Ambulatory heart rate monitors and clinical electrocardiographic (ECG) devices are capable of measuring the length of consecutive cardiac periods (RR intervals). The aim of the study was to assess the agreement between the Polar 810s heart rate monitor (Polar) and the Reynolds digital ambulatory ECG using Pathfinder software version 8.4 (Reynolds v8.4) during cycle ergometry. For this purpose, eight subjects completed incremental cycling exercise that began at 60 W and increased by 30 W each 2-minute period until volitional fatigue. Simultaneous recording of the ECG (Reynolds Pathfinder), RR interval (Polar), and respiratory parameters (Metamax 3B) were undertaken at rest and throughout the exercise period. No significant differences were found in RR intervals measured by Polar and Reynolds v8.4 at any relative intensity. Polar and Reynolds v8.4 displayed strong linear relationships at all relative intensities (r2=0.927 to 0.998). Bland and Altman analyses between Polar and Reynolds v8.4 consistently demonstrated minimal bias in absolute RR interval (<0.10 ms) and the limits of agreement for group differences in RR interval and heart rate were less than +/- 10 ms and +/- 2 beats.min (-1) for all relative intensities, respectively. Power spectral analysis provided similar results for both systems in all bandwidths studied during rest and low intensity exercise. However, significant differences and large relative limits of agreement (>100 % of mean of paired means) were identified in UF at intensities > 40 % VO2max, HF at intensities > 60 % VO2max and LF during exercise at 80-100 % VO2max. These findings demonstrate that RR intervals and heart rate measurements obtained using Polar and Reynolds v8.4 are in good agreement. However, caution should be exercised when interpreting spectral analysis of RR interval data derived from different acquisition systems during physical activity.

We conducted a six-month randomised controlled trial of home telemonitoring for patients with chronic obstructive pulmonary disease (COPD). A total of 40 stable patients with moderate to severe COPD who had completed pulmonary rehabilitation took part. They were randomised to receive standard care (controls) or standard care plus home telemonitoring (intervention). During the monitoring period, patients in the telemonitoring group recorded their symptoms and physical observations twice daily. The data were transmitted automatically at night via the home telephone line. Nurses could access the data through a website and receive alerting email messages if certain conditions were detected. The patients completed the St George's Respiratory Questionnaire, Hospital Anxiety and Depression and the EuroQoL EQ-5D quality of life scores before and after pulmonary rehabilitation, and then periodically during the trial. There were significant and clinically important improvements in the scores immediately following pulmonary rehabilitation, but thereafter there were no differences in quality of life scores between the groups at any time, or consistently within either group over time. The study showed that telemonitoring was safe but, despite being well used, it was not associated with changes in quality of life in patients who had stable COPD.

Patients with asthma have exaggerated bronchoconstriction of their airways in response to certain indirect (e.g. cold air, allergens, dust, exercise) or direct (e.g. inhaled methacholine) stimuli. This 'hyper-reactivity' usually co-exists with airway inflammation, although the pathophysiological mechanisms underlying these changes are not fully understood. It is likely that this hyper-reactivity is associated with abnormal autonomic nervous system (ANS) control. In particular, the parasympathetic (vagal) component of the ANS appears to be implicated in the pathogenesis of asthma. In addition, several studies have suggested the existence of differential alteration in ANS function following exercise in asthmatics compared with non-asthmatic individuals. Several early studies suggested that the altered autonomic control of airway calibre in asthma might be reflected by a parallel change in heart rate. Cardiac vagal reactivity does indeed appear to be increased in asthma, as demonstrated by the cardiac response to various autonomic functions tests. However, other studies have reported a lack of association between bronchial and cardiac vagal tone, and this is in accord with the concept of system-independent ANS control. This review provides a discussion of cardiovascular-autonomic changes associated with either the pathophysiology of asthma per se or with asthma pharmacotherapy treatment. Previous investigations are summarised suggesting an apparent association between altered autonomic-cardiovascular control and bronchial asthma. The full extent of autonomic dysfunction, and its clinical implications, has yet to be fully determined and should be the subject of future investigation.

Collaborative working between health professionals, school teachers and families has resulted in an age-appropriate curriculum, which employs validated educational techniques. This will be refined following pilot courses before formal evaluation in a multicentre randomized controlled trial.