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International audience; In addition to exercise intolerance and a sedentary lifestyle, functional capacity, referring to an individual’s balance, mobility, and transfer abilities, is particularly altered in end-stage disease,1 conferring a high risk for disability, hospitalization, and mortality.2,3 The situation may even be worse in individuals who develop hypoxemic or hypercapnic chronic respiratory failure, that could lead to a stage of vulnerability and physical dependence called frailty.4 Frailty syndrome affects approximatively 1 in 5 patients with chronic obstructive pulmonary disease (COPD),5 with an increasing proportion of frail individuals in the most severe stages of the disease. 6,7 Frail patients with COPD are at higher risk of disability and falls, exercise intolerance, anxiety and depressive symptoms, hospitalizations, and death compared to their non-frail counterparts.6,7Pulmonary rehabilitation (PR) is highly effective at improving dyspnea, exercise tolerance, and health status in patients with moderate to severe COPD.8-10 Although less documented, center-based PR is feasible and has shown similar benefits in COPD patients with chronic respiratory failure.11-13 However, PR attendance and completion are likely compromised in frail individuals with chronic respiratory failure,6,14 to whom a home-based intervention could help in eliminating barriers that affect PR attendance.The design of an effective PR program to prevent or delay functional decline and disability in older persons is a public health priority15 that has been addressed in multiple reviews.16,17 This question has received little attention in patients with COPD, although a few studies reported short-term effectiveness of center-based PR programs for improving balance, gait speed, and frailty syndrome in patients with moderate to severe COPD.18-20 Whether similar benefits of PR could be obtained in COPD patients with chronic respiratory failure who are at risk of altered functional status and physical frailty is uncertain. Home-based PR, using exercise and self-managing interventions tailored to each patient’s individual abilities and needs, is an attractive approach for these individuals that could further increase the program completion.21,22 Furthermore, focusing on functional status and autonomy in daily life activities and individualizing physical exercises in frail COPD patients with chronic respiratory disease could enhance the benefits of PR on functional capacity and frailty syndrome.The main objective of this prospective interventional study was to evaluate the effectiveness of an 8-week, home-based PR program with COPD patients with chronic respiratory failure. A secondary objective was to specifically evaluate the impact of frailty status on the efficacy of PR in improving functional capacity, exercise tolerance, health-related quality of life, and anxiety and depressive symptoms.MethodsParticipants and Study DesignThis was a prospective interventional study conducted in the north of France from December 2018 to October 2020. Participants were referred to the home-based PR program by their pulmonologist who was responsible for providing the clinical assessment and certifying the presence of COPD according to the Global initiative for chronic Obstructive Lung Disease (GOLD) classification system.23 Eligible patients were aged 40 years or above with a diagnosis of COPD as a main disease, and had chronic respiratory failure, defined as the requirement for either long-term oxygen therapy (LTOT) and/or non-invasive ventilation (NIV). Exclusion criteria included recent participation in PR (

Jean-Marie Grosbois,1 Axelle Détrée,2 Adeline Pierache,3,4 Nathalie Bautin,5,6 Thierry Pérez,5,6 Benoit Wallaert,5,6 Cécile Chenivesse,5,6 Olivier Le Rouzic5,6 1FormAction Santé, Pérenchies, F-59840, France; 2Groupe Hospitalier Loos Haubourdin, Réhabilitation Respiratoire, Loos, F-59120, France; 3Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France; 4CHU Lille, Department of Biostatistics, Lille, F-59000, France; 5Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France; 6CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, FranceCorrespondence: Olivier Le Rouzic, Pneumologie et Immuno-Allergologie, Institut Cœur Poumon, 1 boulevard Jules Leclercq, CHU de Lille, Lille, 59037, France, Tel +33 3 20 44 59 48, Fax +33 3 20 44 57 68, Email olivier.lerouzic@univ-lille.frBackground: Cardiovascular and metabolic comorbidities in chronic obstructive pulmonary disease (COPD) are associated with higher symptoms burden. Few center-based studies have evaluated the impact of these comorbidities on short-term pulmonary rehabilitation outcomes with contrasting results.Research Question: This study aimed to determine whether cardiovascular diseases and metabolic comorbidities impacted long-term outcomes of a home-based PR program in COPD patients.Study Design and methods: Data of 419 consecutive COPD patients addressed to our pulmonary rehabilitation program between January 2010 and June 2016 were retrospectively analyzed. Our program consisted of once-weekly supervised home sessions, including therapeutic education and self-management support, with unsupervised retraining exercises and physical activities the other days for 8 weeks. Exercise capacity (6-min stepper test [6MST]), quality of life (visual simplified respiratory questionnaire), and anxiety and depression (hospital anxiety and depression scale) were assessed respectively, before (M0) and at the end (M2) of the pulmonary rehabilitation program, and at 6 (M8) and 12 months (M14) after its achievement.Results: Patients (mean age 64.1± 11.2 years, 67% males, mean forced expiratory volume in one second (FEV1) 39.2± 17.0% predicted) were classified as having cardiovascular comorbidities (n=195), only metabolic disorders (n=122) or none of these comorbidities (n=102). After adjustment, all outcomes appeared similar between groups at baseline and improved after pulmonary rehabilitation with a greater effect at M14 for patients with only metabolic disorders on anxiety and depression score (− 5.0± 0.7 vs − 2.9± 0.8 and − 2.6± 0.6, p=0.021). Quality of life and exercise capacity improvements were not significantly different between the three groups at M2 and M14.Conclusion: Cardiovascular and metabolic comorbidities do not preclude COPD patients from obtaining clinically meaningful improvements in exercise capacity, quality of life and anxiety-depression up to 1 year after a home-based pulmonary rehabilitation.Keywords: anxiety, exercise tolerance, quality of life, comorbidities, home based pulmonary rehabilitation, COPD

Physical activity is reduced in people with asthma compared to the general population, especially in situations where patients have uncontrolled asthma symptoms, persistent airflow obstruction and other long-term medical problems, in particular obesity and anxiety. Exertional dyspnea, which is of multifactorial origin, is the main cause of reduced physical activity reduction and draws patients into a vicious circle further impairing quality of life and asthma control. Both the resumption of a regular physical activity, integrated into daily life, adapted to patients' needs and wishes as well as physical and environmental possibilities for mild to moderate asthmatics, and pulmonary rehabilitation (PR) for severe and/or uncontrolled asthmatics, improve control of asthma, dyspnea, exercise tolerance, quality of life, anxiety, depression and reduce exacerbations. A motivational interview to promote a regular programme of physical activity in mild to moderate asthma (steps 1 to 3) should be offered by all health professionals in the patient care pathway, within the more general framework of therapeutic education. The medical prescription of physical activities, listed in the Public Health Code for patients with long-term diseases, and pulmonary rehabilitation should be performed more often by specialists or the attending physician. Pulmonary rehabilitation addresses the needs of severe asthma patients (steps 4 and 5), and of any asthmatic patient with poorly controlled disease and/or requiring hospitalized for acute exacerbations, regardless of the level of airflow obstruction, and/or with associated comorbidities, and before prescribing biological therapies.

International audience; 1. IntroductionAs a result of COVID-19 pandemic, pulmonary rehabilitation (PR) programs were impeded for patients with non-COVID-19 conditions such as those with chronic respiratory diseases (CRD). Remote interventions are feasible and have demonstrated similar outcomes to traditional centre-based PR, mostly in chronic obstructive pulmonary disease (COPD) [1], [2]. We previously demonstrated the feasibility and effectiveness of face-to-face home-based PR in patients with CRD [3], [4], but due to the pandemic, we transitioned to an intervention combining face-to-face supervised home sessions and telehealthcare. We briefly report the feasibility, safety and effectiveness of this combined intervention conducted in France during the lockdown from March 17 to May 11, 2020.2. Patients and methodsWe retrospectively included all participants that were referred to the 8-week home-based PR program, without other specific criteria than those previously described [3], [4], [5]. Details regarding the ethical approval, informed consent of participants, and PR program can be found elsewhere [3], [4], [5]. The program included an initial educational needs assessment, performed at home or by telehealthcare after March 17, followed by a home visit to provide training equipment, supervise the first exercise session and perform the evaluations. During the lockdown, only two members of the PR team conducted home visits, using personal protective equipment, physical distancing and hand hygiene. After which, the program consisted of once- or twice-weekly structured telehealth calls to achieve 90 minutes of individually supervised intervention weekly. Participants were expected to perform a personalized action plan the rest of the week. Telehealth sessions were promoted through phone or video calls (WhatsApp® and Doctolib®) depending on the resources available to the patient.Dyspnea (modified medical research council, mMRC), fatigue (fatigue assessment scale, FAS), anxiety and depressive symptoms (hospital anxiety and depression scale, HAD), health-related quality of life (visual-analogue scale (VAS) of the EQ-5D-3L questionnaire) and exercise tolerance (6-minute stepper test, 6MST) were assessed at the beginning (M0) and at the end of the intervention (M2).Data were analysed with SAS V9.4 (SAS Institute, Cary NC, USA). The changes in study outcomes over time were analysed using paired Wilcoxon test and Bonferroni post hoc procedure.3. Results3.1. FeasibilityBefore March 17, 55 patients were participating in the home-based intervention. Amongst them, 7 (12.7%) delayed the program after the lockdown. During the lockdown, 65 new patients were referred for PR. Amongst them, 8 (12.3%) patients refused to participate. Of the 105 patients managed during this period, 13 (12.4%) suspended the intervention after one visit, and 9 (8.6%) did not complete the program (13 refusal related to COVID-19 pandemic, three deaths, three exacerbations, three others causes) (Fig. 1). There was no significant difference between participants who delayed or suspended the intervention and those who completed PR (n = 83). Among these 83 participants, 62 received telehealthcare through phone calls and 21 through video calls. Twenty-seven participants did not performed the 6MST because they refused the home visit or team members were unavailable. All participants performed the others outcomes either by face-to-face home visits or telehealthcare.

Resume Introduction La competence relationnelle est essentielle pour un soignant, notamment en rehabilitation respiratoire (RR). La prise en compte du profil comportemental des patients permettrait d’optimiser leur prise en charge et les resultats de la RR. Methodes Huit cent trente-deux patients consecutifs presentant une maladie respiratoire chronique ont ete pris en charge en RR a domicile pendant huit semaines. Une evaluation de la tolerance a l’effort dont le test de stepper (TS6), de l’humeur (HAD) et de la qualite de vie (VSRQ, MRF28) etait realisee en debut et en fin de RR. Le profil du patient etait defini pour mise en place d’une approche comportementale en debut de RR pour 690 patients par l’outil DISC identifiant quatre profils : dominant, influent, stable et conforme, les 142 autres patients composaient le groupe temoin. Resultats Subjectivement, l’alliance therapeutique etait obtenue plus facilement avec l’approche comportementale. Le groupe « Stable » etait plus jeune (60,7 ± 12 ans) et a predominance feminine (52,8 %), tandis que le groupe « Conforme » etait plus âge (67,5 ± 10,6 ans) et a predominance masculine (85,5 %). Il n’y avait pas de difference a l’evaluation initiale pour la tolerance a l’effort, l’humeur et la qualite de vie, et globalement tous les patients amelioraient ces parametres a l’issue du stage de RR. Le pourcentage de repondeurs au TS6 et au VSRQ etait superieur de 7,5 % et 5,3 % en cas d’approche comportementale. Pour les non-repondeurs au TS6 et au VSRQ, seuls les patients ayant beneficie de cette approche amelioraient les autres parametres etudies, le groupe temoin ne les ameliorant pas. Conclusions L’approche comportementale par l’outil DISC permet d’ameliorer la relation patient-soignant et d’obtenir de meilleurs resultats a l’issue d’un stage de RR.

Jonathan Lévesque,1 Anestis Antoniadis,2 Pei Zhi Li,3 Frédéric Herengt,4 Christophe Brosson,5 Jean-Marie Grosbois,6 Alain Bernady,7 Anthony Bender,8,9 Murielle Favre,10 Antoine Guerder,11 Pascale Surpas,12 Thomas Similowski,11,13 Bernard Aguilaniu141Department of Medicine, Pneumology Service, Hôpital Maisonneuve-Rosemont, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 2Laboratoire Jean Kuntzmann UMR5224, Statistics Department, Université Grenoble-Alpes, Grenoble, France; 3Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada; 4Centre de Réadaptation Cardio-Respiratoire-Dieulefit Santé, Dieulefit, France; 5Private Physiotherapist, Cours Liberation, Grenoble, France; 6Pneumology Service, Centre Hospitalier de Béthune, Béthune, France; 7Toki-Eder Centre Médical Cardio-Respiratoire, Cambo-les-Bains, France; 8Private Physiotherapist, Boulevard de Metz Mont-Saint-Martin, France; 9LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; 10Centre de Pneumologie Henri Bazire, Saint-Julien-de-Ratz, France; 11AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Paris, France; 12Centre Médical de Bayère, Charnay, France; 13Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; 14Faculty of Medicine, Université Grenoble-Alpes, Grenoble, FranceBackground: The 3-minute chair rise test (3-minute CRT) and the Disability Related to COPD Tool (DIRECT) are two reproducible and valid short tests that can assess the benefit of pulmonary rehabilitation (PR) in terms of functional capacity and dyspnea in everyday activities.Methods: We determined the minimal clinically important difference (MCID) of the DIRECT questionnaire and 3-minute CRT using distribution methods and anchor encroaches with a panel of eight standard tests in a cohort of 116 COPD patients who completed a PR program in real-life settings.Results: The estimated MCID for the 3-minute CRT and DIRECT scores was five repetitions and two units, respectively, using separate and combined independent anchors. The all-patient (body mass index-obstruction-dyspnea-exercise [BODE] scores 0–7), BODE 0–2 (n=42), and BODE 3–4 (n=50) groups showed improvements greater than the MCID in most tests and questionnaires used. In contrast, the BODE 5–7 group (n=24) showed improvements greater than MCID in only the 3-minute CRT, 6-minute walk test, endurance exercise test, and DIRECT questionnaire.Discussion and conclusion: This study demonstrates that the short and simple DIRECT questionnaire and 3-minute CRT are responsive to capture the beneficial effects of a PR program in COPD patients, including those with severe disease.Trial registration number: NCT03286660. Keywords: MCID, chair tests, tools, COPD, pulmonary rehabilitation, outcomes assessment

(1) Background: Intensive care unit (ICU) survivors from severe COVID-19 acute respiratory distress syndrome (CARDS) with chronic critical illness (CCI) may be considered vast resource consumers with a poor prognosis. We hypothesized that a holistic approach combining an early intensive rehabilitation with a protocol of difficult weaning would improve patient outcomes (2) Methods: A single-center retrospective study in a five-bed post-ICU weaning and intensive rehabilitation center with a dedicated fitness room specifically equipped to safely deliver physical activity sessions in frail patients with CCI. (3) Results: Among 502 CARDS patients admitted to the ICU from March 2020 to March 2022, 50 consecutive tracheostomized patients were included in the program. After a median of 39 ICU days, 25 days of rehabilitation were needed to restore patients’ autonomy (ADL, from 0 to 6; p < 0.001), to significantly improve their aerobic capacity (6-min walking test distance, from 0 to 253 m; p < 0.001) and to reduce patients’ vulnerability (frailty score, from 7 to 3; p < 0.001) and hospital anxiety and depression scale (HADS, from 18 to 10; p < 0.001). Forty-eight decannulated patients (96%) were discharged home. (4) Conclusions: A protocolized weaning strategy combined with early intensive rehabilitation in a dedicated specialized center boosted the physical and mental recovery.

Sarah Gephine,1,2 Patrick Mucci,1 Jean-Marie Grosbois,3 François Maltais,2 Didier Saey2 1University Lille, University Artois, University Littoral Côte d’Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, F-59000, France; 2Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada; 3Formaction Santé, Pérenchies, FranceCorrespondence: Didier SaeyInstitut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5 CanadaEmail Didier.saey@rea.ulaval.caBackground: The prevalence of physical frailty and its clinical characteristics in advanced chronic obstructive pulmonary disease (COPD) is unknown, as well as the usefulness of functional capacity tests to screen for physical frailty. The aim of the study was to evaluate the proportion and clinical portrait of COPD patients with chronic respiratory failure exhibiting physical frailty at the time of referral to home-based pulmonary rehabilitation. We also evaluate the usefulness of the short physical performance battery (SPPB) and timed-up and go (TUG) as potential screening tools for physical frailty. Finally, we evaluated the specific contribution of gait speed to the frailty Fried total score.Methods: This was a prospective observational study in which physical frailty was defined using Fried criteria (body mass loss, exhaustion, low physical activity, slower walking and weakness). Clinical portrait was documented from daily physical activity, exercise tolerance, functional capacity, anxiety and depressive symptoms, health-related quality of life, and fatigue scores. The ability of the SPPB and TUG to predict physical frailty was investigated using receiver operating characteristic curves. Contribution of each Fried criteria was evaluated with a principal component analysis (PCA).Results: Amongst the 44 included participants (FEV1, 33 ± 13% of predicted), 19 were physically frail. Frail individuals had lower daily steps number, exercise tolerance and functional capacity, and higher fatigue, anxiety, and depressive symptom scores (p< 0.05) compared to non-frail individuals. SPPB and TUG did not have an acceptable detection accuracy for screening physical frailty. PCA indicated that gait speed was the main contributor to the Fried total score of physical frailty.Conclusion: Physical frailty affects a large proportion of COPD patients with chronic respiratory failure starting a home-based intervention and was associated with worse clinical status. Although the present results need to be confirmed by adequately powered studies, gait speed seems to have the potential to become a simple screening tool for physical frailty in this population.Keywords: frailty, chronic respiratory failure, pulmonary rehabilitation, gait speed

Pulmonary rehabilitation, whether performed at home or in a specialised centre, is effective in the management of COPD. As gender-related differences in COPD were previously reported, we aimed to evaluate the impact of gender on pulmonary rehabilitation outcomes in the short, medium and long term. In this retrospective observational study of 170 women and 310 men with COPD, we compared the outcomes of an 8-week home-based pulmonary rehabilitation programme including an individualised plan of retraining exercises, physical activities, therapeutic education, and psychosocial and self-management support. Exercise tolerance, anxiety, depression, and quality of life (QOL) were assessed using the 6-min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS) and Visual Simplified Respiratory Questionnaire (VSRQ), respectively. Assessments were carried out before, immediately after the pulmonary rehabilitation programme (T2) and at 8 (T8) and 14 months (T14). At baseline, women were younger (mean 62.1 versus 65.3 years), more often nonsmokers (24.7% versus 7.7%) and had a higher body mass index (28 versus 26.4 kg·m−2). They more often lived alone (50.6% versus 24.5%) and experienced social deprivation (66.7% versus 56.4%). They had significantly lower exercise tolerance (−34 strokes, 6MST) and higher anxiety and depression (+3.2 HADS total score), but there were no between gender differences in QOL (VSRQ). Both groups showed similar improvements in all outcome measures at T2, T8 and T14 with a tendency for men to lose QOL profits over time. Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programme., Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programme https://bit.ly/2XfFakK

Sarah Gephine,1,2 Olivier Le Rouzic,3,4 François Machuron,5 Benoit Wallaert,3 Cécile Chenivesse,3,4 Didier Saey,2 François Maltais,2 Patrick Mucci,1 Jean-Marie Grosbois6 1Univ. Lille, Univ. Artois, Univ. Littoral Côte d’Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille F-59000, France; 2Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada; 3CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille F-59000, France; 4Univ. Lille, Lille F-59000, France; 5Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille F-59000, France; 6FormAction Santé, Pérenchies, FranceCorrespondence: Jean-Marie GrosboisFormAction Santé, Pérenchies, Zone d’Activité du Bois, Rue de Pietralunga, Pérenchies, F-59840, FranceEmail jmgrosbois@formactionsante.comBackground: Long-term effectiveness of pulmonary rehabilitation (PR) is still uncertain in older people with severe chronic obstructive pulmonary disease (COPD). The objective was to compare the effects of home-based PR in people with COPD above and below the age of 70 years.Methods: In this retrospective study, 480 people with COPD were recruited and divided into those ≤ 70 (n=341) and those > 70 years of age (n=139). All participants underwent an 8 weeks of home-based PR, consisting of a weekly supervised 90-minute home session. Six-minute stepper test (6MST), timed-up and go test (TUG), Hospital Anxiety and Depression Scale, and Visual Simplified Respiratory Questionnaire (VSRQ) were assessed at baseline (M0), at 2 (M2), 8 (M8), 14 (M14) months after baseline.Results: The older group was described by fewer current smokers (p < 0.001), more long-term oxygen therapy use (p = 0.024), higher prevalence of comorbidities (p< 0.001), lower 6MST score and higher TUG score (p< 0.001), compared to the younger group. Both groups improved every outcome at M2 compared to baseline. At M2, 88% of people ≤ 70 years of age and 79% of those above 70 were considered as responders in at least one evaluated parameter (p = 0.013). Both groups maintained the benefits at M14, except for the VSRQ score and the number of responders to this outcome in the older group.Conclusion: Regardless of the age, personalized home-based PR was effective for people with COPD in the short term. Above 70 years, an ageing effect appeared on the long-term effectiveness of quality of life benefit.Keywords: chronic obstructive pulmonary disease, exercise tolerance, pulmonary rehabilitation, quality of life, older age

Method: Effectiveness of pulmonary rehabilitation (PR) is still uncertain in elderly people with severe COPD, particularly those with chronic respiratory failure (CRF). The aim of this study was to determine whether being elderly impacts the short and long-term effects of a home-based PR in people with COPD and CRF. Methods: In this retrospective study, 480 people with COPD and CRF were divided into those ≤ 70 (n=341) and those > 70 years of age (n=139). All participants underwent 8-weeks of home-based PR, consisting in one-weekly individualized home session. Six-minute stepper test (6MST), timed-up and go test (TUG), hospital anxiety and depression scale, and visual simplified respiratory questionnaire (VSRQ) were assessed at baseline (T0), and at 2 (T2) and 14 (T14) months after baseline. Individuals improving beyond the clinically important difference for at least one of these variables were considered responders to PR. Results: The older group was characterized by less current smokers (p Conclusion: Regardless of the age, individualized home-based PR was effective for people with COPD and CRF at short and long term, with the exception of VSRQ score whose initial improvement was lost at T14.

Method: Physical frailty affects 25% of people with moderate COPD referred for pulmonary rehabilitation (PR). Effects of PR on frail status remains to be demonstrated, particularly in patients with advanced disease. The aim of the study was to assess the effects of home-based PR on physical frailty in people with severe COPD and chronic respiratory failure (CRF). Methods: 43 participants with COPD and CRF (mean age: 66±8 years, FEV1% predicted: 33±13) underwent 8 weeks of home-based PR consisting in one-weekly supervised home session. Physical frailty was defined using Fried criteria (weight loss, exhaustion, low physical activity, slower walking and weakness). 6-minute stepper test (6MST), short physical performance battery (SPPB) test, fatigue assessment scale (FAS) and hospital anxiety and depression (HAD) questionnaire were assessed before and after PR. Results: At baseline, 19 (44%) participants were frail. Exhaustion (89%) and low physical activity (74%) were the most common markers of frailty found in this population. Frailty syndrome was associated with anxiety and depression (r=0.47, p Conclusion: Physical frailty affects a large number of people with severe COPD and CRF, referred for home-based PR and it is associated with more fatigue, anxiety-depression and functional capacity limitation. However, 80% of people who were frail reversed the syndrome after PR.

Jérémy B Coquart,1 Natacha Heutte,1 Gaelle Terce,2 Jean-Marie Grosbois3 1Université de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint Aignan F-76821, France; 2Centre Hospitalier de Béthune, Service de Pneumologie et de Réhabilitation Respiratoire, Beuvry F-62660, France; 3FormAction Santé, Pérenchies F-59840, FranceCorrespondence: Jérémy B CoquartUniversité de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint Aignan F-76821, FranceTel +33 235 146 775Email jeremy.coquart@univ-rouen.frPurpose: Short and easy questionnaires have been developed to assess the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), such as the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the COPD-specific HRQoL Questionnaire (VQ11). Both are valid, reliable, and sensitive, but their minimal clinically important differences (MCID) are unknown. Consequently, this study aimed to confirm the convergent validities of the MRF-28 and VQ11 and establish their MCID. A retrospective design was used to evaluate the effect of individual home-based pulmonary rehabilitation (PR) in 400 COPD patients.Patients and methods: Exercise tolerance, anxiety and depression based on the Hospital Anxiety and Depression Scale (HADS), and HRQoL using three questionnaires (MRF-28, VQ11, and the Visual Simplified Respiratory Questionnaire: VSRQ) were assessed before and after an individualized home-based PR program (5 sessions of 30–45 mins/week for 8 weeks, including a weekly session supervised by a team member).Results: PR improved all measured variables (p < 0.0001). The correlations were significant (p < 0.0001) between VSRQ and MRF-28 (r = −0.685 at baseline and r = −0.686 after the PR program), and between VSRQ and VQ11 (r = −0.691 at baseline and r = −0.753 after the PR program). Moreover, changes in score (delta between after and before PR program) of VSRQ were also significantly correlated (p < 0.0001) to changes in score of MRF-28 (r = −0.372) and VQ11 (r = −0.423). Last, we calculated MCIDof −5.2 and −2.0 units for MRF-28 and VQ11, respectively.Conclusion: The MRF-28 and VQ11 can be used in routine practice to evaluate the effects of PR on the HRQoL of COPD patients, with MCID of −5.2 and −2.0, respectively.Keywords: visual simplified respiratory questionnaire, VSRQ, home-based pulmonary rehabilitation

International audience

Introduction L’evaluation de la rehabiltation (RHB) s’appuie sur le changement significatif de scores (Dyspnee-QV) et de grandeurs physiologiques d’exercice. Nous avons etabli le MCID du TLC3’ et du questionnaire DIRECT au cours d’une etude en vie reelle [1] . Au cours de cette etude, les tests physiologiques ont ete repetes apres 6 seances d’entrainement afin de juger si l’ampleur du benefice final etait en partie due a l’amelioration de l’aisance loco-motrice. Methodes 116 patients GOLD II, III, IV (VEMS moyen: 1,3 ± 0.5 L; 48 ± 16 % pred.) ont ete evalues en debut et fin de programme mais aussi precocement (a l’exception des questionnaires) apres 6 a 8 seances soit en moyenne au 14e jour (11,8–16,4). Duree moyenne du programme: 42 jours. Les tests d’exercice etaient: TM6, Temps endurance Cycloergometre, TLC-3’, TLC-1’, force musculaire quadriceps (n = 38). Les questionnaires (debut et fin de programme etaient: mMRC, CAT, SGRQ, DIRECT, HAD. Resultats Une amelioration significative etait atteinte pour tous les tests d’exercice TM6, Endurance Cycle, TLC3, TLC1, FMQD, FLQG (respectivement de 48,9 m, 4,1 min, 9,1 levers, 5,7 levers, 13,5, 15,4 U.); et pour tous les scores (excepte le mMRC) soit DIRECT, CAT, SGRQ total respectivement −1,9, −2,7, − 4,7 Unites. Des la 6e seance, environ 50 % du benefice final etait constate pour TM6, Endurance Cycle, TLC3, TLC1, FMQ atteignant le MCID pour TLC3-TLC1-Endurance cycle. Conclusion La RHB est jugee efficace quel que soit le stade GOLD selon le test realise attestant la necessite d’une evaluation multi dimensionnelle avec des tests courts, facilement repetables et avec un MCID valide [2] . Les tests simples s’affranchissant des contraintes liees a l’environnement de travail sont aussi performants que les tests complexes (TM6-Endurance cyclo) pour juger du benefice de la RHB. L’evaluation du benefice physiologique reel d’un programme d’entrainement devrait prendre pour comparaison les mesures fonctionnelles initiales realisees apres 6-8 seances d’entrainement.

Jean-Marie Grosbois,1,2 Justine Heluain-Robiquet,3 François Machuron,4 Gaelle Terce,2 Cécile Chenivesse,3,5,6 Benoit Wallaert,3,5,6 Olivier Le Rouzic3,5 1FormAction Santé, Pérenchies F-59840, France; 2CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France; 3CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France; 4CHU Lille, Department of Biostatistics, University Lille, EA 2694 - Santé Publique: Epidémiologie Et Qualité Des Soins, Lille F-59000, France; 5University Lille, Lille F-59000, France; 6Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, FranceCorrespondence: Jean-Marie Grosbois Email jmgrosbois@formactionsante.comBackground: Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes.Methods: In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline.Results: Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups.Conclusion: Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.Keywords: home-based pulmonary rehabilitation, exercise tolerance, quality of life, anxiety, depression, socioeconomic deprivation

Introduction Pulmonary rehabilitation (PR) is known to improve exercise tolerance, mood, and quality of life in patients with chronic respiratory diseases. The aim of this work was to determine whether PR provides long-term benefits in increasing daily life physical activity in patients with chronic sarcoidosis. Methods This randomized prospective study (registered ClinicalTrials.gov NCT02044939 ) of 38 patients with stage IV chronic sarcoidosis was performed between 2012 and 2016. Patients were assigned to participate in a 2-month PR program (n = 20) or receive counseling (n = 18). Assessments were performed at baseline, 2 months (end of the PR program), 6 months, and 12 months, and included daily life physical activity parameters (measured for 5 consecutive days), exercise tolerance, dyspnea, anxiety, depression, fatigue, and quality of life. The primary outcome was the 12-month change in time spent in activities above an estimated energy expenditure of 2.5 metabolic equivalents (METs). Secondary daily life physical activity outcomes included number of steps per day, total daily energy expenditure, and total energy expenditure above 2.5 METs. Results The primary outcome did not differ between the two groups; mean between-group differences were −13.2 min (95% confidence interval [CI]: −76.3 to 49.8) at 6 months and −18.1 min (95% CI: −55.7 to 19.4) at 12 months. Although PR had no effect on secondary daily life physical activity outcomes, it did significantly increase exercise tolerance at 6 and 12 months and decrease the dyspnea score at 6 months and the fatigue score at 12 months. Conclusion This trial failed to demonstrate a beneficial effect of PR on daily life physical activity in sarcoidosis patients, suggesting that long-term behavioral programs may be necessary to complement PR.

Resume Introduction Les dyspnees inexpliquees apres des epreuves fonctionnelles respiratoires de repos (EFR) et un bilan cardiovasculaire representent une situation frequente en pratique clinique. Le but de ce travail etait de preciser l’interet de l’epreuve fonctionnelle a l’exercice (EFX) pour le diagnostic de ces dyspnees inexpliquees. Methodes Cette etude monocentrique retrospective incluait des patients successifs ayant des examens de repos normaux (examen clinique, hemoglobine, radiographie thoracique, ECG, EFR, echographie cardiaque). L’EFX etait realisee avec analyse des gaz du sang. L’analyse descriptive et la synthese etaient realisees par consensus entre au moins 3 des auteurs et permettait d’evoquer les etiologies suivantes : deconditionnement, hyperventilation inappropriee a l’exercice (HV), anomalies echanges gazeux (AEG), EFX sous-maximale, anomalies cardiovasculaires (ACV) et EFX normale. Resultats Au total, 194 patients etaient inclus, (âge median 53 ans ; sex-ratio (H/F) 0,83 ; IMC moyen 27,3 kg/m2 ± 5,36). On retrouvait 32 % de profils compatibles avec un deconditionnement, 20 % HV, 18 % AEG, 13 % d’epreuves sous-maximales, 9 % ACV, 8 % d’epreuves maximales et normales. Conclusion Cette etude illustre l’interet de realiser l’EFX precocement dans les dyspnees inexpliquees car dans plus de 50 % des cas, celles-ci correspondent soit a un deconditionnement soit a un syndrome d’hyperventilation, redevables d’une prise en charge simple en rehabilitation respiratoire.

International audience; Background: Pulmonary rehabilitation (PR) improves performance in the 6-min walk test (6MWT) in a subset of patients with fibrotic idiopathic interstitial pneumonia (f-IIP); however, a large proportion of patients does not respond to PR.Aim: To investigate the effects of a PR program on cardiorespiratory responses during a 6MWT and to identify the characteristics of patients who do not show improved performance after PR.Design: An observational study.Setting: Patients were recruited from the Competence Centre for Rare Pulmonary Diseases at Lille University Hospital, France and completed an 8-week home-based PR program.Population: A total of 19 patients with f-IIP; 12 with idiopathic pulmonary fibrosis (IPF) and 7 with fibrotic non-specific interstitial pneumonia.Methods: Patients underwent spirometry and completed a 6MWT before and after an 8-week PR program. Gas exchange, heart rate, and pulse O2 saturation were measured continuously during the 6MWT. Quality of life, dyspnea, and anxiety/depression were assessed using the Short-Form 36 (SF-36), the baseline/transition dyspnea index (BDI/TDI), and the Hospital Anxiety and Depression Scale (HADS) questionnaires.Results: Patients who did and did not improve the distance walked in the 6MWT by at least 30 m after PR were classified as responders (N.=9) and non-responders (N.=10), respectively. O2 uptake, ventilation rate, and distance covered during the 6MWT were significantly improved only in the responder group (P

According to the international consensus statement of 2011, idiopathic pulmonary fibrosis (IPF) and idiopathic nonspecific interstitial pneumonia (NSIP) are classified as fibrotic idiopathic interstitial pneumonia (f-IIP) of unknown aetiology [1]. f-IIP patients display persistent and significant dyspnoea, exercise intolerance and poor health-related quality of life [2]. f-IIP is also associated with a marked reduction in daily life physical activity (DLPA) [3], which is related to morbidity and mortality in many chronic diseases, including f-IIP [4–6]., Fibrotic idiopathic interstitial pneumonia patients derived benefit from a pulmonary rehabilitation programme in terms of exercise tolerance, anxiety, depression and quality of life without increasing their daily life physical activity http://ow.ly/WV7U30kgNkU

Background Patients with advanced lung cancer (LC) or malignant pleural mesothelioma (MPM) exhibit limitation of exercise capacities and alteration of quality of life (QoL) induced by cancer and its treatment. Few studies assessed pulmonary rehabilitation (PR) in these chemotherapy-treated patients, and none evaluated a home-based PR program. Methods In this prospective uncontrolled observational pilot study, patients treated by chemotherapy for LC or MPM were screened for a home-based PR program combining exercise training with global cares including therapeutic education and psychosocial management. Feasibility and safety were evaluated by attendance and adherence to PR program. Various exercise tolerance tests, including 6-min walk test (6MWT) and 6-min stepper test (6MST), were performed before and after PR associated with, QoL and psychological assessment (VSRQ and HAD, respectively). Results 243 patients were considered eligible but only 71 (60.6 ± 8.8 years) started a PR and 47 completed the program. Refusals to participate were mostly related to lack of motivation whereas withdrawals to PR were related to cancer-related medical issues. No adverse event related to PR was observed. Baseline 6MWT distance was associated with performance status (r = − 0.45, p = 0.001) and mMRC dyspnea scale (r = − 0.49, p

Jérémy B Coquart,1 Olivier Le Rouzic,2 Ghazi Racil,3 Benoit Wallaert,2 Jean-Marie Grosbois4 1CETAPS, EA 3832, UFR STAPS, University of Rouen, Normandie-Univ, Mont Saint Aignan, France; 2Department of Respiratory Diseases, University of Lille, CHRU Lille, Lille, France; 3Department of Biology, Faculty of Sciences, El Manar University, Tunis, Tunisia; 4FormAction Santé, Pérenchies, France Background: Pulmonary rehabilitation (PR) is a key treatment of chronic obstructive pulmonary disease (COPD) but studies are still needed to identify the most pertinent criteria to personalize this intervention and improve its efficacy.Objective: This real-life retrospective study compared the effects of home-based PR on exercise tolerance, anxiety, depression, and health-related quality of life (HRQoL) in COPD patients, according to their medical equipment.Methods: Exercise tolerance, anxiety, depression, and HRQoL were evaluated in 109 patients equipped with long-term oxygen therapy (LTOT), 84 patients with noninvasive ventilation (NIV), 25 patients with continuous positive airway pressure (CPAP), and 80 patients with no equipment (NE), before, just after, and 6 and 12months after PR.Results: At baseline, the body mass index in the CPAP and NIV groups was higher (p

The aims of this study were to test the reproducibility of the 6-minute stepper test (6MST), and evaluate its accuracy in detecting improved functional capacity after pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). Thirty-five COPD outpatients performed two 6MSTs in the same session, before (6MST1 and 6MST2) and after (6MST3 and 6MST4) PR. The performance, perceived exertion, heart rate and arterial oxygen saturation were measured during each 6MST. The performance was higher during the second 6MST of the same session (before PR: 514 strokes during the 6MST2 > 471 strokes during the 6MST1, and after PR: 559 strokes during the 6MST4 > 508 strokes during the 6MST3; p = 0.04). After PR, 6MST performance was higher than before PR (6MST3 > 6MST1 and 6MST4 > 6MST2; P < 0.01). The bias (the difference in the number of strokes) between the two 6MSTs from the same session (before PR: 6MST2-6MST1 = 42 strokes vs after PR: 6MST4-6MST3 = 52 strokes) was not different (P = 0.34). However, both bias were greater than 0 (P < 0.001). The mean performances for the two 6MSTs of the same session (before PR: 6MST1 and 6MST2 and after PR: 6MST3 and 6MST4) were correlated with the bias between these performances (P < 0.01; r = 0.32). The perceived exertions were lower after PR (P < 0.02). The systematic improvement of performance (8-10%) during the second 6MST of the each session may be explained from the warming of hydraulic jacks of the stepper and/or learning effect. On the other hand, the 6MST seems sufficiently sensitive to detect functional capacity improvements after PR in patients with COPD.

Background and objectives Little is known about the consequences of chronic sarcoidosis on daily life physical activity (DLPA). The aim of this prospective study was to measure DLPA in patients with chronic sarcoidosis and to determine its relationship to clinical and functional parameters. Methods Fifty‐three patients with chronic sarcoidosis and 28 healthy control subjects were enrolled in this multicenter prospective study. Two markers of DLPA (number of steps walked per day [SPD]) and total daily energy expenditure (TEE) were assessed for five consecutive days with a physical activity monitor. Pulmonary function, aerobic capacity (maximal oxygen uptake [VO2max]), exercise capacity (6‐min walk test [6MWT]), and quality of life (self‐reported questionnaires) were also evaluated. Comparisons of DLPA parameters between the two groups were performed using an analysis of covariance adjusted for age, sex, and body mass index (BMI). Relationships between DLPA parameters and patient characteristics were assessed in multivariable linear regression models. Results Patients with sarcoidosis walked significantly fewer SPD than did the control subjects (6395 ± 4119 and 11 817 ± 3600, respectively; P

Resume Introduction La prise en charge globale et personnalisee en rehabilitation respiratoire (RR) des patients presentant une maladie respiratoire chronique est efficace quel que soit le lieu de realisation. L’objectif de cette etude observationnelle prospective etait de comparer deux types de prise en charge dans un centre de rehabilitation ambulatoire, versus une structure de rehabilitation a domicile. Methodes Au total, 286 patients ont ete pris en charge : 137 patients en ambulatoire (âge : 61,2 ± 10,8 ans, IMC : 28,7 ± 7,1), 149 a domicile (âge : 62,9 ± 12 ans, IMC : 26,1 ± 6,6). Le choix entre ambulatoire et domicile etait fonction de l’eloignement du centre et des souhaits du patient. La prise en charge ambulatoire se faisait par groupe de six patients, quatre fois par semaine pendant six semaines. A domicile elle etait individuelle, une fois par semaine pendant huit semaines avec poursuite des activites physiques en autonomie les autres jours de la semaine selon un plan d’action individualise. Les programmes d’education therapeutique (ETP) et de soutien psycho-social etaient identiques dans les deux structures. Le bilan comportait l’evaluation de la tolerance a l’effort par test de stepper de six minutes (TS6), de l’anxiete et la depression et de la qualite de vie. Resultats Il n’y a eu aucun incident ou accident lors de la RR dans les deux structures. L’intolerance a l’effort etait significativement plus marquee au TS6 chez les patients du domicile (332,9 ± 154,8 coups versus 460,2 ± 137,9, p p Conclusion La RR de patients atteints de maladies respiratoires chroniques non selectionnees est aussi sure et efficace a domicile qu’en centre ambulatoire sur la tolerance a l’effort et la qualite de vie. La RR a domicile est une alternative a la prise en charge ambulatoire pourvu que l’ensemble des activites, reentrainement a l’effort, ETP et accompagnement psycho-social, soit realise.

Jérémy B Coquart,1 Jean-Marie Grosbois,2,3 Cecile Olivier,4 Frederic Bart,2 Ingrid Castres,1 Benoit Wallaert4 1Faculté des Sciences du Sport, Université de Rouen, CETAPS, EA 3832, Mont Saint Aignan, 2Service de Pneumologie, Centre Hospitalier de Béthune, Beuvry, 3Formaction Santé, Perenchies, 4Service de Pneumologie et Immunoallergologie, Centre Hospitalier Universitaire de Lille, Hôpital Calmette, Université de Lille 2, France Background: This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR), including transcutaneous neuromuscular electrical stimulation (NMES) or usual endurance physical exercise (UEPE), on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL) in patients with COPD.Methods: Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [GNMES]), while 117 patients participated in home-based PR with the UEPEs (Group UEPE [GUEPE]). NMES was applied for 30 minutes twice a day, every day. The endurance exercises in GUEPE began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for GUEPE, NMES for GNMES, resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home.Results: The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in GUEPE), exercise capacity (+20.8% in GNMES and +21.8% in GUEPE), depression (−15.8% in GNMES and −30.1% in GUEPE), and overall HRQoL (−7.0% in GNMES and−18.5% in GUEPE) in the patients with COPD, regardless of the group (GNMES or GUEPE) or severity of airflow obstruction. Moreover, no significant difference was observed between the groups with respect to these data (P>0.05).Conclusion: Home-based PR including self-monitored NMES seems feasible and effective for severely disabled COPD patients with severe exercise intolerance. Keywords: pulmonary rehabilitation, global management program, severity of airflow obstruction, chronic obstructive pulmonary disease, NMES

JM Grosbois,1,2 C Riquier,3 B Chehere,4 J Coquart,5 H Béhal,6 F Bart,2 B Wallaert,2,3 C Chenivesse3 1FormAction Santé, Pérenchies, France; 2Department of Respiratory Medicine, Centre Hospitalier Germon et Gauthier, Béthune, France; 3Department of Respiratory Medicine Immunology and Allergy, Centre Hospitalier Universitaire de Lille, Competence Center for rare lung diseases, University Lille2, Lille, France; 4EA 7369, URePSSS, Multidisciplinary Research Unit in Sport Health Society, University Lille 2, Lille, France; 5Faculty of Sport Sciences, Sports and Physical Activity, Center for Ecology and Transformation, University of Rouen, Mont Saint Aignan, France; 6Department of Statistical Methods and Biostatistics, Centre Hospitalier Universitaire de Lille, University of Lille Nord, Lille, France Introduction: Exercise tolerance testing is an integral part of the pulmonary rehabilitation (PR) management of patients with chronic obstructive pulmonary disease (COPD). The 6-minute stepper test (6MST) is a new, well-tolerated, reproducible exercise test, which can be performed without any spatial constraints.Objective: The aim of this study was to compare the results of the 6MST to those obtained during a 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) in a cohort of COPD patients.Methods: Ninety-one COPD patients managed by outpatient PR and assessed by 6MST, 6MWT, and CPET were retrospectively included in this study. Correlations between the number of steps on the 6MST, the distance covered on the 6MWT, oxygen consumption, and power at the ventilatory threshold and at maximum effort during CPET were analyzed before starting PR, and the improvement on the 6MST and 6MWT was compared after PR.Results: The number of steps on the 6MST was significantly correlated with the distance covered on the 6MWT (r=0.56; P

Introduction Differents tests et modalites d’efforts sont disponibles pour evaluer la tolerance a l’effort des patients atteints de pneumopathie interstitielle diffuse fibrosante (PIDF), suivant une rehabilitation respiratoire (RR). Parmi les tests de terrain, le test de marche de 6 minutes (TM6) et le test de stepper de 6 minutes (TS6) sont couramment utilises en RR [1] . Si les performances et la saturation pulsee en oxygene (SpO 2 ) sont utilisees comme indices de la tolerance a l’effort, les changements d’adaptations respiratoires ne sont pas documentes lors de ces tests. L’objectif de cette etude etait de mesurer l’impact d’une RR a domicile sur les adaptations cardioventilatoire aux TM6 et TS6 chez des patients atteints de PIDF ( Tableau 1 ). Methodes Quinze patients atteints de PIDF (âge : 64 ± 10 ans) ont beneficie d’une RR a domicile. Ils ont ete vus une fois par semaine pendant 8 semaines. Ce programme consistait en un reentrainement en endurance, un renforcement musculaire, de l’education therapeutique et de l’accompagnement psychosocial [1] . Les activites physiques etaient pratiquees en autonomie les autres jours de la semaine selon un plan d’action individualise. L’evaluation pre-RR et post-RR comprenait le TM6 et le TS6 avec mesure en continu des echanges gazeux (Metamax, Cortex Biophysik GmbH, Leipzig, Germany), de la frequence cardiaque et de la SpO 2 . Resultats La distance de marche au TM6 et le nombre de coups au TS6 etaient significativement augmentes apres la RR (de 430 ± 57 m a 452 ± 76 m, p = 0,026 ; de 266 ± 63 coups a 335 ± 63 coups, p = 0,005, respectivement). Aux deux tests, aucune difference significative n’etait observee avant et apres le programme de RR pour les parametres de repos et en fin d’effort. Une tendance a l’augmentation a ete observee en post-RR pour le VCO 2 , la V E et le V T a la sixieme minute du TM6 ( p = 0,10, p = 0,08 et p = 0,06, respectivement). Le ratio VO 2 /coup lors de la derniere minute du TS6 etait significativement inferieur apres la RR ( p Conclusion L’amelioration des performances aux TM6 et TS6 suite a une RR a domicile, malgre une diminution du cout energetique, ne s’accompagne pas de modifications de la reponse cardioventilatoire, traduisant probablement une meilleure efficience gestuelle suite a la RR.

Objectifs Les objectifs etaient: 1) d’examiner la validite des valeurs de perception de l’effort (RPE) a predire la consommation pic d’oxygene (.VO2pic) des patients obeses et diabetiques durant une epreuve d’effort sousmaximale, et 2) de comparer la precision des predictions obtenues a partir des RPE ≤ 15 et RPE ≤ 17.

Resume Objectifs Les objectifs etaient d’examiner l’influence du niveau de performance sur le point d’oxydation maximale des lipides (Lipoxmax) chez des cyclistes, et d’identifier les zones d’intensites cibles correspondantes au Lipoxmax. Patients et methodes Vingt-quatre cyclistes entraines etaient repartis en deux groupes en fonction de leur niveau de performance en cyclisme (G1: 17 cyclistes de niveau departemental a regional versus G2: sept cyclistes elites ou professionnels). Tous les cyclistes (G1 et G2) realisaient un meme test de calorimetrie d’effort, durant lequel les parametres cardiorespiratoires et la perception de l’effort (RPE) etaient mesures. Le Lipoxmax etait identifie, puis exprime sous la forme d’un pourcentage de la puissance maximale aerobie (PMA), de la consommation maximale d’oxygene ( V ˙ O 2 max ), de la consommation d’oxygene de reserve ( V ˙ O 2 r e serve ), de la frequence cardiaque maximale (FCmax), de la frequence cardiaque de reserve (FCreserve) et a une valeur de RPE. Ces valeurs etaient ensuite comparees par une Anova a une voie (G1 versus G2). Resultats Les intervalles de confiance a 95 % (IC95 %) du Lipoxmax correspondait a 37–44 % PMA, 41–47 % V ˙ O 2 max , 35–42 % V ˙ O 2 r e serve , 44–59 % FCreserve et a RPE 8–10, independant du groupe (p > 0,05). Toutefois, un effet groupe etait note lorsque le Lipoxmax etait exprime en pourcentage de la FCmax (IC95 % = 56–61 % et 60–70 % FCmax pour G1 et G2, respectivement; p = 0,03). Cependant, une large dispersion des valeurs de Lipoxmax etait constatee. Conclusion Chez ces cyclistes, le niveau de performance n’influence pas le Lipoxmax (sauf lorsque ce dernier est exprime en % FCmax). Il semble toutefois difficile d’utiliser des intensites cibles communes pour prescrire l’intensite d’exercice au Lipoxmax chez ces cyclistes.

Introduction L’amelioration, apres un programme de rehabilitation respiratoire (RHB), de la capacite fonctionnelle de travail et de la dyspnee des patients BPCO est appreciee par des tests d’exercice et des questionnaires difficiles a reproduire en dehors des centres specialises. Afin de surveiller le declin eventuel des patients au cours de la RHB, les tests de levers de chaise (TLC) et les questionnaires courts ont ete developpes (CAT, DIRECT 1). Le but de cette etude prospective multicentrique en vraie vie est de comparer le changement de plusieurs tests de capacite fonctionnelle de travail et de questionnaires de qualite de vie et de dyspnee. Les MCID du TLC de 3’ (TLC3) et du questionnaire DIRECT (dyspnee liee aux activites quotidiennes) ont ete precises. Methodes Cent vingt sept patients atteints de BPCO GOLD 2 (n = 55), 3 (n = 53) et 4 (n = 19), capables de parcourir une distance d’au moins 250 metres au TM6, ont ete evalues par 7 centres de RHB en France. Le bilan initial comportait des tests de capacites : TLC-1’, TLC-3’ et test de 5 levers de chaise, epreuve d’endurance sur ergocycle ; et les questionnaires SGRQ, MRC, DIRECT, CAT, HAD. Les tests d’exercice etaient realises a l’inclusion, apres 6 seances et en fin de programme. Le MCID etait calcule pour le TLC3 et le questionnaire DIRECT par la methode de distribution et d’accroche. Resultats Quel que soit le stade de GOLD et les modalites de la RHB, les tests de capacites fonctionnelles etaient significativement ameliores a la fin du programme. Cependant 50 % des benefices etait acquis des la 6e seance pour chacun des tests. En fin de programme le nombre de levers de chaise supplementaires etait pour le TLC3 et le TLC1 respectivement de 9,2 ± 1,7 et 5,7 ± 1,1 levers (p Conclusion Les tests d’evaluation simples (tests de levers de chaise) et les questionnaires courts (CAT, DIRECT) sont aussi performants que les autres tests fonctionnels usuels (TM6, cyclo-endurance) et les questionnaires longs (SGRQ) pour apprecier le benefice de la RHB.

Purpose: The aim of this study was to evaluate a new field test, the six-minute stepper test (6-MST), by studying its reproducibility, sensitivity and validity. Methods: After a familiarization test, 16 patients with chronic obstructive pulmonary disease (COPD) and 15 healthy subjects performed two six-minute stepper tests per day over three evaluation days. Ten of the 16 patients with COPD also performed a six-minute walking test (6-MWT) with an analysis of gas exchange to compare the metabolic requirements of the two tests. Dyspnoea Borg values were evaluated with Borg’s CR-10 scale. Results: The mean (SD) scores for the COPD group for the first and second six-minute stepper tests were 382.49 (106.01) and 412.45 (118.39) strokes/6 minutes, respectively. Crossed comparison between the first or the second six-minute stepper tests of each evaluation day revealed no significant difference, indicating the reproducibility of the test. The sensitivity was demonstrated by a significantly higher performance in the healthy group (P Conclusions: This study demonstrated that the six-minute stepper test is a reproducible, sensitive, secure, well-tolerated and feasible test for patients with COPD. The reproducibility and sensitivity of the six-minute stepper test suggests that this test could be used in the evaluation of exercise tolerance in patients with COPD.

The purpose of our investigation was to suggest a new approach to determine exercise intensities in master elderly athletes. Sixteen trained elderly men (63.0 +/- 2.9 years) and 8 trained elderly women (62.3 +/- 5.5 years), performed an exhaustive exercise test on a cycle ergometer. Rating of perceived exertion (RPE) and heart rate reserve (HRr) were determined at the first and second ventilatory thresholds (VT1 and VT2). There was no significant difference between genders in RPE and HRr, whatever the exercise intensity. RPE scores corresponded to 12.4 +/- 0.9 in men and 12.7 +/- 1.3 in women at VT1. At VT2, RPE was 15.2 +/- 0.8 and 15.3 +/- 1.1 in men and women, respectively. HR at VT1 corresponded to 59.3 +/- 7.0% in men and 59.5 +/- 5.1% in women, whereas at VT2, HR was measured at 80.5 +/- 6.4% and 79.5 +/- 5.9% HRr, in men and women, respectively. Because it is not practical to measure VT1 and VT2 in routine clinical practice, the present study indicated that, in trained older men and women, the RPE value of 12 - 13 and/or 60 % HRr might be used to detect the exercise intensity at VT1. An RPE score of 15 and/or 80 % HRr would appear to be good indexes in the prescription of exercise intensity at VT2.

This study compared the ventilatory responses and exercise tidal flow-volume (Vt) loops during exercise in order to analyze the influence of gender on breathing strategy in a fit aging population. Sixteen trained elderly men (63.0+/-2.9 years) and eight peer women (62.3 +/- 5.5 years) performed an incremental test on a cycle ergometer. At 90% maximal oxygen consumption (VO2max), the women presented a significantly higher expiratory flow limitation (EFL) than the men (38 +/- 10 vs 17 +/- 8% of Vt, respectively) (P

To analyze the influence of step-duration protocol (1 vs. 3 min) on breathing strategy according to the physical fitness of healthy elderly subjects, this study compared the ventilatory responses and exercise tidal flow-volume loops (ETFVL) at the first and second ventilatory thresholds (VT1and VT2). Nineteen master athletes (mean age (± SD), 63.1 ± 3.2 y; [Formula: see text]O2 max, 41.5 mL·(min·kg)-1) and 8 untrained elderly subjects (age, 65.5 ± 2.3 y; [Formula: see text]O2 max, 25.8 mL·(min·kg)-1) performed 2 exhaustive exercise tests on a cycle ergometer. In untrained subjects, at VT1and VT2, no significant difference was measured in ventilatory responses and ETFVL between protocols. Master athletes, at VT2, presented a significantly higher [Formula: see text]CO2(P < 0.01), ventilation ([Formula: see text]E; P < 0.01), breathing frequency (fb; P < 0.05), tidal volume relative to inspiratory capatcity (Vt/IC) (P < 0.01),Vtrelative to forced vital capacity (Vt/FVC; P < 0.05), and lower inspiratory reserve volume relative to FVC (IRV/FVC; P < 0.01) during the 1 min protocol than during the 3 min protocol. Master athletes, at maximal exercise, expressed significantly higher [Formula: see text]CO2(P < 0.01) and dyspnea (P < 0.05) with the shorter protocol. We concluded that, in untrained subjects, neither incremental exercise test had an impact on respiratory responses during exercise. Nevertheless, in master athletes, breathing strategy seems to be protocol dependent. The short test induced higher mechanical ventilatory constraints and dyspneic feeling than the long protocol, which could be explained by a higher [Formula: see text]E itself linked to a greater [Formula: see text]CO2and a higher blood lactate concentration.Key words: exercise flow-volume loops, master athletes, submaximal exercise, mechanical ventilatory constraints.

Resume Objectifs. – Comparer les reponses cardiorespiratoires entre deux ergometres et etablir une relation entre les frequences cardiaques au seuil ventilatoire 1 (SV1) mesurees sur ergocycle et sur rameur, chez des personnes âgees en bonne sante. L’equation calculee doit permettre de ne realiser qu’une seule epreuve d’exercice musculaire permettant l’individualisation de l’entrainement pour deux ergometres differents. Materiels et methodes. – Dix-huit sujets âges (64,4 ± 4,7 ans) en bonne sante, ont effectue deux epreuves d’exercices musculaires triangulaires sur ergocycle et sur rameur. Resultats. – Au SV1, il n’y a pas de difference significative entre les deux ergometres au niveau de la frequence cardiaque (118,3 ± 13,0 batt. min–1 sur ergocycle ; 120,9 ± 15,3 batt. min–1 sur rameur) et de la consommation d’oxygene (17,1 ± 6,2 ml.min–1.kg–1 sur ergocycle ; 17,8 ± 6,2 ml.min–1.kg–1 sur rameur). A l’exercice maximal, sur ergocycle et rameur, la consommation maximale d’oxygene et la ventilation maximale ne presentent pas de difference significative et sont respectivement de : 26,5 ± 8,7 et 26,1 ± 7,7 ml.min–1.kg–1 ; 69,5 ± 8,7 et 70,3 ± 7,7 l.min–1. Conclusion. – Une equation d’equivalence entre les deux ergometres n’est donc pas necessaire et la realisation d’une seule epreuve d’exercice musculaire permet l’individualisation de l’intensite de l’entrainement a la frequence cardiaque correspondant au SV1 pour deux ergometres securisants : le rameur et l’ergocycle, chez une population senior en bonne sante.

We assessed the validity of predicting peak oxygen uptake ([Formula: see text]O2 peak) from the relationship between oxygen uptake ([Formula: see text]O2) and overall ratings of perceived exertion (RPE) obtained during the initial stages of a cardiopulmonary exercise test (CPET).Fifteen healthy participants and 18 patients with chronic obstructive pulmonary disease (COPD) performed a maximal CPET, during which [Formula: see text]O2 and RPE were measured until RPE15.Individual regressions between [Formula: see text]O2 and RPE ≤ 15 were extrapolated to RPE19 to predict [Formula: see text]O2 peak. Mean actual and predicted [Formula: see text]O2 peak were not significantly different in healthy women (18.9 ± 4.1 vs. 20.4 ± 4.5 mL kg(-1) min(-1), respectively) and men (28.9 ± 7.8 vs. 29.7 ± 8.5 mL kg(-1) min(-1), respectively), or in women (15.2 ± 4.7 vs. 15.8 ± 5.0 mL kg(-1) min(-1), respectively) and men (16.2 ± 4.4 vs. 17.4 ± 5.4 mL kg(-1) min(-1), respectively) with COPD (P = 0.067). Moreover, actual and predicted [Formula: see text]O2 peak were highly correlated in healthy participants and COPD patients (r ≥ 0.89; P0.001). The bias and 95 % limits of agreement were -1.0 ± 4.0 and -1.0 ± 4.6 mL kg(-1) min(-1) for healthy and COPD participants, respectively.[Formula: see text]O2 peak can be predicted with acceptable accuracy in healthy participants and patients with COPD from the individual relationship between [Formula: see text]O2 and RPE ≤ 15.