An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease.

This systematic review examined the measurement properties of the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease. Studies that report the evaluation or use of the 6MWT, ISWT or ESWT were included. We searched electronic databases for studies published between January 2000 and September 2013.

An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease.

Field walking tests are commonly employed to evaluate exercise capacity, assess prognosis and evaluate treatment response in chronic respiratory diseases. In recent years, there has been a wealth of new literature pertinent to the conduct of the 6-min walk test (6MWT), and a growing evidence base describing the incremental and endurance shuttle walk tests (ISWT and ESWT, respectively). The aim of this document is to describe the standard operating procedures for the 6MWT, ISWT and ESWT, which can be consistently employed by clinicians and researchers.

Evaluating the interactive web-based program, activate your heart, for cardiac rehabilitation patients: a pilot study.

Background: Conventional cardiac rehabilitation (CR) programs are traditionally based on time-constrained, structured, group-based programs, usually set in hospitals or leisure centers. Uptake for CR remains poor, despite the ongoing evidence demonstrating its benefits. Additional alternative forms of CR are needed.

Potentially modifiable factors contribute to limitation in physical activity following thoracotomy and lung resection: a prospective observational study.

Background: Early mobility is considered important in minimising pulmonary complication, length of stay (LOS) and enhancing recovery following major surgery. We aimed to observe and measure the reduction in early postoperative physical activity following major thoracic surgery, identifying any potentially limiting factors, and factors predictive of reduced activity.

Methods: Patients undergoing thoracotomy and lung resection were prospectively observed for the purposes of this study.

Nutritional assessment and therapy in COPD: a European Respiratory Society statement.

Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist.

A web-based program improves physical activity outcomes in a primary care angina population: randomized controlled trial.

Background: Angina affects more than 50 million people worldwide. Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population. An Internet-based version could offer a feasible alternative.

A self-management programme for COPD: a randomised controlled trial.

Studies of programmes of self-management support for chronic obstructive pulmonary disease (COPD) have been inconclusive. The Self-Management Programme of Activity, Coping and Education (SPACE) FOR COPD is a 6-week self-management intervention for COPD, and this study aimed to evaluate the effectiveness of this intervention in primary care. A single-blind randomised controlled trial recruited people with COPD from primary care and randomised participants to receive usual care or SPACE FOR COPD.

"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.

The minimum clinically important improvement in the incremental shuttle walk test following cardiac rehabilitation.

Background: The aim was to establish the minimum clinically important difference (MCID) in the incremental shuttle walk test (ISWT) following cardiac rehabilitation.

Design: This was a service evaluation, utilising anchor- and distribution-based methods.

Methods: Two hundred and twenty patients performed an ISWT following a six-week cardiac rehabilitation programme comprising supervised aerobic exercise, secondary prevention education and a home exercise programme.

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.

Approaches to outcome assessment in pulmonary rehabilitation.

A comprehensive assessment is the foundation of a successful pulmonary rehabilitation programme. There is a broad selection of outcome measures that tend to be categorized into measures of exercise performance (including measures of strength) quality of life (health status), psychological well-being, nutritional status and more recently knowledge and self-efficacy. There is a growing interest in the measurement of physical activity too, although this is a current line of research activity.

Exercise-based rehabilitation for heart failure.

Background: Previous systematic reviews and meta-analyses consistently show the positive effect of exercise-based rehabilitation for heart failure (HF) on exercise capacity; however, the direction and magnitude of effects on health-related quality of life, mortality and hospital admissions in HF remain less certain. This is an update of a Cochrane systematic review previously published in 2010.

Objectives: To determine the effectiveness of exercise-based rehabilitation on the mortality, hospitalisation admissions, morbidity and health-related quality of life for people with HF.

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.

Exercise capacity and physical activity in patients with COPD and healthy subjects classified as Medical Research Council dyspnea scale grade 2.

Purpose: Patients with chronic obstructive pulmonary disease (COPD) are often classified by Medical Research Council (MRC) dyspnea grade and comparisons thus made to healthy individuals. The MRC grade of a healthy population is assumed to be grade 1, although this may be inaccurate. Physical activity and exercise capacity are not well-defined for those with MRC grade 2.

Differences in content and organisational aspects of pulmonary rehabilitation programmes.

The aim was to study the overall content and organisational aspects of pulmonary rehabilitation programmes from a global perspective in order to get an initial appraisal on the degree of heterogeneity worldwide. A 12-question survey on content and organisational aspects was completed by representatives of pulmonary rehabilitation programmes that had previously participated in the European Respiratory Society (ERS) COPD Audit. Moreover, all ERS members affiliated with the ERS Rehabilitation and Chronic Care and/or Physiotherapists Scientific Groups, all members of the American Association of Cardiovascular and Pulmonary Rehabilitation, and all American Thoracic Society Pulmonary Rehabilitation Assembly members were asked to complete the survey via multiple e-mailings.

'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.

An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.

Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope.

Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.

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.

Commentary: the British Thoracic Society guideline on pulmonary rehabilitation in adults.

The first British Thoracic Society guideline on pulmonary rehabilitation in adults is published in the accompanying Thorax supplement. Focusing on delivery of a quality pulmonary rehabilitation service, the evidenced-based guideline encompasses recommendations on the composition of the service, referral of patients and who benefits, the expected patient-related outcome measures and markers, pulmonary rehabilitation following exacerbations, the post-rehabilitation period and areas requiring further research. In this commentary, we introduce the guideline and discuss pulmonary rehabilitation in the wider context of chronic disease management of respiratory patients.