Zoe J. McKeough

Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial

The aim of this study was to determine if weekly, supervised, outpatient-based exercise plus unsupervised home exercise following an 8-week pulmonary rehabilitation programme would maintain functional exercise capacity and quality of life at 12 months better than standard care of unsupervised home exercise training. Chronic obstructive pulmonary disease (COPD) subjects completed an 8-week pulmonary rehabilitation programme, were randomised to an intervention group (IG) of weekly, supervised, exercise plus home exercise or to a control group (CG) of unsupervised home exercise and followed for 12 months. Outcome measurements at baseline (after pulmonary rehabilitation), and 3, 6 and 12 months included the 6-min walk test and St Georges Respiratory Questionnaire (SGRQ). 59 subjects with moderate COPD (Global Initiative for Chronic Obstructive Lung Disease stage II) were recruited and 48 subjects completed the study. 12-month mean difference showed no significant change from baseline in 6-min walk distance (IG -11 m, 95% CI -21–10 m; CG -6 m, 95% CI -34–11 m) or total SGRQ score (IG 3, 95% CI -0.8–7; CG -3, 95% CI -7–3). 12 months following pulmonary rehabilitation both weekly, supervised, outpatient-based exercise plus unsupervised home exercise and standard care of unsupervised home exercise successfully maintained 6-min walk distance and quality of life in subjects with moderate COPD.

Water-based exercise in COPD with physical comorbidities: a randomised controlled trial

Land-based exercise is often difficult for people with chronic obstructive pulmonary disease (COPD) who have coexisting obesity or musculoskeletal or neurological conditions. This randomised controlled trial aimed to determine the effectiveness of water-based exercise training in improving exercise capacity and quality of life compared to land-based exercise training and control (no exercise) in people with COPD and physical comorbidities. Participants referred to pulmonary rehabilitation were randomly allocated to a water-based exercise, land-based exercise or the control group. The two exercise groups trained for 8 weeks, completing three sessions per week. 45 out of 53 participants (mean±sd age 72±9 years; forced expiratory volume in 1 s 59±15% predicted) completed the study. Compared to controls, water-based exercise training significantly increased 6-min walking distance, incremental and endurance shuttle walk distances, and improved Chronic Respiratory Disease Questionnaire (CRDQ) dyspnoea and fatigue. Compared to land-based exercise training, water-based exercise training significantly increased incremental shuttle walk distance (mean difference 39 m, 95% CI 5–72 m), endurance shuttle walk distance (mean difference 228 m, 95% CI 19–438 m) and improved CRDQ fatigue. Water-based exercise training was significantly more effective than land-based exercise training and control in increasing peak and endurance exercise capacity and improving aspects of quality of life in people with COPD and physical comorbidities.

Short-form Sun-style T'ai Chi as an exercise training modality in people with COPD

The aims of the study were to determine the effect of short-form Sun-style t’ai chi (SSTC) (part A) and investigate exercise intensity of SSTC (part B) in people with chronic obstructive pulmonary disease (COPD). Part A: after confirmation of eligibility, participants were randomly allocated to either the t’ai chi group or control group (usual medical care). Participants in the t’ai chi group trained twice weekly for 12 weeks. Part B: participants who had completed training in the t’ai chi group performed a peak exercise test (incremental shuttle walk test) and SSTC while oxygen consumption (VO2) was measured. Exercise intensity of SSTC was determined by the per cent of VO2 reserve. Of 42 participants (mean±sd forced expiratory volume in 1 s 59±16% predicted), 38 completed part A and 15 completed part B. Compared to control, SSTC significantly increased endurance shuttle walk time (mean difference 384 s, 95% CI 186–510); reduced medial-lateral body sway in semi-tandem stand (mean difference -12.4 mm, 95% CI -21– -3); and increased total score on the chronic respiratory disease questionnaire (mean difference 11 points, 95% CI 4–18). The exercise intensity of SSTC was 53±18% of VO2 reserve. SSTC was an effective training modality in people with COPD achieving a moderate exercise intensity which meets the training recommendations.

Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial

QUESTIONS Does an eight-week program of walk training improve endurance walking capacity in people with COPD compared to cycle training? Does walk training improve peak walking capacity, cycle capacity, and quality of life compared to cycle training? Is the endurance shuttle walk test (ESWT) responsive to change in walking capacity elicited by exercise training? DESIGN Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS 36 people with stable COPD recruited with four dropouts. INTERVENTION Participants were randomised into either a walk or cycle training group. Both groups trained indoors for 30 to 45 minutes per session, three times weekly over eight weeks at Concord Hospital. Training intensities were based on baseline peak exercise tests and progressed as able. OUTCOME MEASURES The primary outcome was endurance walking capacity measured by the ESWT. Secondary outcomes included peak walking capacity, peak and endurance cycle capacity, and health-related quality of life. Measures were taken at baseline (Week 0) and following training (Week 8). RESULTS The walk training group increased their endurance walking time by 279 seconds (95% CI 70 to 483) more than the cycle training group. No significant differences between the groups were found for any other outcome. CONCLUSION Ground walk training increased endurance walking capacity more than cycle training and was similar to cycle training in improving peak walking capacity, peak and endurance cycle capacity and quality of life. This study provides evidence for ground walking as a mode of exercise training in pulmonary rehabilitation programs.

Functional exercise capacity and health-related quality of life in people with asbestos related pleural disease: an observational study

BackgroundFunctional exercise capacity in people with asbestos related pleural disease (ARPD) is unknown and there are no data on health-related quality of life (HRQoL). The primary aims were to determine whether functional exercise capacity and HRQoL were reduced in people with ARPD. The secondary aim was to determine whether functional exercise capacity was related to peak exercise capacity, HRQoL, physical activity or respiratory function.MethodsIn participants with ARPD, exercise capacity was measured by the six-minute walk test (6MWT) and incremental cycle test (ICT); HRQoL by the St George’s Respiratory Questionnaire and physical activity by an activity monitor worn for one week. Participants also underwent lung function testing.Results25 males completed the study with a mean (SD) age of 71 (6) years, FVC 82 (19)% predicted, FEV1/FVC 66 (11)%, TLC 80 (19)% predicted and DLCO 59 (13)% predicted. Participants had reduced exercise capacity demonstrated by six-minute walk distance (6MWD) of 76 (11)% predicted and peak work rate of 71 (21)% predicted. HRQoL was also reduced. The 6MWD correlated with peak work rate (r=0.58, p=0.002), St George’s Respiratory Questionnaire Total score (r=-0.57, p=0.003), metabolic equivalents from the activity monitor (r=0.45, p<0.05), and FVC % predicted (r=0.52, p<0.01).ConclusionsPeople with ARPD have reduced exercise capacity and HRQoL. The 6MWT may be a useful surrogate measure of peak exercise capacity and physical activity levels in the absence of cardiopulmonary exercise testing and activity monitors.Trial registrationANZCTR12608000147381

Arm exercise capacity and dyspnea ratings in subjects with chronic obstructive pulmonary disease.

PURPOSE This study aimed to compare the metabolic, ventilatory, and dyspnea responses to unsupported arm exercise, supported arm exercise and leg exercise between subjects with chronic obstructive pulmonary disease (COPD) and healthy age-matched controls. METHODS For this study, 21 subjects with COPD (mean age, 62 +/- 2 years; predicted forced expiratory volume in 1 second [FEV(1)], 37 +/- 3%) and 7 healthy age-matched control subjects (% pred FEV(1) = 109 +/- 5%) were included in the analyses of three incremental exercise tests to peak work capacity: unsupported arm exercise, supported arm exercise (arm ergometry), and leg exercise (cycle ergometry). Work level, oxygen consumption (VO(2)), minute ventilation (V(E)), dyspnea, and rate of perceived exertion were measured each minute. RESULTS Peak work level and peak VO(2) were significantly reduced in the subjects with COPD for all exercise tests (P <.01 for all), as compared with the control subjects. Within the COPD group, the VO(2) and V(E) at peak exercise were significantly lower for unsupported arm exercise than for both the leg and supported arm exercises (both P <.001). The ratio of V(E) to maximal voluntary ventilation was high for leg exercise (96%), supported arm exercise (91%), and unsupported arm exercise (77%) among the subjects with COPD. At a given percentage of VO(2) peak, dyspnea scores were similar for all the exercise tests. CONCLUSIONS Ventilatory constraints limit exercise performance in COPD. The lowest amount of work, in terms of VO(2,), was during unsupported arm exercise. Because the subjects with COPD had scores showing similar levels of dyspnea at the same percentage of VO(2) peak, it is suggested that patients be encouraged to reach equivalent dyspnea levels when performing unsupported and supported arm exercise training and leg training.

Arm positioning alters lung volumes in subjects with COPD and healthy subjects

Subjects with chronic obstructive pulmonary disease (COPD) have difficulty performing arm exercise, particularly if the arms are unsupported and elevated. The purpose of this study was to evaluate the effect of arm position on static lung volumes in COPD and healthy subjects. Lung volumes were measured by plethysmography in nine COPD subjects (mean age +/- SD = 67.3 +/- 10.3 years; % pred FEV1 +/- SD = 39.7 +/- 10.9%) and nine healthy subjects (mean age +/- SD = 55.8 +/- 8.8 years; % pred FEV1 +/- SD = 102.9 +/- 12.2%) with the arms below 90 degrees shoulder flexion, at 90 degrees shoulder flexion and above 90 degrees shoulder flexion. In all subjects a significant increase in functional residual capacity (FRC) and reduction in inspiratory capacity (IC) was shown with arms above 90 degrees shoulder flexion when compared with both arms below 90 degrees shoulder flexion (mean increase in FRC (95% CI) was 0.17 L (0.06 to 0.27) for COPD and 0.29 L (0.11 to 0.47) for healthy subjects; mean reduction in IC (95% CI) was 0.24 L (0.1 to 0.38) for COPD and 0.45 L (0.22 to 0.68) for healthy subjects) and arms at 90 degrees shoulder flexion (mean increase in FRC (95% CI) was 0.15 L (0.01 to 0.29) for COPD and 0.22 L (0.11 to 0.34) for healthy subjects; mean reduction in IC (95% CI) was 0.14 L (0.01 to 0.26) for COPD and was 0.29 L (0.17 to 0.42) for healthy subjects). These changes may alter lung mechanics and, in COPD subjects, may affect their ability to perform arm exercise above shoulder height

Six-Minute Walk Test as an Outcome Measure : Are Two Six-Minute Walk Tests Necessary Immediately After Pulmonary Rehabilitation and at Three-Month Follow-up?

Spencer LM, Alison JA, McKeough ZJ: Six-minute walk test as an outcome measure: are two six-minute walk tests necessary immediately after pulmonary rehabilitation and at three-month follow-up? Am J Phys Med Rehabil 2008;87:224–228.A 3-mo prospective, longitudinal, repeated-measures study was undertaken in subjects with chronic obstructive pulmonary disease (COPD). The study aimed to determine whether there was a difference in 6-min walk distance (6MWD) when two 6-min walk tests were performed after pulmonary rehabilitation (n = 44) and at 3-mo follow-up (n = 40), and whether the results reflected the program outcomes. There was a significant increase in 6MWD between two 6-min walk tests before rehabilitation (P < 0.001), and at 3-mo follow-up (P < 0.001), but not immediately after rehabilitation (P = 0.1). In terms of program outcomes, there was an increase in 6MWD from before to after pulmonary rehabilitation (P < 0.001); however, the increase was greater if the better of two tests was reported. Six-minute walk tests performed twice before and after pulmonary rehabilitation programs and at 3-mo follow-up assessments ensure accuracy of measurement of the 6MWD and program outcomes.

Australian and New Zealand Pulmonary Rehabilitation Guidelines

The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence‐based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts.

Home‐based telerehabilitation via real‐time videoconferencing improves endurance exercise capacity in patients with COPD: The randomized controlled TeleR Study

Telerehabilitation has the potential to increase access to pulmonary rehabilitation (PR) for patients with COPD who have difficulty accessing centre‐based PR due to poor mobility, lack of transport and cost of travel. We aimed to determine the effect of supervised, home‐based, real‐time videoconferencing telerehabilitation on exercise capacity, self‐efficacy, health‐related quality of life (HRQoL) and physical activity in patients with COPD compared with usual care without exercise training.