The Responsiveness of Exercise Tests in COPD: A Randomized Controlled Trial.

Background: COPD is characterized by reduced exercise tolerance, and improving physical performance is an important therapeutic goal. A variety of exercise tests are commonly used to assess exercise tolerance, including laboratory and field-based tests. The responsiveness of these various tests to common COPD interventions is yet to be compared, but the results may inform test selection in clinical and research settings.

A More Intense Examination of the Intensity of Physical Activity in People Living with Chronic Obstructive Pulmonary Disease: Insights from Threshold-Free Markers of Activity Intensity.

Physical activity (PA) intensity of people living with chronic obstructive pulmonary disease (COPD) is typically evaluated using intensity thresholds developed in younger, healthier populations with greater exercise capacity and free from respiratory symptoms. This study therefore compared (i) PA differences between COPD and non-COPD controls using both traditional intensity thresholds and threshold-free metrics that represent the volume and intensity of the whole PA profile, and (ii) explored the influence of exercise capacity on observed differences. Moderate-to-vigorous physical activity (MVPA), average acceleration (proxy for volume, mg) and intensity distribution of activity were calculated for 76 individuals with COPD and 154 non-COPD controls from wrist-worn ActiGraph accelerometry.

Findings of the Chronic Obstructive Pulmonary Disease-Sitting and Exacerbations Trial (COPD-SEAT) in Reducing Sedentary Time Using Wearable and Mobile Technologies With Educational Support: Randomized Controlled Feasibility Trial.

Background: Targeting sedentary time post exacerbation may be more relevant than targeting structured exercise for individuals with chronic obstructive pulmonary disease. Focusing interventions on sitting less and moving more after an exacerbation may act as a stepping stone to increase uptake to pulmonary rehabilitation.

Objective: The aim of this paper was to conduct a randomized trial examining trial feasibility and the acceptability of an education and self-monitoring intervention using wearable technology to reduce sedentary behavior for individuals with chronic obstructive pulmonary disease admitted to hospital for an acute exacerbation.

Chronic obstructive pulmonary disease (COPD), illness narratives and Elias's sociology of knowledge.

This paper draws on Elias's sociology of knowledge to provide a critical assessment of illness narratives. Focusing on a cohort of chronic obstructive pulmonary disease (COPD) patients (n = 26), the paper employs a comparative analysis of mixed method data derived from qualitative interviews, quantitative questionnaires, and physiological and accelerometer testing. The article firstly compares four narratives conveyed in interviews with the broader paradigmatic approach to illness narratives and existing COPD-specific studies.

Experiences of patients undergoing pulmonary rehabilitation during an exacerbation of chronic respiratory disease.

Chronic obstructive pulmonary disease (COPD) is characterized in the later stages by acute exacerbations that often require hospitalization. Pulmonary rehabilitation is recommended for patients with COPD to aid symptom control, improve quality of life and increase physical activity. We have previously reported a large intervention trial commenced during a hospital admission.

Individualised risk in patients undergoing lung volume reduction surgery: the Glenfield BFG score.

Lung volume reduction surgery (LVRS) has been shown to be beneficial in patients with chronic obstructive pulmonary disease, but there is low uptake, partly due to perceived concerns of high operative mortality. We aimed to develop an individualised risk score following LVRS.This was a cohort study of patients undergoing LVRS.

Agreement between adherences to four physical activity recommendations in patients with COPD: does the incremental shuttle walk test predict adherence?

Introduction And Objectives: There are various recommendations for physical activity (PA). However agreement between all of these measures has not been established. Furthermore, given the challenges of measuring PA there is interest in evaluating whether a measure of exercise performance can be used as a surrogate measure to identify who is likely to achieve the recommendations.

Study protocol for Chronic Obstructive Pulmonary Disease-Sitting and ExacerbAtions Trial (COPD-SEAT): a randomised controlled feasibility trial of a home-based self-monitoring sedentary behaviour intervention.

Introduction: An acute exacerbation of chronic obstructive pulmonary disease (COPD) marks a critical life event, which can lower patient quality of life and ability to perform daily activities. Patients with COPD tend to lead inactive and highly sedentary lifestyles, which may contribute to reductions in functional capacity. Targeting sedentary behaviour (SB) may be more attainable than exercise (at a moderate-to-vigorous intensity) for behaviour change in patients following an exacerbation.

Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial.

Introduction: Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue.

Bedside assessment of quadriceps muscle by ultrasound after admission for acute exacerbations of chronic respiratory disease.

Rationale: Hospitalization represents a major event for the patient with chronic respiratory disease. There is a high risk of readmission, which over the longer term may be related more closely to the underlying condition of the patient, such as skeletal muscle dysfunction.

Objectives: We assessed the risk of hospital readmission at 1 year, including measures of lower limb muscle as part of a larger clinical trial.

"We are not worthy"--understanding why patients decline pulmonary rehabilitation following an acute exacerbation of COPD.

Purpose: To explore how patients who refuse referral to pulmonary rehabilitation (PR) appraise acute exacerbations of chronic obstructive pulmonary disease (COPD), in the context of having considered and declined PR.

Method: Six participants recently hospitalized with an acute exacerbation COPD who refused a referral to PR subsequent to hospital discharge participated in in-depth interviews. Transcripts were subjected to interpretative phenomenological analysis (IPA).

An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial.

Objective: To investigate whether an early rehabilitation intervention initiated during acute admission for exacerbations of chronic respiratory disease reduces the risk of readmission over 12 months and ameliorates the negative effects of the episode on physical performance and health status.

Design: Prospective, randomised controlled trial.

Setting: An acute cardiorespiratory unit in a teaching hospital and an acute medical unit in an affiliated teaching district general hospital, United Kingdom.

Ventilatory requirements of quadriceps resistance training in people with COPD and healthy controls.

Background: It is proposed that resistance training (RT) does not activate the cardiopulmonary system to the same extent as whole-body exercise. This is important for patients with chronic obstructive pulmonary disease (COPD) who are ventilatory limited.

Objective: The aim was to assess the ventilatory response to an isokinetic quadriceps RT program in people with COPD and healthy controls.

The role of the emphysema multidisciplinary team in a successful lung volume reduction surgery programme†.

Objectives: Lung volume reduction surgery (LVRS) for advanced emphysema is well established, with strong evidence from the National Emphysema Treatment Trial. However, there is still reluctance to offer the procedure, and many have looked for alternative, unproven treatments. The multidisciplinary approach has been well established in treatment of lung cancer and, more recently, in coronary artery surgery.

How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study.

Background: There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors.

Methods: Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention.

'Consumed by breathing' - a critical interpretive meta-synthesis of the qualitative literature.

Objective: To derive an improved understanding of how patients respond to, appraise, and understand the experience of an acute exacerbation of chronic obstructive pulmonary disease via a critical interpretive meta-synthesis.

Methods: Search terms - Exacerbate* OR hospital* AND 'Chronic obstructive' OR emphysema OR bronchitis AND interview* OR qualitative. Inclusion criteria - Primary research published in English of patients' experiences of an acute exacerbation of chronic obstructive pulmonary disease.

Physical activity monitoring: addressing the difficulties of accurately detecting slow walking speeds.

Objective: To test the accuracy of a multi-sensor activity monitor (SWM) in detecting slow walking speeds in patients with chronic obstructive pulmonary disease (COPD).

Background: Concerns have been expressed regarding the use of pedometers in patient populations. Although activity monitors are more sophisticated devices, their accuracy at detecting slow walking speeds common in patients with COPD has yet to be proven.

Age-specific normal values for the incremental shuttle walk test in a healthy British population.

Purpose: The Incremental Shuttle Walk Test (ISWT) is an important functional and prognostic marker in chronic disease. Aging has a detrimental effect on exercise performance. The objective of this study was to produce normal age-specific values for the ISWT in a healthy British population and to explore whether additional variables improve the accuracy of a predictive equation.

Development of the i-BODE: validation of the incremental shuttle walking test within the BODE index.

Background: The BODE index has been shown to predict mortality in COPD. The index includes the 6 min walking test as the measure of exercise capacity. The incremental shuttle walking test (ISWT) is an alternative measure of exercise capacity which can be used to prescribe exercise and has been found to correlate well with peak VO2.

Dichloroacetate enhances performance and reduces blood lactate during maximal cycle exercise in chronic obstructive pulmonary disease.

Rationale: Impaired skeletal muscle function contributes to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). This is characterized by reduced mitochondrial adenosine triphosphate generation, and greater reliance on nonmitochondrial energy production. Dichloroacetate (DCA) infusion activates muscle pyruvate dehydrogenase complex (PDC) at rest, reducing inertia in mitochondrial energy delivery at the onset of exercise and diminishing anaerobic energy production.

A prospective analysis of the inter-relationship between lung volume reduction surgery and body mass index.

Objectives: LVRS is thought to result in significant improvements in BMI. Patients with a higher BMI at the time of diagnosis of COPD are known to have better survival, and those with a low BMI prior to LVRS have significantly worse perioperative morbidity. We aimed to assess the influence of BMI on the outcome of LVRS in our own experience.

Comparison of the peak exercise response measured by the ramp and 1-min step cycle exercise protocols in patients with exertional dyspnea.

Study Objectives: To compare the peak exercise response and determine the limits of agreement between the ramp and the 1-min step cycle protocols in a representative population of patients with exertional breathlessness attending a respiratory outpatient clinic.

Design: Crossover with the test order double blinded and randomized.

Setting: Outpatient exercise physiology laboratory.