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Introduction: Pulmonary rehabilitation (PR) is an effective treatment for people with chronic respiratory disease but is delivered to <5% of eligible individuals. Home-based telerehabilitation achieves similar clinical outcomes to centre-based PR in clinical trials. We aimed to evaluate the clinical implementation of telerehabilitation. Method(s): Suitable individuals with respiratory disease referred for PR at Alfred Health have been offered the option of an 8-week home-based telerehabilitation program (one home visit followed by twice-weekly exercise training sessions, with real time supervision, for 8-weeks). Equipment was provided to patients, as necessary. Standard PR assessments were conducted pre and post program. Program completion was defined as undertaking >=70% of prescribed sessions. Real-world implementation was evaluated against the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Result(s): Reach: Across 2-years (Sept 2020-22), 269 people were referred with 55 (21%) undertaking telerehabilitation (25 female, mean (SD) age 61 (11) years, 6-min walk distance (6MWD) 430 (120) metres, Chronic Respiratory Questionnaire Dyspnoea (CRQD) domain 16 (6)). Participant diagnoses included COPD (n = 11), ILD (n = 15), bronchiectasis (n = 5), asthma (n = 2), post COVID-19 (n = 9), and pulmonary hypertension (n = 4). Forty participants (73%) completed >=70% of prescribed sessions. Effectiveness: Significant and clinically meaningful improvements were demonstrated (CRQD MD 4 (95% CI 1, 6);6MWD MD 24 m (95% CI 8, 41)). Adoption: Training to deliver telerehabilitation and perform home visits was completed by PR clinicians (n = 7 and n = 4 respectively). Implementation: All participants independently supplied Wi-Fi, and 40% used their own exercise equipment or internet-enabled device. Most participants had an in-person home visit (n = 45), and undertook cycle-based training (n = 46). Fifteen participants required additional support for iPad or videoconferencing navigation. There were no serious adverse advents. Maintenance will be evaluated following this pilot period. Conclusion(s): 'Real-world' telerehabilitation achieves clinically meaningful outcomes for patients and provided access to an effective model of PR particularly when centre-based programs were unavailable due to COVID-19 restrictions.
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BACKGROUND: Physical activity (PA) confers numerous benefits to health and health care costs, yet most adults are not meeting recommended PA guidelines. Stress may be a factor that influences PA behavior. Research investigating the impact of stress on PA has yielded inconsistent findings. Most studies find that stress negatively impacts PA, but there is some evidence that habitual exercising buffers this association. OBJECTIVE: This study aims to examine the relationship between stress and exercise habits among habitual exercisers with internet-connected home fitness equipment (Peloton Bike) during the COVID-19 lockdown. METHODS: Participants were recruited through Facebook (N=146) and asked to complete an internet-based survey that assessed COVID-19-related stressors, perceived stress associated with those stressors, and general perceived stress. Self-reported exercise was assessed on the survey using the Godin Leisure-time Exercise Questionnaire (GLTEQ). Participants were also asked for consent to access their Peloton usage data through the Peloton platform. From their usage data, the frequency and duration of cycling classes was calculated for 4 weeks prior to and 12 weeks following the survey. Hierarchical regression equations tested the association between stress reported on the survey and subsequent exercise participation. Exercise participation was quantified both as the frequency and duration of Peloton cycling over the 12 weeks following the survey and as self-reported moderate to vigorous activity on a second survey completed by a subset of participants 12 weeks after the initial survey. RESULTS: There were 146 participants in our Peloton analysis sample and 66 in the self-reported exercise analysis. Peloton user data showed that study participants cycled frequently (mean 5.9 times per week) in the month prior to the initial survey, and that presurvey Peloton use was a strong predictor of exercise frequency (R2=0.57; F2,143=95.27; P<.001) and duration (R2=0.58; F2,143=102.58; P<.001) for the 12 subsequent weeks. Self-reported overall exercise likewise showed that this sample was very active, with an average of more than 8 times per week of moderate to vigorous exercise at the initial survey. Self-reported exercise on the initial survey was a strong predictor of self-reported exercise 12 weeks later (R2=0.31; F1,64=29.03; P<.001). Perceived stress did not impact Peloton cycling duration or frequency (P=.81 and .76, respectively) or self-reported exercise (P=.28). CONCLUSIONS: The results suggest that stress did not negatively impact exercise participation among habitually active adults with access to internet-connected home fitness equipment. Habitual exercise may buffer the impact of stress on participation in regular moderate to vigorous activity. Future research should examine the role that the availability of home-based internet-connected exercise equipment may play in this buffering.
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IntroductionA blinded ambulatory oxygen assessment protocol on a treadmill was established in 2005. Patients perform 2 walking tests, up to fifteen minutes each, on a treadmill at a set speed with a 30 minute rest between tests. The patient wears nasal cannulae on both tests, through which they receive 2L/min of air or Oxygen. Patients rate their breathlessness on a BORG scale every minute and this is recorded with Oxygen saturation via ear probe and heart rate. An increase in distance (10%) or decrease in BORG scores (1 point/10%) would indicate a need for ambulatory Oxygen prescription. The British Thoracic Society (BTS) 2015 ambulatory Oxygen therapy assessment protocol also states that an increase in SpO2 to ≥90% throughout the test would show a benefit to the patient1.AimHow many patients referred for assessment would benefit from prescription of ambulatory Oxygen based on the current BTS protocol?MethodsTest results, demographic and clinical data were collated for all patients referred for ambulatory Oxygen assessment over 1 year.Results88 patients were referred for assessment with 18 excluded (n=70). 11 patients only carried out the baseline test on air without progressing to the second test on oxygen as there was no significant desaturation during exercise. Of the 59 remaining patients 34 would be recommended ambulatory oxygen therapy, 19 would not and the remaining 6 may require higher flow rates than the 4L/min O2 that is the highest rate within the protocol. Only 18 patients (18/59=31%) had a decrease in BORG (felt better) by 10% or 1 point whilst on supplemental O2. 10 patients (10/59=17%) reported higher BORG scores on Oxygen (?fatigue, ? walked further).ConclusionOf the 70 patients included in the audit 34 (48.57%) would be recommended ambulatory oxygen therapy, 30 (42.86%) would not and the remaining 6 (8.57%) may require higher flow rates than the 4L/min that is the highest rate within the protocol. This protocol has been particularly useful during the COVID pandemic and the SOP has been shared with other departments.ReferencesHardinge M, Annandale J, Bourne S, et al. British Thoracic Society guidelines for home oxygen use in adults: accredited by NICE. Thorax 2015;70:i1-i43.
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Knee osteoarthritis (KOA) among obese people is a common joint pain with loss of physical functioning, disability and reduction in quality of life QoL). This study aimed to compare the effect of aquatic and Thera-band exercise on pain intensity and QoL among obese people with KOA. A total of 45 KOA participants with BMI ≥ 27.5 kg.m-² were randomly recruited and randomly assigned into three groups;aquatic (AQG), Thera-band exercise (TBG) and control (CG);carried out the exercise program, two times weekly, 60 minutes per session, for eight weeks. Quality of life was measured using modified KOOS questionnaire with five sub-domains;pain, symptoms, activities of daily living (ADL), sports/ recreation and knee-related QoL. The results showed no significant difference in age, weight, BMI, and KOA involvement background in all groups. The MANCOVA results displayed a significant interaction of group×time effect on all sub-domains of QoL;pain, symptoms, ADL, sports/recreation and total QoL. In addition, pairwise comparisons between groups among QoL sub-domains revealed that there was significant difference between AQG and TBG in all dimensions of QoL (pain, symptom, ADL and knee-related QoL) exception in sports/recreation domain. For overall aquatic exercise could reduce pain and improve QoL greater that Thera-band exercise after eight weeks of the exercise program. As a conclusion, this progressive aquatic exercise program had a superior effectiveness to reduce all dimensions of QoL, although Thera-band exercise cannot be ignored as an effective, simple and inexpensive method to create a self-exercise program among obese people who suffering from KOA.
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Nine Ski mountaineering (Ski-Mo), ten Nordic-Cross Country (NCC) and twelve world elite biathlon (Bia) athletes were evaluated for cardiopulmonary exercise test (CPET) performance as the primary aim of our descriptive preliminary report. A multicenter retrospective analysis of CPET data was performed in 31 elite winter sports athletes, which were obtained in 2021 during the annual medical examination. The matched data of the elite winter sports athletes (14 women, 17 male athletes, age: 18–32 years) were compared for different CPET parameters, and athlete’s physique data and sport-specific training schedules. All athletes showed, as estimated in elite winter sport athletes, excellent performance data in the CPET analyses. Significant differences were revealed for VE VT2 (respiratory minute volume at the second ventilatory threshold (VT2)), highest maximum respiratory minute volume (VEmaximum), the indexed ventilatory oxygen uptake (VO2) at VT2 (VO2/kg VT2), the oxygen pulse at VT2, and the maximum oxygen pulse level between the three professional winter sports disciplines. This report provides new evidence that in different world elite winter sport professionals, significant differences in CPET parameters can be demonstrated, against the background of athlete’s physique as well as training control and frequency.
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There is limited research examining the perception of exertion during exercise while wearing a facemask. The current study examined if mask usage during moderate or vigorous physical activity (MVPA) changed the self-reported perception of exertion. Seventy-two adults (18 years and older) who were physically active before the COVID-19 pandemic completed a questionnaire that assessed exercise habits and perceptions of mask wearing during MVPA. Participants reported their ratings of perceived exertion (RPE, on a scale of 1–10) while exercising. Wearing a mask resulted in higher RPE vs. no mask during both vigorous (8.4 ± 0.2 vs. 7.4 ± 0.1;p < 0.001) and moderate PA (6.6 ± 0.2 vs. 5.6 ± 0.2;p < 0.001). Qualitative analysis revealed mostly negative perceptions of exercising while wearing a mask, including respiratory issues, detriments to cardiovascular endurance, and general discomfort. A total of 40% of participants reported that they stopped exercising in an indoor/public setting because of a mask mandate in their region. Participants reported participating in less vigorous PA (4.7 ± 0.4 vs. 4.0 ± 0.4 h/week;p = 0.046), but not less moderate PA (3.3 ± 0.3 vs. 3.0 ± 0.3 h/week;p = 0.443) pre vs. during the pandemic. Our study suggests that facemask usage during MVPA causes an increase in RPE and may be one reason for a decrease in vigorous PA during the COVID-19 pandemic.
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Purpose: Osteoarthritis (OA) affects more than 300 million people worldwide with the knee and hip joints among the most clinically prevalent. Pain, stiffness, and physical disability are hallmark symptoms that impair quality of life. Good Life with osteoArthritis from Denmark (GLA:D®) is an evidence-based program providing education and exercise-therapy for people with knee and hip OA, now offered in 8 countries. A key barrier to GLA:D® is the need to attend 14 in-person sessions over 8-weeks, particularly for those in rural areas or with substantial occupational or family caring responsibilities. In the COVID-19 pandemic we expanded implementation support for GLA:D®in Australia to provide it via telehealth. The aim of this mixed methods project was to evaluate the implementation of GLA:D® via telehealth in Australia using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. Methods: Quantitative: People with knee or hip OA who reported completing GLA:D® via telehealth-only or a hybrid model of in-person and telehealth (minimum 3 telehealth sessions) at 3-month follow-up from March 2020-October 2021 were identified from the GLA:D®Australia registry. RE-AIM dimensions were examined descriptively. For the effectiveness domain mean differences [MD, (95% confidence intervals (CI)), effect size (ES)] from baseline to 3-month follow-up were calculated for pain (visual analogue scale, 0-100) and joint-related quality of life (knee injury and osteoarthritis outcome score or hip disability and osteoarthritis outcome score -quality of life sub-scales). Participants rated perceived recovery on a global rating of change (scale -3 to 3;1-3=recovered) and how satisfied they were with the GLA:D® program (scale 1-5;4,5=satisfied) at 3-month follow-up. Qualitative: One-on-one semi-structured interviews were conducted with 23 GLA:D® trained physiotherapists (n=12 telehealth adopters;n=11 non-adopters) from diverse (private/public practice, urban/rural) settings. Interviews were transcribed and analysed using a reflexive thematic approach guided by the RE-AIM QuEST framework. Results: Reach: 138 people (39 telehealth-only and 99 hybrid model;69% female) completed GLA:D.® Mean (SD) age and BMI were 64 (9) years 29.8 (5.5) kg/m2, respectively. Key themes on patient barriers and enablers for telehealth reach were technology literacy and access, personal preference and perceived value of telehealth, and availability of exercise equipment. Pandemic restrictions limiting access to in-person GLA:D® was an enabler. Effectiveness: For telehealth-only, average pain [MD=-10 (95%CI=-16, -4), ES=-0.54] and joint-related quality of life [MD=9 (95%CI=3, 14), ES=0.51] improved significantly. This was similar for hybrid model with average pain [MD=-11 (95%CI=-16, -6, ES=-0.43)] and joint-related quality of life [MD=12 (95%CI=8, 16, ES=0.65)] also improved. At 3-months, 81% of participants reported recovery and 88% were satisfied with GLA:D®. Most physiotherapists who adopted GLA:D® telehealth believed it was as effective as in-person for most patients and felt patients were better able to continue exercising at home upon completion. Adoption: 92 physiotherapists (74 health services) delivered GLA:D® via telehealth. Most physiotherapists who had adopted GLA:D® via telehealth stated it had become a normal part of their practice. Barriers to adoption included preferring, and greater confidence with providing, in-person GLA:D®. Implementation: Both education sessions were attended by 70% (n=96) of participants and 91% (n=125) attended more than 10 exercise-therapy sessions. GLA:D® telehealth implementation involved program modifications, including to assessment, exercise instruction, equipment modifications, and reduced fee structures. Maintenance: GLA:D® telehealth participants completed 3-month follow-ups throughout the entire study timeframe, with 16 (12%) in the final 2 months of evaluation, indicating ongoing participant engagement. Physio herapists stated GLA:D® telehealth was an opportunity for increased program access to immunocompromised, rural, and working patients. Barriers to sustainability identified included lack of personnel capacity, low patient demand, and a need for future telehealth training and support. Conclusions: Telehealth delivery of GLA:D® in Australia during the pandemic was most used as part of a hybrid model, combined with in-person delivery. Patient outcomes following GLA:D® via telehealth were comparable to published data related to in-person delivery, indicating it is an effective method to implement group-based care for OA. Yet, implementation was limited, impeded by low perceived value by patients and lack of confidence and training of physiotherapists. This evaluation will guide new strategies and training to support GLA:D via telehealth as a viable mode of program delivery in the future in Australia and internationally.
ABSTRACT
Keywords: Digital;Improvement;Respiratory Purpose: In March 2020, all clinics and group sessions were suspended due to the COVID-19 pandemic and most of our respiratory clients were shielding. During our initial contact with these clients, they reported being less active than they were pre-lockdown. Reduced physical activity is directly related to quality of life (QoL). So, it became important for our team to look into innovative ways to engage with our clients. The aim was to find an effective alternative way for clients to participate in our Pulmonary Rehabilitation (PR) while the restrictions were in place. Methods: This service evaluation used a mixed method approach to investigate the effectiveness of Virtual PR (VPR). Both quantitative and qualitative data were collected during the initial assessment (IA) and post assessment (PA) for comparison. Informal feedbacks were collected from clients and staff during the VPR group sessions. Quantitative data: 1. COPD Assessment Tool (CAT), measures the impact of condition on client's health. 2. Patient Health Questionnaire (PHQ-9) for depression. 3. Generalised Anxiety Disorder (GAD-7) for anxiety. 4. Exercise Tolerance test (ET) Qualitative data: 1. Medical Research Council dyspnoea scale (MRC) 2. Client satisfactory survey during PA. Results: Of the 52 digitally enabled clients that were offered VPR, 88% completed the programme. 4% dropped out and the remaining 8% were expelled due to medical reasons. 11% of those who completed were housebound either due to their condition or lack of transport. 93% of the clients attended ten or more of the allocated 12 sessions. At the end of VPR, 13% of clients reported an improvement in MRC, and 65% of the clients had attained minimally important difference in ET. During IA, 86% reported to have medium to high impact on CAT. 43% of those clients had dropped to a lower impact level during post assessment. Initially, 63% reported to have psychological symptoms in at least one or both of the questionnaires (PHQ-9, GAD-7). Of these 29 clients who reported symptoms, 62% showed improvement at the end. 95% have said that VPR has motivated them to be active, 41% would have preferred face to face (F2F) sessions for the social aspects of the group, but all participants agreed that VPR was a good alternative. 95% of clients rated 8 or above for the quality of the sessions. During informal interviews, clients said VPR has saved them travel time and reduced dependency on family for transport. Staff reported lack of exercise equipment had an impact on the progress when compared to F2F. Conclusion(s): VPR as a digital solution has a positive effect on both physiological and psychological symptoms, thus improving QoL. Also, proved to be cost, time and clinically effective way to rehabilitate housebound clients. VPR is a good alternative to F2F sessions, but further work needs to be done to enable clients in digital and data poverty to uptake VPR to ensure fair access. Impact: VPR has been imbedded into our pathway and will be offered based on clinical decision and clients’ choice. Referral form will be revised to reflect the optional digital pathway. Funding acknowledgements: So far, this project has been funded at team level for the virtual platform licence. Funding has been secured for digital devices and data through the organisation (NELFT NHS trust) for a project on, ‘VPR for clients in digital/data poverty’.
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The COVID-19 pandemic has had drastic effects on many industries around the globe. With shelter-in-place orders set to slow the spread of the virus, many high-risk facilities like gyms were forced to close until further notice. Individuals who rely on these facilities for access to exercise equipment had to find alternatives. For these reasons, individuals are now purchasing their own exercise equipment, creating "at-home gyms." This has overloaded the exercise equipment market, creating a substantial positive surge in production. This increase in demand and new manufacturing regulations have disrupted exercise equipment companies' supply chains. The goal of this paper is to identify all impacts of COVID-19 on this industry in the U.S. and analyze current methods of regulating production and delivery. We determine the effects the pandemic has had on the economy relating to the fitness equipment industry and investigate potential correlations between certain equipment types and delays. The paper discusses the performance of other kinds of at-home exercise programs offered by the fitness industry. Throughout the paper, we analyze, detail, and compare both solutions from equipment companies and consumers' responses. © 2021 IISE Annual Conference and Expo 2021. All rights reserved.