Exercise intolerance and impaired quality of life (QoL) are characteristic of lung transplant candidates and recipients. This review investigated the effects of exercise training on exercise capacity, QoL and clinical outcomes in pre- and post-operative lung transplant patients.A systematic literature search of PubMed, Nursing and Allied Health, Cochrane (CENTRAL), Scopus and CINAHL databases was conducted from inception until February, 2020. The inclusion criteria were assessment of the impact of exercise training before or after lung transplantation on exercise capacity, QoL or clinical outcomes.21 studies met the inclusion criteria, comprising 1488 lung transplant candidates and 1108 recipients. Studies consisted of five RCTs, two quasi-experimental and 14 single-arm cohort or pilot studies. Exercise training improved or at least maintained exercise capacity and QoL before and after lung transplantation. The impact on clinical outcomes was less clear but suggested a survival benefit. The quality of evidence ranged from fair to excellent.Exercise training appears to be beneficial for patients before and after lung transplantation; however, the evidence for direct causation is limited by the lack of controlled trials. Well-designed RCTs are needed, as well as further research into the effect of exercise training on important post-transplant clinical outcomes, such as time to discharge, rejection, infection, survival and re-hospitalisation.

@ERSpublications In response to #COVID19, healthcare professionals should scale up virtual consultations for assessing core patient-reported outcomes and providing home-based rehabilitation programmes #COPD https://bit.ly/30gQEpG @emilyhume

Background The ageing process can result in the decrease of respiratory muscle strength and consequently increased work of breathing and associated breathlessness during activities of daily living in older adults. Objective This systematic review and meta-analysis aims to determine the effects of inspiratory muscle training (IMT) in healthy older adults. Methods A systematic literature search was conducted across four databases (Medline/Pubmed, Web of Science, Cochrane Library CINAHL) using a search strategy consisting of both MeSH and text words including older adults, IMT and functional capacity. The eligibility criteria for selecting studies involved controlled trials investigating IMT via resistive or threshold loading in older adults (>60 years) without a long-term condition. Results Seven studies provided mean change scores for inspiratory muscle pressure and three studies for functional capacity. A significant improvement was found for maximal inspiratory pressure (PImax) following training (n = 7, 3.03 [2.44, 3.61], P = <0.00001) but not for functional capacity (n = 3, 2.42 [−1.28, 6.12], P = 0.20). There was no significant correlation between baseline PImax and post-intervention change in PImax values (n = 7, r = 0.342, P = 0.453). Conclusions IMT can be beneficial in terms of improving inspiratory muscle strength in older adults regardless of their initial degree of inspiratory muscle weakness. Further research is required to investigate the effect of IMT on functional capacity and quality of life in older adults.

Highlights  Short application of portable NIV does not cause adverse haemodynamic effects in healthy individuals  Portable NIV makes the respiratory muscles work harder in healthy individuals.  Caution should be taken to avoid worsening of dyspnoea induced by pNIV in patients with acute respiratory failure.

Background: We previously showed that use of portable non-invasive ventilation (pNIV) during recovery periods within intermittent exercise improved breathlessness and exercise tolerance in COPD patients compared to pursed-lip breathing (PLB). However, in a minority of patients recovery from dynamic hyperinflation (DH) was better with PLB, based on inspiratory capacity. We further explored this using Optoelectronic Plethysmography to assess total and compartmental thoracoabdominal volumes. Methods: Fourteen COPD patients (mean±SD) (FEV1: 55±22% predicted) underwent, in a balanced order sequence, two intermittent exercise protocols on the cycle ergometer consisting of five repeated 2-min exercise bouts at 80% peak capacity, separated by 2-min recovery periods, with application of pNIV or PLB in the first minute of recovery.Results: Our findings identified 7 patients showing clinically meaningful recovery in DH with pNIV (DH responders) while 7 showed similar or better recovery in DH with PLB. When pNIV was applied, DH responders compared to DH non-responders exhibited greater tidal volume (by 0.8±0.3 L, p=0.015), inspiratory flow rate (by 0.6±0.5 L/sec, p=0.049), prolonged expiratory time (by 0.6±0.5 sec, p=0.006) and duty cycle (by 0.7±0.6 sec, p=0.007). DH responders showed a clinically meaningful reduction in end-expiratory thoracoabdominal DH (by 265±633 ml) predominantly driven by reduction in the abdominal compartment (by 210±494 ml); this effectively offset end-inspiratory rib-cage DH. Compared to DH non-responders, DH responders had significantly greater BMI by 8.4±3.2, p=0.022 and tended towards less severe resting hyperinflation by 0.3±0.3 L.Conclusion: COPD patients who mitigate end-expiratory rib-cage DH by expiratory abdominal muscle recruitment benefit from pNIV application.