Literature Reviews

December 2011

Exercise Training and Rehabilitation

Title: Muscle and blood redox status after exercise training in severe COPD patients.
Authors: Rodriguez DA, Kalko S, Puig-Vilanova E, Perez-Olabarrìa M, Falciani F, Gea J, Cascante M, Barreiro E, Roca J.
Source: Free Radic Biol Med. 2011 Oct 4. [Epub ahead of print].

Summary: Rodriguez et al. hypothesized that high-intensity exercise training of long duration does not deteriorate muscle redox status. The authors conclude that in severe COPD patients, high-intensity exercise training of long duration improves exercise capacity while preventing the enhancement of systemic and muscle oxidative stress.

Title: Effects of whole body vibration in patients with chronic obstructive pulmonary disease - A randomized controlled trial.
Authors: Gloeckl R, Heinzelmann I, Baeuerle S, Damm E, Schwedhelm AL, Diril M, Buhrow D, Jerrentrup A, Kenn K.
Source: Respir Med. 2011 Nov 19. [Epub ahead of print].

Summary: Additional whole body vibration (WBV) training during pulmonary rehabilitation may be a new approach that has not yet been investigated in patients with COPD. WBV training seems to be a promising new exercise modality for patients with COPD and may enhance the effects of a multidisciplinary rehabilitation program.

Title: Strength training increases maximum working capacity in patients with COPD - Randomized clinical trial comparing three training modalities.
Authors: Vonbank K, Strasser B, Mondrzyk J, Marzluf BA, Richter B, Losch S, Nell H, Petkov V, Haber P.
Source: Respir Med. 2011 Nov 25. [Epub ahead of print].

Summary: The purpose of this study was to compare the effects of three different exercise modalities in patients with COPD including endurance training (ET), progressive strength training (ST) and the combination of strength training and endurance training (CT). Progressive strength training alone increases not only muscle strength and quality of life, but also exercise capacity in patients with COPD, which may have implications in prescription of training modality.

Title: Effects of Training at Mild Exercise Intensities on Quadriceps Muscle Energy Metabolism in Patients with Chronic Obstructive Pulmonary Disease.
Authors: Guzun R, Aguilaniu B, Wuyam B, Mezin P, Koechlin-Ramonatxo C, Auffray C, Saks V, Pison C.
Source: Acta Physiol (Oxf). 2011 Nov 25. doi: 10.1111/j.1748-1716.2011.02388.x. [Epub ahead of print].

Summary: Guzun et al. aimed to study the effects of physical training at mild intensities on skeletal muscle energy metabolism in 8 patients with Chronic Obstructive Pulmonary Disease (COPD) and 8 paired healthy sedentary subjects. This study shows that physical training at mild intensity is able to induce comparable changes in skeletal muscles oxidative energy metabolism in COPD patients and sedentary healthy subjects, but different changes of maximal mechanical and metabolic power.

Title: Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease.
Authors: Zainuldin R, Mackey MG, Alison JA.
Source: Cochrane Database Syst Rev. 2011 Nov 9;11:CD008008.

Summary: Zainuldin et al. aimed to determine the effects of training intensity (higher versus lower) or type (continuous versus interval training) on primary outcomes in exercise capacity and secondary outcomes in symptoms and HRQoL for people with COPD. Comparisons between the higher and lower training intensity were limited due to the small number of included studies and participants. Consequently, there are insufficient data to draw any conclusions on exercise capacity, symptoms and HRQoL for this comparison. For comparisons between continuous and interval training, both appear to be equally effective in improving exercise capacity, symptoms and HRQoL.

Title: Functional and muscular effects of neuromuscular electrical stimulation in patients with severe COPD: a randomized clinical trial.
Authors: Vivodtzev I, Debigaré R, Gagnon P, Mainguy V, Saey D, Dubé A, Paré ME, Bélanger M, Maltais F.
Source: Chest. 2011 Nov 23. [Epub ahead of print].

Summary: Vivodtzev et al. investigated the functional and muscular effects of NMES in advanced COPD. In patients with severe COPD, NMES improved muscle CSA. This was associated with a more favorable muscle anabolic to catabolic balance. Improvement in walking distance after NMES training was associated with gains in muscle strength, reduced ventilation during walking and with the ability to tolerate higher stimulation intensity.

Title: Exercise performance after standard rehabilitation in COPD patients with lung hyperinflation.
Authors: Crisafulli E, Venturelli E, Biscione G, Vagheggini G, Iattoni A, Lucic S, Ambrosino N, Pasqua F, Cesario A, Clini EM.
Source: Intern Emerg Med. 2011 Nov 22. [Epub ahead of print].

Summary: Crisafulli et al. retrospectively evaluated the effect of a standard PR course on exercise tolerance and symptoms according to the presence or absence of associated lung hyperinflation, as defined by lung function parameters in three Italian rehabilitation centers. Tolerance, gas exchange and perceived symptoms during effort are the parameters that gain a significant benefit from standard rehabilitation in COPD patients with a lung hyperinflation condition.

Title: Social comparison and anxious mood in pulmonary rehabilitation: The role of cognitive focus.
Authors: Petersen S, Taube K, Lehmann K, Van den Bergh O, von Leupoldt A.
Source: Br J Health Psychol. 2011 Sep 2. doi: 10.1111/j.2044-8287.2011.02048.x. [Epub ahead of print].

Summary: Despite the strong social component of pulmonary rehabilitation, the effect of social comparison processes on anxiety has not been explored in this context. This study demonstrates the important role of social comparison focus in moderating beneficial effects of pulmonary rehabilitation. Downward assimilation and upward contrast might be important targets in reducing anxiety in pulmonary rehabilitation.

Title: Developing the model of pulmonary rehabilitation for chronic heart failure.
Author: Evans RA.
Source: Chron Respir Dis. 2011;8(4):259-69.

Summary: This article reviews the similar symptoms, mechanisms and consequences between COPD and CHF; the rationale and evidence for exercise training in CHF; evidence for combined exercise rehabilitation for CHF and COPD; and adaptations necessary to include patients with CHF into PR.

Physical Activity

Title: Physical activity monitoring in COPD: Compliance and associations with clinical characteristics in a multicenter study.
Authors: Waschki B, Spruit MA, Watz H, Albert PS, Shrikrishna D, Groenen M, Smith C, Man WD, Tal-Singer R, Edwards LD, Calverley PM, Magnussen H, Polkey MI, Wouters EF.
Source: Respir Med. 2011 Nov 24. [Epub ahead of print].

Summary: The purpose of this multi-center study was to assess the COPD patients' compliance with physical activity monitoring and how activity relates to disease characteristics in a multi-center setting. The excellent compliance with wearing a physical activity monitor irrespective of study site and consistent associations with relevant disease characteristics support the use of activity monitoring as a valid outcome in multi-center studies.

Co-morbidities and Inflammation

Title: Frequency and relevance of ischemic electrocardiographic findings in patients with chronic obstructive pulmonary disease.
Authors: Vanfleteren LE, Franssen FM, Uszko-Lencer NH, Spruit MA, Celis M, Gorgels AP, Wouters EF.
Source: Am J Cardiol. 2011 Dec 1;108(11):1669-74.

Summary: Vanfleteren et al. aimed to determine the frequency of ischemic ECG changes and its relevance in relation to clinical outcome and predictors of impaired survival in 536 patients with COPD. In conclusion, ischemic ECG changes are common in patients with COPD and associated with poor clinical outcome irrespective of forced expiratory volume in the first second.

Title: Vitamin D Levels and Risk of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: a Prospective Cohort Study.
Authors: Kunisaki KM, Niewoehner DE, Connett JE; for the COPD Clinical Research Network.
Source: Am J Respir Crit Care Med. 2011 Nov 10. [Epub ahead of print].

Summary: Kunisaki et al. hypothesized that low blood levels of 25(OH)D in patients with chronic obstructive pulmonary disease (COPD) would be associated with an increased risk of acute exacerbations of COPD (AECOPD). In patients with severe COPD, baseline 25(OH)D levels are not predictive of subsequent AECOPD.

Title: Low-grade adipose tissue inflammation in patients with mild-to-moderate chronic obstructive pulmonary disease.
Authors: van den Borst B, Gosker HR, Wesseling G, de Jager W, Hellwig VA, Snepvangers FJ, Schols AM.
Source: Am J Clin Nutr. 2011 Nov 9. [Epub ahead of print].

Summary: Van den Borst et al. studied the influence of COPD and exercise-induced oxygen desaturation on adipose tissue inflammation (ATI) and its contribution to systemic inflammation. In COPD patients, mild-to-moderate COPD, per se, does not enhance ATI or its contribution to systemic inflammation compared with in well-matched healthy control subjects. However, to our knowledge, our study provides a first indication for a possible role of ATMs in the systemic inflammatory response in COPD that requires additional investigation.

Exercise Performance, Balance and Functional Performance

Title: Association of six-minute walk distance (6MWD) with resting pulmonary function in patients with chronic obstructive pulmonary disease (COPD).
Authors: Fujimoto H, Asai K, Watanabe T, Kanazawa H, Hirata K.
Source: Osaka City Med J. 2011 Jun;57(1):21-9.

Summary: Little is known concerning which resting pulmonary function test measurements relate to six-minute walk distance (6MWD). The present results suggest that age, IC, and DLCO/VA were significantly associated with 6MWD in patients with COPD.

Title: The effects of a 'new' walking aid on exercise performance in patients with COPD: A randomized cross-over trial.
Authors: Vaes AW, Annegarn J, Meijer K, Cuijpers MW, Franssen FM, Wiechert J, Wouters EF, Spruit MA.
Source: Chest. 2011 Nov 23. [Epub ahead of print].

Summary: Vaes et al. compared the direct effects of a 'new' ambulation aid (a modern draisine) to a rollator on six-minute walk distance (6MWD) in COPD. The mean difference in 6MWD between modern draisine and rollator seems clinically relevant, with the same metabolic requirements and symptom Borg scores. Therefore, this 'new' ambulation aid could be a good alternative for the rollator to improve functional exercise performance in patients with COPD.

Title: Impairments in Systems Underlying Control of Balance in COPD.
Authors: Beauchamp MK, Sibley KM, Lakhani B, Romano J, Mathur S, Goldstein RS, Brooks D.
Source: Chest. 2011 Nov 23. [Epub ahead of print].

Summary: Beauchamp et al. aimed to determine the specific components of balance that are impaired in COPD and to investigate the association between balance and peripheral muscle strength and physical activity. Individuals with COPD exhibit impairments in all balance subcomponents and demonstrate slower reaction times in response to perturbations. Deficits in balance are associated with reduced physical activity levels and skeletal muscle weakness.

Title: Symptoms and functional performance in Korean immigrants with asthma or chronic obstructive pulmonary disease.
Authors: Park SK, Stotts NA, Douglas MK, Donesky-Cuenco D, Carrieri-Kohlman V.
Source: Heart Lung. 2011 Nov 2. [Epub ahead of print].

Summary: This study sought to examine concurrent symptoms, symptom clusters, and the effects of symptoms on functioning in Korean immigrants with asthma or chronic obstructive pulmonary disease (COPD). The symptom cluster, consisting of 7 symptoms, showed the greatest effect on levels of functioning, which emphasizes the importance of assessment for coexisting symptoms in populations with these diseases.

Title: Dynamic hyperinflation during exercise in patients with precapillary pulmonary hypertension.
Authors: Richter MJ, Voswinckel R, Tiede H, Schulz R, Tanislav C, Feustel A, Morty RE, Ghofrani HA, Seeger W, Reichenberger F.
Source: Respir Med. 2011 Nov 17. [Epub ahead of print].

Summary: Richter et al. analysed flow volume loops during exercise in 61 patients with precapillary pulmonary hypertension (PH) in comparison with 21 patients with COPD, 39 patients with pulmonary fibrosis and 38 healthy controls. Patients with PH demonstrate a characteristic change in inspiratory capacity during exercise, which might contribute to impaired exercise tolerance.

Title: Dynamic hyperinflation is associated with a poor cardiovascular response to exercise in COPD patients.
Authors: Tzani P, Aiello M, Elia D, Boracchia L, Marangio E, Olivieri D, Clini E, Chetta A.
Source: Respir Res. 2011 Nov 10;12(1):150. [Epub ahead of print].

Summary: The aim of this study was to investigate the relationship between dynamic hyperinflation and cardiovascular response to maximal exercise in COPD patients. The present study shows that COPD patients with dynamic hyperinflation have a poor cardiovascular response to exercise. This finding supports the view that in COPD patients, dynamic hyperinflation may affect exercise performance not only by affecting ventilation, but also cardiac function.


Title: Differences in social support of caregivers living with partners suffering from COPD or dementia.
Authors: Nordtug B, Krokstad S, Sletvold O, Holen A.
Source: Int J Older People Nurs. 2011 Nov 23. doi: 10.1111/j.1748-3743.2011.00302.x. [Epub ahead of print].

Summary: This study compared social support between home-dwelling caregivers of partners with chronic obstructive pulmonary disease or dementia. Professional aid was more utilised by the dementia group and by men. Conclusions.  Differences in caregivers' needs for social support were related to their partner's disease.

Chronic Care

Title: Determinants of polypharmacy and compliance with GOLD guidelines in patients with chronic obstructive pulmonary disease.
Authors: Franssen FM, Spruit MA, Wouters EF.
Source: Int J Chron Obstruct Pulmon Dis. 2011;6:493-501. Epub 2011 Sep 26.

Summary: The aims of this study were to investigate determinants of polypharmacy and to study the consistency of actual respiratory drug use with current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in pulmonary rehabilitation candidates with COPD. Franssen et al. conclude that polypharmacy of respiratory medications is common in COPD patients with persistent symptoms. In addition to severity of disease, health status is an independent predictor of polypharmacy. Actual drug use in COPD patients referred for pulmonary rehabilitation is partially inconsistent with current GOLD guidelines.

Health Status

Title: Factors associated with good self-rated health and quality of life in subjects with self-reported COPD.
Authors: Arne M, Lundin F, Boman G, Janson C, Janson S, Emtner M.
Source: Int J Chron Obstruct Pulmon Dis. 2011;6:511-9. Epub 2011 Oct 7.

Summary: To gain a more positive outlook on the disease it is interesting to investigate factors associated with good, self-rated health and quality of life in subjects with self-reported COPD in the population. In this population-based public health survey, better self-rated health status and quality of life in subjects with self-reported COPD was associated with higher levels of physical activity, social support, and absence of economic problems.


Title: Using Telehealth technology to deliver pulmonary rehabilitation in chronic obstructive pulmonary disease patients.
Authors: Stickland M, Jourdain T, Wong EY, Rodgers WM, Jendzjowsky NG, Macdonald GF.
Source: Can Respir J. 2011 Jul;18(4):216-20.

Summary: Stickland et al. aimed to examine the efficacy of PR delivered via Telehealth (Telehealth-PR) compared with PR delivered in person through a standard outpatient hospital-based program (Standard-PR). Telehealth-PR was an effective tool for increasing COPD PR services, and demonstrated improvements in quality of life and exercise capacity comparable with Standard-PR.

Skeletal Muscles

Title: Reduction of Muscle Mass Mediated by Myostatin in an Experimental Model of Pulmonary Emphysema.
Authors: Fermoselle C, Sanchez F, Barreiro E.
Source: Arch Bronconeumol. 2011 Nov 4. [Epub ahead of print].

Summary: The objective was to evaluate the molecular mechanisms that are potentially implicated in the limited development of muscle mass in the diaphragm and gastrocnemius of mice with experimentally-induced emphysema. The reduction of the myosin content observed in the diaphragm of mice with emphysema could explain their smaller size. Oxidative stress, myostatin and FoxO could be implicated in the loss of this structural protein.