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Patients with nonsmall cell lung cancer achieving ≤22 repetitions during a 1-min sit-to-stand test are at increased risk of post-operative complications https://bit.ly/3T7pnS9., Competing Interests: Conflict of interest: H. Demeyer reports support for the present work as a post-doctoral research fellow of FWO Flanders. D. Stevens reports support from Kom op Tegen Kanker starter's grant (Emmanuel Vanderschueren) and Ghent University Hospital Innovation Fund, and received fees from Bristol Myers Squibb, AstraZeneca and TEVA, outside the submitted work. Conflict of interest: M.A. Spruit reports grants from Lung Foundation Netherlands and Stichting Astma Bestrijding, and grants and fees from Boehringer Ingelheim, AstraZeneca, Chiesi and TEVA, outside the submitted work; all were paid to his institute. Conflict of interest: The remaining authors have nothing to disclose., (Copyright ©The authors 2024.)

There was no learning effect found on 6-min walk distance (6MWD) in patients with long COVID, performing a 6-min walk test twice. However, considerable variation in the difference between the two 6MWDs was observed: only 51% showed an increase. https://bit.ly/3H70G1r., Competing Interests: Conflict of interest: We know of no conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved for submission by all the named authors., (Copyright ©The authors 2024.)

Objective: Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can have a negative impact on functional capacity, symptoms and health-related quality of life (HRQOL). This study aimed to i) investigate the recovery of muscle strength, functional capacity, symptoms, and HRQOL in patients after a severe AECOPD; ii) compare with matched patients with stable COPD (SCOPD); and iii) assess whether these assessments at hospital discharge could discriminate patients' risk for future events., Methods: This observational study assessed patients with AECOPD during hospital discharge (T1) and one month after discharge (T2). Patients with SCOPD were assessed once. Quadriceps force, handgrip strength, short physical performance battery (SPPB), 6-min walk distance (6 MWD), COPD assessment test (CAT), London chest activity of daily living (LCADL), modified medical research council, checklist individual strength-fatigue, patient health questionnaire, and physical activity (Actigraph) were measured. Exacerbation-related readmission and mortality within six months and 1-year were collected., Results: Forty-four patients with AECOPD were matched with 44 patients with SCOPD. At T2, a significant improvement was found for the SPPB total score, 6 MWD, CAT score, and LCADL score. Compared to patients with SCOPD, a worse LCADL score was found at T2 in patients with AECOPD. Patients with AECOPD that were readmitted or died had a worse SPPB classification and five-repetition sit-to-stand test at T1., Conclusion: Patients after severe AECOPD improved in functional capacity and HRQOL one month after hospital discharge, but ADL performance was still worse compared to SCOPD. Patients who were readmitted or died had significantly worse scores on functional tests at hospital discharge., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To investigate the effectiveness of different types of interventions aimed at enhancing device-measured physical activity (PA) and summarize the devices and methodologies used to measure PA in adults with cancer., Data Sources: A systematic review was prospectively registered on PROSPERO (CRD42020199466). The search was conducted in PubMed, The Cochrane Library, EMBASE (via Ovid), and PEDro from 2005 onward., Study Selection: Prospective interventional studies (randomized controlled trials [RCTs], non-randomized controlled trials, and single-group trials), that included adults within 12 months from cancer diagnosis, and device-measured PA before and after commencement of an intervention were included. Studies were excluded if PA was measured at a single time point. Two independent reviewers screened 3033 records and 30 articles met the inclusion criteria., Data Extraction: Two reviewers independently extracted the data. PEDro scale and GRADE approach were used to assess methodological quality of RCTs and overall quality of evidence, respectively. A meta-analysis of relevant RCTs was conducted., Data Synthesis: Thirty studies were identified, mainly including adults with multiple cancer types. Interventions were behavior change interventions (n=15), exercise training (n=13), neuromuscular electrostimulation (n=1), or a nutritional program (n=1). The meta-analysis showed improvements on moderate-to-vigorous intensity PA (MVPA) in the experimental group (8 studies; standardized mean difference (SMD)=0.23; 95% CI 0.06-0.39); with subgroup analysis showing that findings were mainly driven by behavior change interventions (5 studies; SMD=0.23, 95% CI 0.05-0.41). An uncertain effect on sedentary behavior, daily steps, and light intensity PA was found. PA was measured with medical devices and commercial wearables, quality of the methodology was variable., Conclusions: Behavior change interventions increased device-derived MVPA in adult cancer patients who underwent the intervention within 12 months of the cancer diagnosis. Various devices and methodologies were used to assess PA, which limits comparisons across the studies., (Copyright © 2023 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Long COVID is a prevalent condition with many multisystemic symptoms, such as fatigue, dyspnoea, muscle weakness, anxiety, depression and sleep difficulties, impacting daily life and (social and physical) functioning. Pulmonary rehabilitation (PR) may improve physical status and symptoms of patients with long COVID, yet the evidence is limited. Therefore, this trial aims to study the effect of primary care PR on exercise capacity, symptoms, physical activity and sleep in patients with long COVID., Methods and Analysis: PuRe-COVID is a prospective, pragmatic, open-label, randomised controlled trial. A sample of 134 adult patients with long COVID will be randomised to a 12 week PR programme in primary care, supervised by a physiotherapist or to a control group, following no PR. A 3 month and 6 month follow-up period is foreseen. The primary endpoint will be the change in exercise capacity measured by 6-minute walk distance (6MWD) at 12 weeks, hypothesising a more significant improvement in the PR group. Other parameters, such as pulmonary function tests (including maximal inspiratory pressure/maximal expiratory pressure), patient-reported outcomes (COPD Assessment Test, modified Medical Research Council Dyspnoea Scale, Checklist Individual Strength, post-COVID-19 Functional Status, Nijmegen questionnaire, Hospital Anxiety and Depression Scale, Work Productivity and Activity Impairment Questionnaire and EuroQol-5D-5L), physical activity measured by an activity tracker, hand grip strength and sleep efficiency, are secondary and exploratory outcomes.The recruitment started on 19 April 2022, and 52 patients were included as of 14 December 2022., Ethics and Dissemination: Ethical approval was obtained in Belgium from the relevant institutional review boards on 21 February 2022 (Antwerp University Hospital, approval number 2022-3067) and on 1 April 2022 (Ziekenhuis Oost-Limburg in Genk, approval number Z-2022-01). Findings from this randomised controlled trial will be disseminated in peer-reviewed publications and presentations at international scientific meetings., Trial Registration Number: NCT05244044., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative impact on patients' health status, including physical function and patient-reported outcomes. We aimed to explore the associations between physical tests and patient-reported outcome measures (PROMs) in hospitalised patients for an AECOPD. Patients were assessed on the day of discharge. Quadriceps force, handgrip strength, short physical performance battery (SPPB), five-repetition sit-to-stand test (5STS), four-meter gait speed test (4MGS), balance test, six-minute walk test (6MWT), COPD Assessment Test (CAT), London Chest Activity of Daily Living scale (LCADL), modified Medical Research Council (mMRC) dyspnea scale, Checklist of Individual Strength (CIS)-fatigue subscale, and Patient Health Questionnaire (PHQ-9) were collected. Sixty-nine patients with an AECOPD were included (54% female; age 69 ± 9 years; FEV 1 39.2 (28.6-49.1%) predicted). Six-minute walk distance was strongly correlated with mMRC ( ρ : -0.64, p < 0.0001) and moderately correlated with LCADL total score, subscales self-care and household activities ( ρ ranging from -0.40 to -0.58, p < 0.01). Moreover, 4MGS was moderately correlated with mMRC ( ρ : -0.49, p < 0.0001). Other correlations were weak or non-significant. During a severe AECOPD, physical tests are generally poorly related to PROMs. Therefore, a comprehensive assessment combining both physical tests and PROMs needs to be conducted in these patients to understand their health status.

Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure ( n = 13) and a small statistically significant effect ( ES = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.

1. Using different experimental conditions and applying various substrates, a wide range of metabolic rates could be observed in incubations with human erythrocytes. 2. Lower rates of substrate utilization resulted in a decrease of the ATP and, more pronounced, of the 2,3-bisphosphoglycerate concentration while carbon utilization rates beyond 14 mumol C/ml packed cells in 120 min yielded constant levels of ATP and 2,3-bisphosphoglycerate indicating that steady state had been achieved. 3. It can be concluded, that a carbon utilization rate of 14 mumol C/ml cells in 120 min is able to cover the energy requirement of the red cells under steady state conditions which could be calculated to amount to 3.6 mumol ATP/ml cells in 120 min at 37 degrees C. 4. The contribution of the 2,3-bisphosphoglycerate bypass to carbon metabolism could be calculated to range between 15--25% at metabolic rates below 14 mumol C/ml cells in 120 min (presteady state). When steady state has been achieved, the share of this bypass increases up to 61% with increasing metabolic rates.

1) Erythrocytes are able to metabolize D-ribose, D-xylitol, D-xylulose, D-fructose and D-glucose; the rates of metabolism increase in that order from 2430 to 26200 ng atom C/ml packed cells per 120 min of incubation. 2) The utilization of the carbon of these substrates and its recovery in the products were found to be in balance, when the change in the 2,3-bisphosphoglycerate concentration was taken into account. 3) The metabolic rates strongly affected the 2,3-bisphosphoglycerate level. Without addition of substrate the decomposition rate of this intermediate was found to be 1030 nmol/ml packed cells per 120 min. 4) The net decrease of the 2,3-bisphosphoglycerate concentration and the conversion of this compound into lactate provides a NAD regeneration system which enables the red blood cells to utilize xylitol. 5) The rate of carbon metabolism via the pentose phosphate cycle is determined by the NADPH requirement of the erythrocytes which was found to be 160 nmol/ml packed cells per 120 min under the experimental conditions employed.

Metabolism of the substrates D-ribose, xylitol, D-Xylulose, D-fructose, D-glucose and mixtures of these compounds were studied in human erythrocytes. The metabolic rates obtained with the various substrates affected the intracellular levels of ATP and 2,3-bisphosphoglycerate. Small amounts of substrate utilization resulted in a decrease of the ATP and more pronounced of the 2,3-bisphosphoglycerate concentration while carbon utilization rates beyound 14 microgram atom C/ml packed cells/120 min yielded constant levels of ATP and 2,3-bisphosphoglycerate. From these results it can be concluded that a carbon utilization rate of 14 microgram atom C/ml cells/120 min is able to cover the ATP requirement of the red cells under steady state conditions. Based on the carbon utilization rates obtained with the various substrates and the rates of 2,3-bisphosphoglycerate decomposition an attempt is made to calculate the contribution of the 2,3-bisphosphoglycerate bypass to substrate metabolism. In case of xylitol as substrate the decrease in the 2,3-bisphosphoglycerate content provides the regeneration of NAD thus facilitating uptake and metabolism of xylitol.