Valérie Coats

Feasibility and effectiveness of a home-based exercise training program before lung resection surgery

BACKGROUND Patients with lung cancer often experience a reduction in exercise tolerance, muscle weakness and decreased quality of life. Although the effectiveness of pulmonary rehabilitation programs is well recognized in other forms of cancers and in many pulmonary diseases, few researchers have studied its impact in patients with lung cancer, particularly in those awaiting lung resection surgery (LRS). OBJECTIVES To investigate the feasibility of a short, home-based exercise training program (HBETP) with patients under investigation for non-small cell lung cancer and potential candidates for LRS, and to determine the effectiveness of this program on exercise tolerance, skeletal muscle strength and quality of life. METHODS Sixteen patients with lung cancer awaiting LRS participated in a four-week HBETP including moderate aerobic activities (walking and cycling) and muscle training performed three times weekly. Before and after the intervention, a cardiopulmonary exercise test, a 6 min walk test and the assessment of muscle strength and quality of life were performed. RESULTS Thirteen patients completed the four-week HBETP and all the patients completed >75% of the prescribed exercise sessions. The duration of the cycle endurance test (264±79 s versus 421±241 s; P<0.05) and the 6 min walk test distance (540±98 m versus 568±101 m; P<0.05) were significantly improved. Moreover, the strength of the deltoid, triceps and hamstrings were significantly improved (∆ post-pre training 1.82±2.83 kg, 1.32±1.75 kg and 3.41±3.7 kg; P<0.05, respectively). CONCLUSION In patients with lung cancer awaiting LRS, HBETP was feasible and improved exercise tolerance and muscle strength. This may be clinically relevant because poor exercise capacity and muscle weakness are predictors of postoperative complications.

Distal leg muscle function in patients with COPD.

Abstract Quadriceps muscle weakness and increased fatigability are well described in patients with chronic obstructive pulmonary disease (COPD). Whether these functional alterations also exist in distal leg muscles in patients with COPD is uncertain. Fifteen patients with COPD and 15 aged-matched healthy controls performed a 12-minute standardized treadmill exercise during which a fixed total expense of 40 Kcal was reached. The strength of i) dorsiflexors, ii) plantar flexors and iii) quadriceps was assessed at rest and after exercise using maximal voluntary contraction (MVC) and potentiated twitch force (Twpot). Resting MVC and Twpot were significantly lower in patients with COPD when compared with controls respectively for i) dorsiflexors (24.9 ± 8.4 vs. 31.2 ± 8.5 Nm, p < 0.05 and 4.3 ± 1.3 vs. 5.7 ± 1.8 Nm, p < 0.05), ii) plantar flexors (49.5 ± 11.8 vs. 62.1 ± 19.6 Nm, p < 0.05 and 10.8 ± 3.5 vs. 13.4 ± 2.7 Nm, p < 0.05), and iii) quadriceps muscles. There was a greater force loss in the distal leg muscles 15 minutes post-exercise in patients with COPD, while the strength of the quadriceps muscle remained stable in both groups. Patients with COPD had weaker dorsiflexor and plantar flexor muscles when compared to age-matched healthy controls. In addition, when exposed to the same absolute walking task, the fatigability of the distal leg muscles was higher in patients with COPD.

Test-retest reliability of lower limb isokinetic endurance in COPD: A comparison of angular velocities.

Background The purpose of this study was to determine and compare the test-retest reliability of quadriceps isokinetic endurance testing at two knee angular velocities in patients with chronic obstructive pulmonary disease (COPD). Methods After one familiarization session, 14 patients with moderate to severe COPD (mean age 65±4 years; forced expiratory volume in 1 second (FEV1) 55%±18% predicted) performed two quadriceps isokinetic endurance tests on two separate occasions within a 5–7-day interval. Quadriceps isokinetic endurance tests consisted of 30 maximal knee extensions at angular velocities of 90° and 180° per second, performed in random order. Test-retest reliability was assessed for peak torque, muscle endurance, work slope, work fatigue index, and changes in FEV1 for dyspnea and leg fatigue from rest to the end of the test. The intraclass correlation coefficient, minimal detectable change, and limits of agreement were calculated. Results High test-retest reliability was identified for peak torque and muscle total work at both velocities. Work fatigue index was considered reliable at 90° per second but not at 180° per second. A lower reliability was identified for dyspnea and leg fatigue scores at both angular velocities. Conclusion Despite a limited sample size, our findings support the use of a 30-maximal repetition isokinetic muscle testing procedure at angular velocities of 90° and 180° per second in patients with moderate to severe COPD. Endurance measurement (total isokinetic work) at 90° per second was highly reliable, with a minimal detectable change at the 95% confidence level of 10%. Peak torque and fatigue index could also be assessed reliably at 90° per second. Evaluation of dyspnea and leg fatigue using the modified Borg scale of perceived exertion was poorly reliable and its clinical usefulness is questionable. These results should be useful in the design and interpretation of future interventions aimed at improving muscle endurance in COPD.

Exercise-Based Rehabilitation for People with Lung Cancer

Lung cancer is the leading cause of cancer-related death worldwide. Patients living with lung cancer often experience severe physical and psychological symptoms including dyspnea, fatigue, anxiety, decreased exercise tolerance, muscle weakness and compromised health-related quality of life as a direct consequence of the disease or as an indirect consequence of the cancer therapy itself. As both screening and treatment modalities improve, the number of people living with a diagnosis of lung cancer is increasing. Consequently, management of cancer-related symptoms as well as improvement of overall quality of life and functional status become critical issues in lung cancer patients. Thus, during the last decade, a wide range of exercise prescriptions and training modalities has been proposed and an emerging literature has addressed the effects of exercise-based rehabilitation programs along the continuum of the disease. The aim of this review is to address the latest literature regarding the feasibility and effectiveness of exercise-based rehabilitation for patients with lung cancer receiving treatments (perioperative, during chemotherapy/radiation therapy or following them) or for patients with advanced diseases. We also address how the use of new technologies or training modalities such as home-based telerehabilitation or neuromuscular electrical stimulation appears to be a promising approach to improve accessibility and participation in exercisebased rehabilitation programs. Evidence from our review suggests that pre and post-operative exercise-based rehabilitation appear to be safe and effective approaches to use with patients with lung cancer and for those with advanced disease receiving chemotherapy/radiation therapy. Larger randomized controlled trials are needed to confirm the efficacy of exercise interventions in this population.

Reliability and Usability of the eChez-Soi In-home Telerehabilitation Platform: A New Internet-based Communication and Real-time Monitoring Software Solution Combined with Interactive Exercises - Results of a Longitudinal Pilot Study in Four Patients with Lung Cancer

This longitudinal pilot study aims to describe the components and functionalities of the eChez-Soi homebased telerehabilitation platform, and present preliminary results on its technological reliability and usability. Four patients receiving chemotherapy treatments for lung cancer followed an 8 week home-based telerehabilitation program using the new eChez-Soi platform. All 60 planned sessions supervised by a clinician occurred with few technological problems. Only one session had to be rescheduled because of unresolved audiovisual communication problems. In 20 sessions, temporary problems were experienced, mostly related to the audiovisual signal (n=16), while few technical problems were associated with the sensors (n=1) and the interactive exercise software (n=1). The usability of the platform was very good, with an overall satisfaction rating of 4.63±0.43 (max. score=5) for all aspects evaluated, namely its dimension, safety, effectiveness, ease of use and game environment. These preliminary results support the reliability and usability of our new platform as a whole but highlight the challenges encountered in ensuring a stable audiovisual signal when delivering services via a standard home-based Internet connection.