Djeya Kaliaraju

Pedometer Step Count Targets During Pulmonary Rehabilitation in COPD: A Randomized Controlled Trial

Rationale: Increasing physical activity is a key therapeutic aim in chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) improves exercise capacity, but there is conflicting evidence regarding its ability to improve physical activity levels. Objectives: To determine whether using pedometers as an adjunct to PR can enhance time spent in at least moderate‐intensity physical activity (time expending ≥3 metabolic equivalents [METs]) by people with COPD. Methods: In this single‐blind randomized controlled trial, participants were assigned 1:1 to receive a control intervention (PR comprising 8 wk, two supervised sessions per week) or the trial intervention (PR plus pedometer‐directed step targets, reviewed weekly for 8 wk). In the randomization process, we used minimization to balance groups for age, sex, FEV1 percent predicted, and baseline exercise capacity and physical activity levels. Outcome assessors and PR therapists were blinded to group allocation. The primary analysis was based on the intention‐to‐treat principle. Measurements and Main Results: The primary outcome was change from baseline to 8 weeks in accelerometer‐measured daily time expending at least 3 METs. A total of 152 participants (72% male; mean [SD] FEV1 percent predicted, 50.5% [21.2]; median [first quartile, third quartile] time expending ≥3 METs, 46 [21, 92] min) were enrolled and assigned to the intervention (n = 76) or control (n = 76) arm. There was no significant difference in change in time expending at least 3 METs between the intervention and control groups at 8 weeks (median [first quartile, third quartile] difference, 0.5 [−1.0, 31.0] min; P = 0.87) or at the 6‐month follow‐up (7.0 [−9, 27] min; P = 0.16). Conclusions: Pedometer‐directed step‐count targets during an outpatient PR program did not enhance moderate‐intensity physical activity levels in people with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT01719822).

Does pulmonary rehabilitation reduce peripheral blood pressure in patients with chronic obstructive pulmonary disease

Pulmonary rehabilitation (PR) can improve aerobic exercise capacity, health-related quality of life and dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Recent studies have suggested that exercise training may improve blood pressure and arterial stiffness, albeit in small highly selected cohorts. The aim of the study was to establish whether supervised outpatient or unsupervised home PR can reduce peripheral blood pressure. Resting blood pressure was measured in 418 patients with COPD before and after outpatient PR, supervised by a hospital-based team (HOSP). Seventy-four patients with COPD undergoing an unsupervised home-based programme acted as a comparator group (HOME). Despite significant improvements in mean (95% confidence interval) exercise capacity in the HOSP group (56 (50–60) m, p < 0.001) and HOME group (30 (17–42) m, p < 0.001) systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) did not change in either the HOSP (SBP: p = 0.47; DBP: p = 0.06; MAP: p = 0.38) or HOME group (SBP: p = 0.67; DBP: p = 0.38; MAP: p = 0.76). Planned subgroup analysis of HOSP patients with known hypertension and/or cardiovascular disease showed no impact of PR upon blood pressure. PR is unlikely to reduce blood pressure, and by implication, makes a mechanism of action in which arterial stiffness is reduced, less likely.

Reply to: Are All Steps Created Equal? Revisiting Pedometer Use During Pulmonary Rehabilitation for Individuals Living with COPD

Ms Claire M. Nolan MSc 1,2 c.nolan15@imperial.ac.uk Dr Matthew Maddocks PhD 3 matthew.maddocks@kcl.ac.uk Dr Jane L. Canavan PhD 1 jane.canavan@ouh.nhs.uk Ms Sarah E. Jones MSc 1 s.jones5@rbht.nhs.uk Ms Veronica Delogu MSc 1 v.delogu@rbht.nhs.uk Mr Djeya Kaliaraju MSc 2 d.kaliaraju@rbht.nhs.uk Mr Winston Banya MSc 1,4 w.banya@rbht.nhs.uk Dr Samantha S. C. Kon PhD 1,5 samanthakon@doctors.org.uk Professor Michael I. Polkey PhD 1 m.polkey@rbht.nhs.uk Dr William D-C. Man PhD 1,2 research@williamman.co.uk

Reply to Rodrigues et al: Increasing Physical Activity in Daily Life in COPD: Each Piece Counts to Solve the Puzzle

Ms Claire M. Nolan MSc 1,2 c.nolan15@imperial.ac.uk Dr Matthew Maddocks PhD 3 matthew.maddocks@kcl.ac.uk Dr Jane L. Canavan PhD 1 jane.canavan@ouh.nhs.uk Ms Sarah E. Jones MSc 1 s.jones5@rbht.nhs.uk Ms Veronica Delogu MSc 1 v.delogu@rbht.nhs.uk Mr Djeya Kaliaraju MSc 2 d.kaliaraju@rbht.nhs.uk Mr Winston Banya MSc 1,4 w.banya@rbht.nhs.uk Dr Samantha S. C. Kon PhD 1,5 samanthakon@doctors.org.uk Professor Michael I. Polkey PhD 1 m.polkey@rbht.nhs.uk Dr William D-C. Man PhD 1,2 research@williamman.co.uk

Reply to Rodrigues et al.: Increasing Physical Activity in Daily Life in Chronic Obstructive Pulmonary Disease: To Solve the Puzzle, Every Piece Counts

Ms Claire M. Nolan MSc 1,2 c.nolan15@imperial.ac.uk Dr Matthew Maddocks PhD 3 matthew.maddocks@kcl.ac.uk Dr Jane L. Canavan PhD 1 jane.canavan@ouh.nhs.uk Ms Sarah E. Jones MSc 1 s.jones5@rbht.nhs.uk Ms Veronica Delogu MSc 1 v.delogu@rbht.nhs.uk Mr Djeya Kaliaraju MSc 2 d.kaliaraju@rbht.nhs.uk Mr Winston Banya MSc 1,4 w.banya@rbht.nhs.uk Dr Samantha S. C. Kon PhD 1,5 samanthakon@doctors.org.uk Professor Michael I. Polkey PhD 1 m.polkey@rbht.nhs.uk Dr William D-C. Man PhD 1,2 research@williamman.co.uk

Reply to: Increasing Physical Activity in Daily Life in COPD: Each Piece Counts to Solve the Puzzle

Ms Claire M. Nolan MSc 1,2 c.nolan15@imperial.ac.uk Dr Matthew Maddocks PhD 3 matthew.maddocks@kcl.ac.uk Dr Jane L. Canavan PhD 1 jane.canavan@ouh.nhs.uk Ms Sarah E. Jones MSc 1 s.jones5@rbht.nhs.uk Ms Veronica Delogu MSc 1 v.delogu@rbht.nhs.uk Mr Djeya Kaliaraju MSc 2 d.kaliaraju@rbht.nhs.uk Mr Winston Banya MSc 1,4 w.banya@rbht.nhs.uk Dr Samantha S. C. Kon PhD 1,5 samanthakon@doctors.org.uk Professor Michael I. Polkey PhD 1 m.polkey@rbht.nhs.uk Dr William D-C. Man PhD 1,2 research@williamman.co.uk

Segmental bioelectrical impedance analysis of lower limb muscle mass in patients with COPD

Background: Skeletal muscle mass loss, particularly of the lower limbs, is associated with increased mortality in COPD. However quantification of lower limb muscle mass through imaging modalities such as CT or MRI are not practical in routine clinical practice. Segmental bioelectrical impedance analysis (BIA) is a potentially quick non-invasive alternative. Aim: To validate lower limb muscle mass measured by segmental bioelectrical impedance analysis (LLMM-BIA) against measures of lower limb muscle strength, physical performance and exercise capacity. Method: In 58 COPD patients LLMM-BIA was measured using a Tanita® MC-780. Other measurements included quadriceps maximum voluntary contraction (QMVC), five-repetition sit-to-stand test (5STS), 4 metre gait speed (4MGS) and Incremental shuttle walk (ISW). Results: Baseline Characteristics: 53%M: 47%F; mean (SD) age 71 (10); FEV1 43 (15) % predicted; QMVC 24.9 (10.3)kg; 5STS 11.39 (3.59)s; 4MGS 0.82 (0.21)m/s; ISW 213 (161) m; LLMM-BIA 15.2 (4.1)kg. Pearson correlation coefficients are presented in [Table 1]. Conclusion: LLMM-BIA did not correlate with quadriceps strength, lower limb physical performance measures or exercise capacity raising questions over the validity of the measure. View this table: Correlation coefficients between LLMM-BIA and quadriceps strength, 5STS, 4MGS and ISW in patients with COPD.