AUTHOR CORRECTION - ERS International Congress 2019:highlights from Best Abstract awardees

Lorna E. Latimer, Marieke Duiverman, Mahmoud I. Abdel-Aziz, Gulser Caliskan, Sara M. Mensink-Bout, Alberto Mendoza-Valderrey, Aurelien Justet, Junichi Omura, Karthi Srikanthan, Jana De Brandt. Breathe 2019; 15: e143–e149. This article from the December 2019 issue of Breathe was published with an error in the name of one of the authors. The corrected author list is shown above. The article has been corrected and republished online.</p

ERS International Congress 2019:highlights from Best Abstract awardees

#ERSCongress 2019: highlights from Best Abstract awardees http://bit.ly/2XWlD7Y

Whole-body & muscle responses to aerobic exercise training and withdrawal in ageing & COPD

BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients exhibit lower peak oxygen uptake (V′(O(2))(peak)), altered muscle metabolism and impaired exercise tolerance compared with age-matched controls. Whether these traits reflect muscle-level deconditioning (impacted by ventilatory constraints) and/or dysfunction in mitochondrial ATP production capacity is debated. By studying aerobic exercise training (AET) at a matched relative intensity and subsequent exercise withdrawal period we aimed to elucidate the whole-body and muscle mitochondrial responsiveness of healthy young (HY), healthy older (HO) and COPD volunteers to whole-body exercise. METHODS: HY (n=10), HO (n=10) and COPD (n=20) volunteers were studied before and after 8 weeks of AET (65% V′(O(2))(peak)) and after 4 weeks of exercise withdrawal. V′(O(2))(peak), muscle maximal mitochondrial ATP production rate (MAPR), mitochondrial content, mitochondrial DNA (mtDNA) copy number and abundance of 59 targeted fuel metabolism mRNAs were determined at all time-points. RESULTS: Muscle MAPR (normalised for mitochondrial content) was not different for any substrate combination in HO, HY and COPD at baseline, but mtDNA copy number relative to a nuclear-encoded housekeeping gene (mean±sd) was greater in HY (804±67) than in HO (631±69; p=0.041). AET increased V′(O(2))(peak) in HO (17%; p=0.002) and HY (21%; p<0.001), but not COPD (p=0.603). Muscle MAPR for palmitate increased with training in HO (57%; p=0.041) and HY (56%; p=0.003), and decreased with exercise withdrawal in HO (−45%; p=0.036) and HY (−30%; p=0.016), but was unchanged in COPD (p=0.594). mtDNA copy number increased with AET in HY (66%; p=0.001), but not HO (p=0.081) or COPD (p=0.132). The observed changes in muscle mRNA abundance were similar in all groups after AET and exercise withdrawal. CONCLUSIONS: Intrinsic mitochondrial function was not impaired by ageing or COPD in the untrained state. Whole-body and muscle mitochondrial responses to AET were robust in HY, evident in HO, but deficient in COPD. All groups showed robust muscle mRNA responses. Higher relative exercise intensities during whole-body training may be needed to maximise whole-body and muscle mitochondrial adaptation in COPD

The effect of COVID rehabilitation for ongoing symptoms Post HOSPitalisation with COVID-19 (PHOSP-R):protocol for a randomised parallel group controlled trial on behalf of the PHOSP consortium

Introduction Many adults hospitalised with COVID-19 have persistent symptoms such as fatigue, breathlessness and brain fog that limit day-to-day activities. These symptoms can last over 2 years. Whilst there is limited controlled studies on interventions that can support those with ongoing symptoms, there has been some promise in rehabilitation interventions in improving function and symptoms either using face-to-face or digital methods, but evidence remains limited and these studies often lack a control group. Methods and analysis This is a nested single-blind, parallel group, randomised control trial with embedded qualitative evaluation comparing rehabilitation (face-to-face or digital) to usual care and conducted within the PHOSP-COVID study. The aim of this study is to determine the effectiveness of rehabilitation interventions on exercise capacity, quality of life and symptoms such as breathlessness and fatigue. The primary outcome is the Incremental Shuttle Walking Test following the eight week intervention phase. Secondary outcomes include measures of function, strength and subjective assessment of symptoms. Blood inflammatory markers and muscle biopsies are an exploratory outcome. The interventions last eight weeks and combine symptom-titrated exercise therapy, symptom management and education delivered either in a face-to-face setting or through a digital platform (www.yourcovidrecovery.nhs.uk). The proposed sample size is 159 participants, and data will be intention-to-treat analyses comparing rehabilitation (face-to-face or digital) to usual care. Ethics and dissemination Ethical approval was gained as part of the PHOSP-COVID study by Yorkshire and the Humber Leeds West Research NHS Ethics Committee, and the study was prospectively registered on the ISRCTN trial registry (ISRCTN13293865). Results will be disseminated to stakeholders, including patients and members of the public, and published in appropriate journals. Article summary Strengths and limitations of this study • This protocol utilises two interventions to support those with ongoing symptoms of COVID-19 • This is a two-centre parallel-group randomised controlled trial • The protocol has been supported by patient and public involvement groups who identified treatments of symptoms and activity limitation as a top priorit

Cardiorespiratory and muscle molecular responses to exercise training in advanced age and chronic obstructive pulmonary disease

INTRODUCTION: Maintenance of cardiorespiratory fitness is important for health in advanced age and in chronic obstructive pulmonary disease (COPD). Aerobic training increases peak oxygen uptake (V̇O2PEAK) in health. Quadriceps weakness is common in COPD. Non-volitional neuromuscular electrical stimulation (NMES) may improve muscle mass and strength as an alternative or adjunct to voluntary resistance exercise (RE). This thesis examines the impact of aerobic exercise training and withdrawal on cardiorespiratory and skeletal muscle molecular markers of adaptation to exercise in advanced age and in COPD and the acute mRNA responses to RE and NMES in COPD. METHODS: Young and older healthy individuals and patients with COPD performed eight weeks aerobic cycling exercise training followed by four weeks exercise withdrawal. Exercise tests and quadriceps muscle biopsies were performed at baseline, after four and eight weeks training and after four weeks exercise withdrawal. Separately, patients with COPD had quadriceps muscle biopsies before and 24 hours after a single bout of RE or NMES. RESULTS: V̇O2PEAK increased similarly in young and older sedentary volunteers after training, but was unchanged in patients with COPD. Cardiorespiratory adaptations were not reversed by four weeks exercise withdrawal in healthy volunteers but V̇O2PEAK decreased in patients with COPD. Change in abundance of targeted mRNA transcripts in quadriceps muscle was strikingly similar in all three groups, predicted influence over the same biological functions and was maintained after exercise withdrawal. Voluntary RE influenced the abundance of a broader range of mRNA targets that NMES; a small number of transcripts were influenced similarly by both interventions. CONCLUSIONS: Young and older sedentary volunteers and patients with COPD experienced the same muscle molecular responses to aerobic training and subsequent exercise withdrawal. Training did not increase V̇O2PEAK in COPD patients suggesting that the limitation to aerobic training adaptations is either downstream of muscle mRNA signalling or due to central limitations. Contractions evoked by neuromuscular electrical stimulation are sufficient to change the abundance of skeletal muscle mRNA targets but voluntary resistance exercise exerts a broader influence

Effect of aerobic exercise training on pulse wave velocity in adults with and without long-term conditions: a systematic review and meta-analysis

Rationale There is conflicting evidence whether aerobic exercise training (AET) reduces pulse wave velocity (PWV) in adults with and without long-term conditions (LTCs).Objective To explore whether PWV improves with AET in adults with and without LTC, to quantify the magnitude of any effect and understand the influence of the exercise prescription.Data sources CENTRAL, MEDLINE and EMBASE were among the databases searched.Eligibility criteria We included studies with a PWV measurement before and after supervised AET of at least 3 weeks duration. Exclusion criteria included resistance exercise and alternative measures of arterial stiffness.Design Controlled trials were included in a random effects meta-analysis to explore the effect of AET on PWV. Uncontrolled studies were included in a secondary meta-analysis and meta-regression exploring the effect of patient and programme factors on change in PWV. The relevant risk of bias tool was used for each study design.Results 79 studies (n=3729) were included: 35 controlled studies (21 randomised control trials (RCT) (n=1240) and 12 non-RCT (n=463)) and 44 uncontrolled (n=2026). In the controlled meta- analysis, PWV was significantly reduced following AET (mean (SD) 11 (7) weeks) in adults with and without LTC (mean difference −0.63; 95% CI −0.82 to −0.44; p&lt;0.0001). PWV was similarly reduced between adults with and without LTC (p&lt;0.001). Age, but not specific programme factors, was inversely associated with a reduction in PWV −0.010 (−0.020 to −0.010) m/s, p&lt;0.001.Discussion Short-term AET similarly reduces PWV in adults with and without LTC. Whether this effect is sustained and the clinical implications require further investigation

Understanding the effectiveness of different exercise training programme designs on V̇O_2peakin COPD: a component network meta-analysis

Pulmonary rehabilitation programmes including aerobic training improve cardiorespiratory fitness in patients with COPD, but the optimal programme design is unclear. We used random effects additive component network meta-analysis to investigate the relative effectiveness of different programme components on fitness measured by V̇O2peakin COPD. The included 59 studies involving 2191 participants demonstrated that V̇O2peakincreased after aerobic training of at least moderate intensity with the greatest improvement seen following high intensity training. Lower limb aerobic training (SMD 0.56 95% CI 0.32;0.81, intervention arms=86) and the addition of non-invasive ventilation (SMD 0.55 95% CI 0.04;1.06, intervention arms=4) appeared to offer additional benefit but there was limited evidence for effectiveness of other exercise and non-exercise components