 11 May 2020. Baseline characteristics were collected from medical charts (including KATZ index and Clinical Frailty scale (CFS)), and a remote assessment was conducted 12 months after discharge. The main outcomes were the scores of the physical and mental components (PCS and MCS) of the Short-Form 36 (SF-36) and performance on the one-minute sit-to-stand test (STST1′). Scores

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

Background: Exercise training is a cornerstone of care for people with cystic fibrosis (pwCF); it improves exercise capacity and health-related physical fitness, but no meta-analysis has investigated its effects on muscle function in young pwCF. The objective of this meta-analysis was to assess the effects of exercise on peripheral muscle strength in young pwCF. Methods: An electronic search was conducted in four databases (Pubmed, Science Direct, CENTRAL, and PEDRO) from their inception to July 2022. Grey literature databases (OpenGrey, the European Respiratory Society, the American Thoracic Society, and the European Cystic Fibrosis Society) were also consulted. Randomized controlled trials comparing any type of exercise with standard care in young pwCF (5 to 19 years old) were included. Two authors independently selected the relevant studies, extracted the data, assessed the risk of bias (using the Rob2 tool), and rated the quality of the evidence. Results: Ten studies met the inclusion criteria, involving 359 pwCF. Exercise training improved both lower and upper limb muscle strength (SMD 1.67 (95%CI 0.80 to 2.53), I2 = 76%, p < 0.001 and SMD 1.30 (95%CI 0.66 to 1.93), I2 = 62%, p < 0.001, respectively). Improvements were also reported in muscle mass and maximal oxygen consumption. Results regarding physical activity levels were inconclusive. The overall risk of bias for the primary outcome was high. Conclusions: Exercise training may have a positive effect on peripheral muscle strength in young pwCF. The evidence quality is very low and the level of certainty is poor. There is a need for high-quality randomized controlled studies to confirm these results.

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

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

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

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

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

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

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

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

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

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

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

Introduction L’evaluation des capacites a l’exercice est recommandee avec la realisation d’une epreuve d’effort incrementale ou d’un test de marche de 6 minutes (TDM6) chez les enfants de plus 10 ans atteints de mucoviscidose. Ces deux evaluations peuvent etre limitees par des contraintes techniques et une incertitude existe pour les enfants plus jeunes. Le test de lever de chaise d’une minute (TLC) est un test de tolerance a l’effort simple et valide chez les patients adultes atteints de mucoviscidose. L’objectif de cette etude etait d’evaluer la performance du TLC comme outil d’evaluation des capacites physiques pour les enfants (de 6 a 18 ans) atteints de mucoviscidose. Methodes Dans cette etude multicentrique, les patients ont realise en cross-over un TLC et un TDM6. L’ordre des tests etait randomise et chaque test a ete realise deux fois pour limiter l’effet d’apprentissage. La distance parcourue au TDM6 et le nombre de repetitions au TLC recueillis a la fin de chaque deuxieme test ont ete utilises pour evaluer les correlations. La force des muscles respiratoires et du quadriceps ont egalement ete mesurees. Les parametres cardiorespiratoires, la dyspnee sur l’echelle de BORG et la fatigue dans les jambes sur l’EVA ont ete recueillis. Resultats Trente-six enfants atteints de mucoviscidose ont ete inclus (âge moyen 12,0 ± 3,5 ans et VEMS 95,8 ± 25,0 %). Une moyenne de 39 ± 10,7 repetitions au TLC et de 590 ± 105,2 metres au TDM6 ont ete realisees. Une correlation significative a ete retrouvee entre les performances au TLC et au TDM6 (r = 0,49 ; p Conclusion Le TLC ne peut pas etre utilise comme une alternative complete au TDM6 mais peut etre envisage de part sa simplicite en cas d’impossibilite de realiser un TDM6. Il peut etre utilise chez les enfants de moins de dix ans comme premiere evaluation a l’effort precoce.

Introduction Le diagnostic precoce des exacerbations de la BPCO est essentiel. Les exacerbations sont caracterisees par une majoration des symptomes qui pourraient affecter les capacites physiques. Les changements dans les capacites physiques des patients atteints de BPCO au cours du reentrainement a l’effort pourraient fournir une indication predictive en ce qui concerne la survenue d’une exacerbation. Methodes C’est une etude retrospective, multicentrique, qui consiste a voir s’il y a un lien entre la survenue d’une exacerbation et la baisse des performances sur le velo (produit de la puissance par la distance) ou le tapis de marche (distance). Nous avons recense cinquante patients BPCO qui ont suivi un programme de rehabilitation respiratoire entre janvier 2015 et octobre 2018. Ils ont eu au moins une exacerbation pendant cette periode. Nous avons analyse les 5 seances avant l’exacerbation (S − 1, S − 2, S − 3, S − 4, S − 5) et les 3 seances apres l’exacerbation (S + 1, S + 2, S + 3). Nous avons ensuite compare les seances. Resultats Soixante-dix exacerbations ont ete analysees. Nous avons constate une baisse significative de la performance sur le cycloergometre lors de la derniere seance avant exacerbation par rapport aux seances precedentes (difference moyenne : 74,5 % (IC95 %, 12,6–136,5) ; p Fig. 1 ). Conclusion L’analyse des performances sur le cycloergometre est une methode potentiellement utile pour predire la survenue d’une exacerbation. Des etudes prospectives sont necessaires pour confirmer son interet clinique et pratique.

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