Exercise capacity impairment in COPD patients with comorbidities

Silva, Guilherme; Morano, María Tereza Aguiar Pessoa; Cavalcante, Antonio George de Matos; Andrade, Natalia M.; Daher, Elizabeth De Francesco; Pereira, ED

doi:10.1016/j.rppnen.2015.04.003

Cited by 8 publications

(4 citation statements)

References 32 publications

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“…35,37 In other populations, comorbidities are also associated with lower 6MWD results, similar to our findings. 38,39 Interestingly, included studies evaluating patients with ARDS versus all other non-ARDS ICU studies had consistently lower 6MWD, with a mean difference of 73-meters (95% CI: 13-133) that is almost twice the minimal important difference for ICU survivors. 4 This difference may be an underestimation as the non-ARDS studies may have included patients with ARDS, and thus likely having a lower point-estimate of 6MWD compared to a purely non-ARDS cohort.…”

Section: Discussionmentioning

confidence: 97%

Six-Minute Walk Distance After Critical Illness: A Systematic Review and Meta-Analysis

Parry

Nalamalapu

Nunna

et al. 2019

J Intensive Care Med

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Background and Objectives: Impaired physical functioning is common and long lasting after an intensive care unit (ICU) admission. The 6-minute walk test (6MWT) is a validated and widely used test of functional capacity. This systematic review synthesizes existing data in order to: (1) evaluate 6-minute walk distance (6MWD) in meters over longitudinal follow-up after critical illness, (2) compare 6MWD between acute respiratory distress syndrome (ARDS) versus non-ARDS survivors, and (3) evaluate patient- and ICU-related factors associated with 6MWD. Data Sources: Five databases (PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsychINFO, and Cochrane Controlled Trials Registry) were searched to identify studies reporting 6MWT after hospital discharge in survivors from general (ie, nonspeciality) ICUs. The last search was run on February 14, 2018. Databases were accessed via Johns Hopkins University Library. Data Extraction and Synthesis: Pooled mean 6MWD were reported, with separate linear random effects models used to evaluate associations of 6MWD with ARDS status, and patient- and ICU-related variables. Twenty-six eligible articles on 16 unique participant groups were included. The pooled mean (95% confidence interval [CI]) 6MWD results at 3- and 12-months post discharge were 361 (321-401) and 436 (391-481) meters, respectively. There was a significant increase in 6MWD at 12 months compared to 3 months ( P = .017). In ARDS versus non-ARDS survivors, the mean (95% CI) 6MWD difference over 3-, 6-, and 12-month follow-up was 73 [13-133] meters lower. Female sex and preexisting comorbidity also were significantly associated with lower 6MWD, with ICU-related variables having no consistent associations. Conclusions: Compared to initial assessment at 3 months, significant improvement in 6MWD was reported at 12 months. Female sex, preexisting comorbidity, and ARDS (vs non-ARDS) were associated with lower 6MWT results. Such factors warrant consideration in the design of clinical research studies and in the interpretation of patient status using the 6MWT.

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Section: Discussionmentioning

confidence: 97%

Six-Minute Walk Distance After Critical Illness: A Systematic Review and Meta-Analysis

Parry

Nalamalapu

Nunna

et al. 2019

J Intensive Care Med

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“…Consequently, exercise performance is a critical parameter that allows the prediction of functional impairment and risk of death among COPD patients. 39,40,41 Thus, exercise tolerance enhancement is so important that it is currently stated as one of COPD treatment goals. 1 Relevance of omega-3 in exercise tolerance is seen as they act as natural ligands of peroxisome proliferator-activated receptors (PPARs) and PPAR-gamma coactivators (PGC)-1α, which regulate skeletal muscle morphology and oxidative metabolism.…”

Section: Role In Exercise Capacitymentioning

confidence: 99%

Evidence on the Efficacy of Omega-3 Polyunsaturated Fatty Acids as an Adjunct Therapy for Chronic Obstructive Pulmonary Disease

Dirjayanto¹

2021

J Asian Med Stud Assoc

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Background: As the fourth leading cause of death worldwide, Chronic Obstructive Pulmonary Disease (COPD) places a significant burden on healthcare-related costs. COPD is characterized by airflow impairment, including chronic bronchitis, small airways obstruction, and emphysema. COPD pathophysiology involves inflammation correlated with lung decline, body composition alteration, and decreased quality of life. Since preceding studies have shown its roles in inflammatory processes, omega-3 is proposed as a potential adjunct treatment in slowing down COPD progression.Aim: To analyse the efficacy of omega-3 as a potential adjunct therapy in COPD management.Method: A literature review was conducted by retrieving studies published from 2010-2020 through PubMed, EBSCOhost, Cochrane Controlled Register of Trials (CENTRAL), Scopus, Clinical Key, Wiley, and Science Direct that evaluate the effect of omega-3 supplementation in COPD management.Outcome: The search yielded 12 studies with a total of 6,474 subjects. Outcomes suggested that omega-3 leads to a reduction in inflammation, improved body composition, enhanced exercise capacity, higher quality of life, and lower exacerbation occurrences. Association found for lung function was weak, but this might be due to the study designs. The only potential adverse effect was diarrhoea, but this is insignificant.Conclusion: To conclude, omega-3 supplementation in COPD management showed promising results, considering its efficacy in slowing down COPD progression, minimal side effects, cost-effectiveness, and feasibility. However, the incorporation of this intervention into management guidelines require more trials with larger samples to establish more substantial evidence and more in-depth understanding of its roles.

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“…Impaired exercise tolerance is a major problem in patients with chronic obstructive pulmonary disease (COPD) with usually multifactorial causes including airflow limitation, reduced gas exchange, peripheral muscle weakness and coronary heart disease. 1 – 3 It is associated with poor prognosis and impaired quality of life. 4 A bicycle constant work rate exercise test (CWRET) at 75–80% of peak maximum workload ( W MAX ) is frequently used to assess the impact of COPD on functional capacity and the response to medical treatment or pulmonary rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

A new protocol for exercise testing in COPD; improved prediction algorithm for W_MAX and validation of the endurance test in a placebo-controlled double bronchodilator study

Tufvesson

Radner

Simonsen

et al. 2021

Ther Adv Respir Dis

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Background: Two new protocols have been developed for bicycle exercise testing in chronic obstructive pulmonary disease (COPD) with an individualized cardiopulmonary exercise test (ICPET) and subsequent customized endurance test (CET), which generate less interindividual spread in endurance time compared with the standard endurance test. Main objectives of this study were to improve the prediction algorithm for WMAX for the ICPET and validate the CET by examining treatment effects on exercise performance of indacaterol/glycopyrronium (IND/GLY) compared with placebo. Methods: COPD patients, with forced expiratory volume in 1 s ( FEV1) 40–80% predicted, were recruited. Pooled baseline data from two previous studies ( n = 38) were used for the development of an improved WMAX prediction algorithm. Additional COPD patients ( n = 14) were recruited and performed the ICPET, using the new prediction formula at visit 1. Prior to the CET at visits 2 and 3, they were randomized to a single dose of IND/GLY (110/50 µg) or placebo. Results: The improved multiple regression algorithm for WMAX includes diffusing capacity for carbon monoxide ( DLCO), FEV1, sex, age and height and correlated to measured WMAX ( R2 = 0.89 and slope = 0.89). Treatment with IND/GLY showed improvement in endurance time versus placebo, mean 113 s [95% confidence interval (CI): 6–220], p = 0.037, with more prominent effect in patients with FEV1 < 70% predicted. Conclusion: The two new protocols for ICPET (including the new improved algorithm) and CET were retested with consistent results. In addition, the CET showed a significant and clinically relevant prolongation of endurance time for IND/GLY versus placebo in a small number of patients.

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Exercise capacity impairment in COPD patients with comorbidities

Cited by 8 publications

References 32 publications

Six-Minute Walk Distance After Critical Illness: A Systematic Review and Meta-Analysis

Six-Minute Walk Distance After Critical Illness: A Systematic Review and Meta-Analysis

Evidence on the Efficacy of Omega-3 Polyunsaturated Fatty Acids as an Adjunct Therapy for Chronic Obstructive Pulmonary Disease

A new protocol for exercise testing in COPD; improved prediction algorithm for W_MAX and validation of the endurance test in a placebo-controlled double bronchodilator study

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Exercise capacity impairment in COPD patients with comorbidities

Cited by 8 publications

References 32 publications

Six-Minute Walk Distance After Critical Illness: A Systematic Review and Meta-Analysis

Six-Minute Walk Distance After Critical Illness: A Systematic Review and Meta-Analysis

Evidence on the Efficacy of Omega-3 Polyunsaturated Fatty Acids as an Adjunct Therapy for Chronic Obstructive Pulmonary Disease

A new protocol for exercise testing in COPD; improved prediction algorithm for WMAX and validation of the endurance test in a placebo-controlled double bronchodilator study

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Product

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A new protocol for exercise testing in COPD; improved prediction algorithm for W_MAX and validation of the endurance test in a placebo-controlled double bronchodilator study