Chronic obstructive pulmonary disease is a common, progressive disorder associated with disabling symptoms, skeletal muscle dysfunction, and substantial morbidity and mortality. Current national guidelines recommend pulmonary rehabilitation (PR) to improve dyspnea, functional capacity, and quality of life. Many PR exercise programs are based on guidelines from the American College of Sports Medicine. Recommendations have also been published by the American Association of Cardiovascular and Pulmonary Rehabilitation and the American Thoracic Society. Translating exercise science into effective training and clinical care requires interpretation and the use of diverse national PR guidelines and recommendations. Pulmonary rehabilitation clinicians often vary in their education and background, with most nurses and respiratory care practitioners lacking formal training in exercise physiology. Patients often have comorbidities that may further complicate exercise provision and prescription. This article describes the results of an informal, nonscientific survey of the American Association of Cardiovascular and Pulmonary Rehabilitation members exploring current PR exercise prescription practices as a basis for discussion and reviews current national exercise recommendations for chronic obstructive pulmonary disease. Further, it describes areas of uncertainty regarding exercise prescription in PR and suggests strategies for providing effective exercise training, given the diversity of guidelines, clinician preparedness, and patient complexity.

Background Results from clinical trials have shown that sugar-sweetened beverages (SSBs) lead to increased BMI and obesity. This relationship has yet to be explored in observational data for non-clinical populations of adults. Objective To compare adults who drank 4+ SSBs daily to those who drank 0 in the population of adults in New York City, and to better understand adult risk factors associated with higher daily SSB consumption and BMI. Design Secondary analysis of cross-sectional data using propensity score matching (PSM). Participants/Setting 2009 NYC Community Health Survey (n=9,934). Main outcome measure BMI Statistical Analyses For each of the participants who consumed 4+ SSBs daily, PSM identified matched comparisons who did not drink any SSBs. T-tests compared BMI in unadjusted and matched pairs. A post hoc analysis compared features of those likely to drink SSBs and those not. Results In unmatched analyses, participants who consumed 4+ SSBs daily (n=475) had higher BMI than those who consumed 0 SSBs (n=3,818; difference=1.4 kg/m2, SE=0.29; t-value=4.81, p<0.001); however, when compared to similar participants using nearest neighbor with replacement matching (n=1,062), the difference between those who consumed 4+ SSBs daily and those who consumed none decreased (difference=0.37 kg/m2, SE=0.36; t-value=1.01, p=0.32). Analyses also indicated that those likely to drink SSBs and those unlikely to drink SSBs differed in several important characteristics, including sex, age, race, ethnicity, SES, education, diet, and exercise. Conclusions The data preclude strong causal conclusions about the role of SSB in obesity. However, our results suggest that there is a subset of participants demographically and behaviorally similar with higher BMI regardless of their self-reported SSB intake. In addition to targeting SSBs, public health policies and programs should identify and address other modifiable aspects of this profile and tailor approaches to the groups identified to be most affected by high BMI.

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