Inspiratory muscle training (IMT) for adults discharged from hospital with community acquired pneumonia (CAP) – a feasibility study

Patients report significant morbidity following community-acquired pneumonia (CAP); 70% report persistent symptoms and up to 50% impaired daily activity at 4 weeks post-discharge. Respiratory muscle weakness is one possible mechanism for delayed recovery. Inspiratory muscle training (IMT) increases strength and endurance of inspiratory muscles, with improvements in patient-reported outcomes in other conditions. To our knowledge IMT has not previously been investigated in CAP. To assess the tolerability of IMT in adults discharged from hospital with community-acquired pneumonia. Patients hospitalised with a diagnosis of CAP between February 2017 and March 2018 were eligible for inclusion and convenience sampling was used for participant selection. Participants received an IMT device (POWERbreath KHP2) following familiarisation. Training frequency (twice daily) and load (50% PImax) were fixed, however training volume was incremental during weeks 1–3 (10, 20, 30 breaths) and constant thereafter (30 breaths.) Participants were followed by combination of telephone and clinic visits for 9 weeks. Outcomes of interest were; utilisation of IMT device per protocol (defined as >94% training adherence), patient-reported IMT acceptability, and number of device-related side effects. Statistical analysis was conducted using Stata (version 15.1.) Twenty-two participants were recruited; 16 were male (72.7%), mean age was 55.2 years (range 27.9–77.3.) Participants completed IMT per protocol in 72.7% cases. One unrelated, unexpected serious adverse event (death) occurred during follow-up and 3 participants active at this time were stopped from further IMT by research sponsor pending investigation. Two participants were lost to follow-up. Side effects during IMT were reported on 15 occasions across 22 participants over a total 1183 training days. Reported side effects included chest pain (x2), cough (x1), dyspnoea (x4), and dizziness (x8). All side-effects were rated grade 1 and did not prevent participants from continuing training. Participant-reported IMT acceptability, defined by participants rating training as both ‘useful’ and ‘helpful’ at each follow-up contact, was 99.4%. Inspiratory muscle training appears to be safe, tolerable, and acceptable to patients following CAP. Distinguishing CAP related symptoms and device-related side effects is challenging in patients recovering following an acute infective illness. A clinical trial to determine efficacy is warranted.Nottingham University Hospitals Trus

Acute COVID-19, the Lived Experience, and Lessons to Learn for Future Pandemics

Objectives: The study aimed to increase the understanding of the lived experience of patients during the acute phase of a coronavirus disease 2019 (COVID-19) infection. Method: A Web-based survey was distributed through established patient and public engagement and involvement groups and networks, social media, and by means of word of mouth. The survey covered questions relating to patient demographics, COVID-19 diagnosis, symptom profile, and patient experience during acute COVID-19. Results: The findings demonstrate the varying symptom profiles experienced by people in the acute stage of COVID-19 infection, with participants sharing how they managed care at home, and/or accessed medical advice. Findings also highlight themes that people were concerned with being unable to receive care and believed they needed to rely heavily on family, with extreme thoughts of death. Conclusions: Although the urgent threat to public health has been negated by efficacious vaccines and enhanced treatment strategies, there are key lessons from the lived experience of COVID-19 that should be used to prepare for future pandemics and public health emergencies

Impact of Weekly Swimming Training Distance on the Ergogenicity of Inspiratory Muscle Training in Well-Trained Youth Swimmers

The aim of this study was to examine the impact of weekly swimming training distance upon the ergogenicity of inspiratory muscle training (IMT). Thirty-three youth swimmers were recruited and separated into a LOW and HIGH group based on weekly training distance ( 41 km.wk-1, respectively). The LOW and HIGH groups were further subdivided into control and IMT groups for a 6-week IMT intervention giving a total of four groups: LOWcon, LOWIMT, HIGHcon, HIGHIMT. Before and after the intervention period, swimmers completed maximal effort 100 m and 200 m front crawl swims, with maximal inspiratory and expiratory mouth pressures (PImax and PEmax, respectively) assessed before and after each swim. IMT increased PImax (but not PEmax) by 36% in LOWIMT and HIGHIMT groups (P < 0.05) but 100 m and 200 m swims were faster only in the LOWIMT group (3% and 7% respectively, P < 0.05). Performance benefits only occurred in those training up to 31 km.wk-1 and indicate that the ergogenicity of IMT is affected by weekly training distance. Consequently, training distances are important considerations, among others, when deciding whether or not to supplement swimming training with IMT

Pre-COVID-19 physical activity status does not protect against reductions in post-covid-19 symptoms: a correlation relativistic analysis during the lockdown

People who exhibit unhealthy lifestyle behaviours are at greater risk of severe disease outcomes, risk of hospitalisation and mortality when infected with COVID-19. Accordingly, it is suggested that those with higher levels of cardiorespiratory fitness and who engage in regular physical activity (PA) are associated with a reduced risk of adverse outcomes. Although improved physiological function may protect individuals against severe acute COVID-19 outcomes, it is unknown whether it offers protection against developing sustained symptom profile, known as post-acute COVID-19 syndrome or Long COVID. Affecting an estimated 2 million people in the UK and 144 million globally, Long COVID is challenging healthcare services with broader social and economic impacts. Accordingly, this project aimed to determine the impact of PA status on Long COVID. An online survey was developed Utilizing adapted versions of preexisting Patient Re-ports Outcome Measures (Qualtrics, Provo, Utah, United States). Participants self-reported PA status in line with the World Health Organisation guidelines and their pre- and post-COVID-19 health status and symptom profile. A Mann-Whitney U test was used to analyse between-group responses, and a Wilcoxon Signed Rank test was used to analyse within-group responses. The survey was completed by 381 participants, of which n=253 reported meeting or exceeding the recommended guidelines of PA. A significant difference was found between pre- and post-COVID-19 health, whilst a Mann-Whitney U test concluded that there was no significant difference between PA groups and post-COVID-19 health status. According to the results, increased PA and cardiorespiratory fitness might offer protection against severe disease outcomes in the acute phase of infection but this does not offer full protection against developing a long-term symptom profile and increased mechanistic understanding of the physiological determinants is needed to restore the pre-COVID-19 status and assist in the development of multi-disciplinary interventions

Effects of load mass carried in a backpack upon respiratory muscle fatigue.

The purpose of this study was to investigate whether loads carried in a backpack, with a load mass ranging from 0 to 20 kg, causes respiratory muscle fatigue. Methods: Eight males performed four randomised load carriage (LC) trials comprising 60 min walking at 6.5 km h−1 wearing a backpack of either 0 (LC0), 10 (LC10), 15 (LC15) or 20 kg (LC20). Inspiratory (PImax) and expiratory (PEmax) mouth pressures were assessed prior to and immediately following each trial. Pulmonary gas exchange, heart rate (HR), blood lactate and glucose concentration and perceptual responses were recorded during the first and final 60 s of each trial. Results: Group mean PImax and PEmax were unchanged following 60-min load carriage in all conditions (p > .05). There was an increase over time in pulmonary gas exchange, HR and perceptions of effort relative to baseline measures during each trial (p  .05). Conclusions: These findings indicate that sub-maximal walking with no load or carrying 10, 15 or 20 kg in a backpack for up to 60 min does not cause respiratory muscle fatigue despite causing an increase in physiological, metabolic and perceptual parameters.N/

Pilot study : can inspiratory muscle training relieve symptoms ff dyspnoea and improve quality of life for advanced cancer patients ?: 1872 Board #24 June 2, 3: 30 PM - 5: 00 PM.

Dyspnoea is a common symptom of advanced cancer patients, and impacts upon physical, social and psychological wellbeing. Currently opioids are recommended for those suffering with chronic dyspnoea, despite an association with longer term health issues. Inspiratory muscle training (IMT) promotes chronic adaptations within the inspiratory musculature and has consistently been shown to reduce dyspnoea and improve lung mechanics, functional exercise capacity and quality of life in a variety of clinical populations, however this has yet to be tested in patients with cancer.N/

Attenuating post-exertional malaise in Myalgic encephalomyelitis/chronic fatigue syndrome and long-COVID: Is blood lactate monitoring the answer?

Highlights • Lactate monitoring has the potential to extend beyond applied sports settings and could be used to monitor the physiologic and pathophysiological responses to external and internal stimuli in chronic disease areas such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post-Covid syndrome or Long Covid. • It is applicable due to the recurrent, episodic and often disabling post-exertional symptom exacerbation (PESE) otherwise referred to as post-exertional malaise (PEM) which is a characteristic symptom of ME/CFS and Long Covid that can last for days and/or weeks. • Lactate monitoring presents an opportunity to support those living with ME/CFS and Long COVID, by allowing patients and practitioners to determine the intensity and anaerobic contribution to everyday tasks which could aid the development of pacing strategies that prevent PEM/PESE

Physiological impact of load carriage exercise: Current understanding and future research directions

Load carriage (LC) refers to the use of personal protective equipment (PPE) and/or load-bearing apparatus that is mostly worn over the thoracic cavity. A commonplace task across various physically demanding occupational groups, the mass being carried during LC duties can approach the wearer's body mass. When compared to unloaded exercise, LC imposes additional physiological stress that negatively impacts the respiratory system by restricting chest wall movement and altering ventilatory mechanics as well as circulatory responses. Consequently, LC activities accelerate the development of fatigue in the respiratory muscles and reduce exercise performance in occupational tasks. Therefore, understanding the implications of LC and the effects specific factors have on physiological capacities during LC activity are important to the implementation of effective mitigation strategies to ameliorate the detrimental effects of thoracic LC. Accordingly, this review highlights the current physiological understanding of LC activities and outlines the knowledge and efficacy of current interventions and research that have attempted to improve LC performance, whilst also highlighting pertinent knowledge gaps that must be explored via future research activities

The Role of Physical Activity in Cancer Recovery: An Exercise Practitioner’s Perspective

Less than 20% of cancer patients meet the recommended physical activity (PA) guidelines, partially due to poor knowledge and enforcement/encouragement amongst health-care professionals (HCPs). The primary aim of this study was to explore the perceptions of exercise practitioners on the role of PA and the physiological and psychological benefits to recovering cancer patients; the secondary aim was to understand the barriers and facilitators of promoting PA to cancer survivors. The third aim was to, seek the perspectives on the effectiveness of referral systems between the hospitals and PA structures. A purposive sample of five exercise practitioners’ (four male and one female) with experience with cancer patients participated in a semi-structured interview (45–60 min). Interviews addressed five key topics: intervention procedures, patient well-being, patient education on PA, effectiveness of referrals from hospitals, and post-intervention PA. Interviews were transcribed verbatim and analysed via thematic analysis. The participants believed that recovering cancer patients possess a knowledge of the physiological benefits of PA, yet psychological understanding remains unknown. Social environments are key to participation in PA and most HCPs lacked knowledge/awareness of the benefits of engaging in PA. There is a need to improve HCPs knowledge of the benefits of PA, whilst providing standardised training on how PA can improve cancer patients’ outcomes

Using cardiorespiratory fitness assessment to identify pathophysiology in long COVID – Best practice approaches

Cardio-respiratory fitness (CRF) is well-established in the clinical domains as an integrative measure of the body's physiological capability and capacity to transport and utilise oxygen during controlled bouts of physical exertion. Long COVID is associated with >200 different symptoms and is estimated to affect ∼150 million people worldwide. The most widely reported impact is reduced quality of life and functional status due to highly sensitive and cyclical symptoms that manifest and are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli, more commonly known as post-exertional symptom exacerbation (PESE) which prevents millions from engaging in routine daily activities. The use of cardiopulmonary exercise testing (CPET) is commonplace in the assessment of integrated physiology; CPET will undoubtedly play an integral role in furthering the pathophysiology and mechanistic knowledge that will inform bespoke Long COVID treatment and management strategies. An inherent risk of previous attempts to utilise CPET protocols in patients with chronic disease is that these are compounded by PESE and have induced a worsening of symptoms for patients that can last for days or weeks. To do this effectively and to meet the global need, the complex multi-system pathophysiology of Long COVID must be considered to ensure the design and implementation of research that is both safe for participants and capable of advancing mechanistic understanding