Effects of low-intensity exercise and home-based pulmonary rehabilitation with pedometer feedback on physical activity in elderly patients with chronic obstructive pulmonary disease.

PURPOSE: We evaluated the effects of low-intensity and home-based pulmonary rehabilitation (PR) on physical activity (PA) and the feedback provided by a pedometer in stable elderly patients with chronic obstructive pulmonary disease (COPD). METHODS: We assessed PA using a newly developed triaxial accelerometer (A-MES™, Kumamoto, Japan), which measures the time spent walking, standing, sitting and lying down. Twenty-seven elderly patients with COPD (age 74 ± 8 yrs; %FEV1 56.6 ± 18.7%) participated. They were randomly selected to undergo PR (pulmonary rehabilitation only) or PR + P (PR plus the feedback from using a pedometer). Their PA and pulmonary function, exercise capacity (6-min walking distance; 6MWD), quadriceps femoris muscle force (QF) were evaluated before the PR began (baseline) and at 1 year later. We compared the patients' changes in PA and other factors between the baseline values and those obtained 1 year later and analyzed the relationships between the changes in PA and other factors in the both groups. RESULTS: The increase in the time spent walking in the PR + P group (51.3 ± 63.7 min/day) was significantly greater than that of PR group (12.3 ± 25.5 min/day) after the PR. The improvement rate of daily walking time after PR was significantly correlated with that of the 6MWD and QF in all subjects. CONCLUSIONS: These data suggest that low-intensity and home-based PR with the feedback from using pedometer was effective in improving PA, and the improvements of physiological factors were correlated with increased walking time in stable elderly patients with COPD.

Dynamic hyperinflation and dyspnea during the 6-minute walk test in stable chronic obstructive pulmonary disease patients.

The purpose of this study was to investigate the relationship between dynamic hyperinflation and dyspnea and to clarify the characteristics of dyspnea during the 6-minute walk test (6MWT) in chronic obstructive pulmonary disease patients. Twenty-three subjects with stable moderate chronic obstructive pulmonary disease (age 73.8±5.8 years, all male) took part in this study. During the 6MWT, ventilatory and gas exchange parameters were measured using a portable respiratory gas analysis system. Dyspnea and oxygen saturation were recorded at the end of every 2 minute period during the test. There was a significant decrease in inspiratory capacity during the 6MWT. This suggested that dynamic hyperinflation had occurred. Dyspnea showed a significant linear increase, and there was a significant negative correlation with inspiratory capacity. It was suggested that one of the reasons that dyspnea developed during the 6MWT was the dynamic hyperinflation. Even though the tidal volume increased little after 2 minutes, dyspnea increased linearly to the end of the 6MWT. These results suggest that the mechanisms generating dyspnea during the 6MWT were the sense of respiratory effort at an early stage and then the mismatch between central motor command output and respiratory system movement.

Quantitative assessment of walking time and postural change in patients with COPD using a new triaxial accelerometer system.

BACKGROUND: The purpose of this study was to quantify the walking time and frequency of postural changes in daily life in patients with chronic obstructive pulmonary disease (COPD) using a new triaxial accelerometer system. METHODS: Twenty-six elderly patients with stable COPD (age 76.8 ± 6.2 years; percent forced expiratory volume in one second [%FEV1] 52.9% ± 26.3%) and 20 age-matched elderly subjects (age 73.0 ± 4.2 years; %FEV1 124.0% ± 22.3%) participated in the study. The subjects' time spent walking (slow, fast), standing, sitting, and lying down and the frequency of their postural changes (getting up, standing up) were assessed for 7 consecutive days using an Activity Monitoring And Evaluation System (A-MES™). We analyzed the relationships among walking times, frequency of postural changes, and physiologic factors in both COPD patients and controls. RESULTS: The COPD patients' total walking time, including slow (<2 km/hour) and fast (≥2 km/hour) walking, and their frequency of standing up were significantly lower than those of the age-matched controls (P < 0.01). The fast walking time in daily life was significantly correlated with the 6-minute walking distance, quadriceps femoris muscle force, and dyspnea (P < 0.01). CONCLUSION: These results suggest that both slow (<2 km/hour) and fast (≥2 km/hour) walking time and frequency of postural changes is significantly decreased in COPD patients compared with healthy elderly subjects. The data also suggest that the COPD patients' different walking times in daily life are significantly correlated with exercise capacity and dyspnea. The 6-minute walking distance had the strongest correlation with fast walking time.

Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD.

STUDY OBJECTIVES: The first aim of this study was to investigate the effects of nutritional supplementation combined with low-intensity exercise on body components, exercise tolerance, and health-related quality of life (HRQOL) in malnourished patients with COPD. The second aim of this study was to examine the degree of systemic inflammation and the actual changes in levels of systemic CRP, TNFα, IL-6 and IL-8 actual changes after a combination of nutritional supplementation and low-intensity exercise in these patients. DESIGN: A prospective randomized trial. PATIENTS: Thirty-two moderate to severe, clinically stable malnourished COPD patients. METHODS: Patients were randomly divided into a nutritional supplementation with low-intensity exercise group and a control group. Lung function, maximum inspiratory and expiratory muscle force, the Chronic Respiratory Disease Questionnaire (CRQ), the 6-min walking distance (6MWD), and the Borg scale were measured at baseline and were re-assessed at 3 months after intervention. The degree of systemic inflammation and the changes in levels of systemic CRP, TNFα, IL-6 and IL-8 were assessed before and after a combination nutritional supplementation with low-intensity exercise. RESULTS: Body weight and FFM increased significantly after 12 weeks of nutritional supplementation therapy in patients with COPD. The dietary intake energy increased and the REE:REEpred ratio decreased significantly in the nutrition with low-intensity exercise group. PI(max), Quadriceps muscle force and the 6-min walking distance (6MWD) increased significantly from baseline through week 12. Health status, as assessed by CRQ, improved in the domains of dyspnea and total sores significantly in the nutrition with low-intensity exercise group after intervention. In this group, hsCRP, IL-6, IL-8, and TNFα, decreased significantly after intervention compared with the control group. CONCLUSIONS: The combination of nutritional supplementation with low-intensity exercise training was successful in increasing weight and energy intake as well as exercise capacity and health-related QOL in our patients. Moreover, REE and major inflammatory cytokines decreased significantly after nutritional supplementation with low-intensity exercise training. The present study results suggest a potential role for the combination of nutritional supplementation and low-intensity exercise in the management of malnourished patients with COPD.

Effective home-based pulmonary rehabilitation in patients with restrictive lung diseases.

Patients with chronic obstructive pulmonary disease (COPD) are commonly referred for pulmonary rehabilitation (PR), but the use of PR is not common for patients with restrictive lung disease, neuromuscular diseases, and those who have sustained a severe respiratory illness or undergone thoracic surgery. We investigated the effects of PR in patients with restrictive lung diseases in comparison with COPD patients using a home-based setting. Twenty-six restrictive lung diseases patients and 40 COPD patients who had a Medical Research Council (MRC) dyspnea score >or= 2, a clinically stable condition, and who had completed a 6-month PR program, were enrolled in the present study. The definition of restrictive lung disease was a forced vital capacity (FVC) of 70%. Our PR consisted of breathing retraining, exercise training, respiratory muscle stretching calisthenics, level walking, inspiratory and expiratory muscle exercises, and a monthly education program. Patients were strongly instructed to practice this program daily at home, and were supervised by a respiratory therapist every 2 weeks in our hospital. Patients with restrictive lung diseases showed the significant increases in inspiratory and expiratory muscle forces, the 6-minute walking distance, the Chronic Respiratory Disease Questionnaire and the Short-Form 36, and decreased MRC scores after 6 months. In conclusion, our home-based PR improves respiratory muscle forces, exercise tolerance, health-related quality of life, and the perception of dyspnea in patients with restrictive lung disease to the same extent as in COPD patients.

Predicting outcomes after hip fracture repair.

OBJECTIVE: To compare the activities of daily living before and after hip fracture and construct a statistical model for discharge destination and independent walking. The classification accuracy of the model was determined from an independent sample. DESIGN: Prospective study: FIM prefracture, at discharge, and at 6-mo follow-up were obtained from 63 patients who underwent operations for acute hip fractures. A statistical model for discharge destination and independent walking was made and classification accuracy was checked using 78 independent samples. RESULTS: The motor FIM scores at prefracture decreased significantly at discharge (P < 0.0001) and at 6-mo follow-up (P < 0.0001), but at 6-mo follow-up, they had increased significantly compared with those at discharge (P = 0.0103). A mobility subscale was used to predict discharge destination, and mobility and social cognition subscales were related to independent walking. The predictive accuracy was 87%. CONCLUSIONS: Motor FIM scores increase for at least 6 mos after hip fracture, and discharge destination and independent walking were highly predictable from FIM mobility and social cognition subscales.