Home-based pulmonary rehabilitation in patients undergoing (chemo)radiation therapy for unresectable lung cancer: a prospective explorative study

Aims The prevention of pulmonary toxicity is an important goal for patient candidate to radiation therapy for lung cancer. There is a lack of evidence on the role of exercise training for patients with unresectable stage III lung cancer candidated to radical treatment. The aim of this study was to evaluate the feasibility of a home-based pulmonary rehabilitation (PR) program and to identify reliable tools in terms of respiratory function, exercise capacity and quality of life. Methods Patients' recruitment lasted from April 2020 till February 2022. The PR program was proposed concomitantly to radiation therapy to the first 20 patients (interventional group, IG), and the other 20 patients were identified as an observational group (OG). All patients were assessed at baseline (T0) and after 8 weeks (T2) with 6 minute walking test (6MWT), modified Borg Scale (mBORG), SF-36 questionnaire (SF-36) and pulmonary function test (PFT); after 4 weeks (T1), only SF-36 was administered. Results A decrease of 13.8 m in the walked-distance was registered in the OG between T0 and T2 (p = 0.083). Instead, an increase of 56.6 m in the distance walked was recorded in the IG between T0 and T2 (p <= 0.001). In the OG, the mBORG scores showed a negative trend. On the contrary, in the IG, these scores showed a slight improvement. In the OG, all the items of SF-36 scores decreased between T0 and T1. In the IG, an increased trend from T0 to T2 was observed for all the items of SF-36. No clinically significant variations were detected from baseline to T2 in both groups regarding PFT. Conclusion The 6MWT, mBORG and SF-36 resulted as useful tools to assess the role of a PR program. A significant gain in functional exercise capacity and a prevention of the physiological impairment of QoL during radio(chemo)therapy was registered

South African HIV-1 subtype C transmitted variants with a specific V2 motif show higher dependence on α4β7 for replication.

CAPRISA, 2015.Abstract available in pdf

Isolated Resistance Training Programs to Improve Peripheral Muscle Function in Outpatients with Chronic Obstructive Pulmonary Diseases: A Systematic Review

This systematic review aims to establish which isolated resistance training (RT) programs have been used in outpatients with chronic obstructive pulmonary disease (COPD) and their impact on all aspects of peripheral skeletal muscle function. Electronic databases were systematically searched up to June 2021. The eligibility criteria were: (1) randomized controlled trials investigating the effects of supervised and isolated RT programs in outpatients with COPD and (2) RT programs lasting 8–12 weeks, (3) including at least one outcome measure related to trainable muscle characteristics. Initially, 6576 studies were identified, whereas 15 trials met the inclusion criteria. All the included trials reported that isolated RT improved both upper and lower limbs’ maximal strength. Muscle endurance and power also increased after RT but received less attention in the analysis. Furthermore, few studies assessed the effect of RT on muscle mass and cross-sectional area, reporting only limited improvement. Isolated RT programs carried out 2–3 days a week for 8–12 weeks improved skeletal muscle function in individuals with COPD. The RT program should be specifically focused to the trainable muscle characteristic to be improved. For this reason, we further encourage the introduction of a detailed assessment of muscle function and structure during the pulmonary rehabilitation practice

A novel quantitative technological approach to muscle and exercise dysfunction in the clinical rehabilitation practice of patients with chronic obstructive pulmonary disease

La broncopneumopatia cronica ostruttiva (BPCO) è una patologia polmonare eterogenea caratterizzata da tosse produttiva, dispnea e limitazione della tolleranza all'esercizio. Inoltre, la disfunzione dei muscoli scheletrici è una delle conseguenze sistemiche più importanti della BPCO. Infatti, la disfunzione muscolare influisce negativamente sulla capacità di svolgere attività funzionali e aumenta il rischio di mortalità. Tuttavia, tale disfunzione può essere prevenuta e migliorata con l'esercizio fisico nei soggetti affetti da BPCO. In questo contesto, i progressi tecnologici possono ampliare la valutazione della funzione muscolare e consentire di ottenere dati quantitativi nella riabilitazione della BPCO. I tre obiettivi principali di questa tesi erano: (i) Identificare gli attuali metodi di valutazione e trattamento della disfunzione muscolare nella BPCO, concentrandosi sulle tecnologie impiegate e sulla pratica clinica riabilitativa. (ii) Progettare e implementare in ambito clinico riabilitativo un setting tecnologico per valutare quantitativamente la funzione muscolare e la performance funzionale in pazienti con BPCO. (iii) Sviluppare un programma di allenamento per la disfunzione muscolare basata su esercizi eccentrici in pazienti con BPCO. Questa tesi include cinque studi, tra cui tre revisioni sistematiche (RS), uno studio osservazionale prospettico e uno studio randomizzato controllato (RCT). Due RS hanno evidenziato rispettivamente l'eterogeneità dell'approccio nei programmi di allenamento per la disfunzione muscolare e la minore attenzione alle diverse proprietà muscolari nei pazienti con BPCO. Una terza RS ha evidenziato limitazioni nell'implementazione delle tecnologie nel contesto clinico riabilitativo della BPCO. Tuttavia, la valutazione dettagliata della funzione muscolare, supportata da tecnologie portatili, è stata fondamentale per prevedere le prestazioni funzionali nei pazienti con BPCO durante lo studio osservazionale svolto. Inoltre, l'RCT ha mostrato che specifiche modalità di esercizio possono migliorare ulteriormente la funzione muscolare dopo la riabilitazione polmonare nei pazienti con BPCO. In conclusione, l'uso di tecnologie portatili è fondamentale per una valutazione oggettiva, accurata e riproducibile della funzione muscolare e delle prestazioni funzionali nei pazienti con BPCO. Pertanto, è necessario stabilire l’utilizzabilità clinica di tali dispositivi, nonché la loro validità e affidabilità applicata a test specifici e funzionali nella pratica riabilitativa della BPCO.Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by productive cough, dyspnea, and exercise limitation. Moreover, the dysfunction of skeletal muscles is one of the most important systemic consequences of COPD. Muscle dysfunction negatively affects the ability to perform functional activities and increases the mortality risk. However, skeletal muscle dysfunction can be prevented and improved with exercise training in individuals with COPD. In this context, technological advancements can expand the assessment of muscle function and enable obtaining quantitative data in the current COPD practice. The three main objectives of this thesis were: (i) To identify current assessment methods and treatment prescriptions for muscle dysfunction in COPD, focusing on technologies employed and clinical rehabilitation practice. (ii) Design and implementation in the clinical setting of a technological set up to quantitatively evaluate muscle function and functional performance in outpatients with COPD. (iii) To develop a training prescription for muscle dysfunction based on eccentric exercises in inpatients with COPD. This thesis involved five studies, including three systematic reviews (SRs), one prospective observational study, and one randomized controlled trial (RCT). Two SRs respectively showed heterogeneity of approach in training prescriptions for muscle dysfunction and less attention to different muscle properties in patients with COPD. A third SR reported limitations to the implementation of technologies in the clinical setting of COPD. However, the detailed assessment of muscle function, supported by portable technologies, was critical to predict functional performance in patients with COPD during the observational study. Moreover, the RCT showed that specific exercise modalities, may further improve muscle function after pulmonary rehabilitation in patients with COPD. In conclusion, the use of wearable devices is critical for the objective, accurate, and reproducible assessment of muscle function and functional performance in patients with COPD. Therefore, it is necessary to establish the clinical feasibility of such devices, as well as their validity and reliability applied to specific and functional tests in COPD rehabilitation practice

Currently available technological solutions for the functional assessment of patients with COPD.

Systematic Revie

Technologies for the Instrumental Evaluation of Physical Function in Persons Affected by Chronic Obstructive Pulmonary Disease: A Systematic Review

Several systems, sensors, and devices are now available for the instrumental evaluation of physical function in persons with Chronic Obstructive Pulmonary Disease (COPD). We aimed to systematically review the literature about such technologies. The literature search was conducted in all major scientific databases, including articles published between January 2001 and April 2022. Studies reporting measures derived from the instrumental assessment of physical function in individuals with COPD were included and were divided into application and validation studies. The quality of validation studies was assessed with the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias tool. From 8752 articles retrieved, 21 application and 4 validation studies were included in the systematic review. Most application studies employed accelerometers, gait analysis systems, instrumented mattresses, or force plates to evaluate walking. Surface electro-myography or near-infrared spectroscopy were employed in four studies. Validation studies were heterogeneous and presented a risk of bias ranging from inadequate to doubtful. A variety of data regarding physical function can be retrieved from technologies used in COPD studies. However, a general lack of standardization and limitations in study design and sample size hinder the implementation of the instrumental evaluation of function in clinical practice

The Efficacy of Electromagnetic Diathermy for the Treatment of Musculoskeletal Disorders: A Systematic Review with Meta-Analysis

OBJECTIVE: This study aims to establish the effect of electromagnetic diathermy therapies (e.g., shortwave, microwave, capacitive resistive electric transfer) on pain, function, and quality of life in treating musculoskeletal disorders. METHODS: We conducted a systematic review according to the PRISMA statement and Cochrane Handbook 6.3. The protocol has been registered in PROSPERO: CRD42021239466. The search was conducted in PubMed, PEDro, CENTRAL, EMBASE, and CINAHL. RESULTS: We retrieved 13,323 records; 68 studies were included. Many pathologies were treated with diathermy against placebo, as a standalone intervention or alongside other therapies. Most of the pooled studies did not show significant improvements in the primary outcomes. While the analysis of single studies shows several significant results in favour of diathermy, all comparisons considered had a GRADE quality of evidence between low and very low. CONCLUSIONS: The included studies show controversial results. Most of the pooled studies present very low quality of evidence and no significant results, while single studies have significant results with a slightly higher quality of evidence (low), highlighting a critical lack of evidence in the field. The results did not support the adoption of diathermy in a clinical context, preferring therapies supported by evidence

Effects of Combined Endurance and Resistance Eccentric Training on Muscle Function and Functional Performance in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

Objective: To evaluate the adherence to treatment and efficacy of an eccentric-based training (ECC) program on peripheral muscle function and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Design: Prospective, assessor-blinded, randomized controlled trial. Setting: The cardiopulmonary rehabilitation unit of a tertiary subacute referral center. Participants: Thirty (N=30) stable inpatients (mean age 68±8 years; FEV1 44±18% of predicted) with COPD were included in the study. Interventions: Inpatients were randomly assigned to 4 weeks of a combined endurance and resistance ECC (n=15) or conventional training (CON; n=15). Main outcome measures: Quadriceps peak torque (PT) was the primary outcome measure for muscle function. Rate of force development (RFD), muscle activation and quality (quadriceps PT/leg lean mass), 6-min walk distance (6MWD), 4-meter gait speed (4mGS), 10-meter gait speed, 5-repetition sit-to-stand (5STS), dyspnea rate, and mortality risk were the secondary outcomes. Evaluations were performed at baseline and repeated after 4 weeks and 3 months of follow-up. Results: Quadriceps PT, RFD, and muscle quality improved by 17±23% (P&lt;.001), 19±24%, and 16±20% (both P&lt;.05) within the ECC group. Besides, a significant between-group difference for RFD (56±94 Nm/s, P=.038) was found after training. Both groups showed clinically relevant improvements in 6MWD, 4mGS, dyspnea rate, and mortality risk, with no significant differences between groups. Conclusion: Combined endurance and resistance ECC improved lower limbs muscle function compared with CON in inpatients with COPD. In contrast, ECC did not further improve functional performance, dyspnea, and mortality risk. ECC may be of particular benefit to effect on skeletal muscle function in patients with COPD

Muscle Power in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

: This study aimed to review the impact of training on muscle power in patients with chronic obstructive pulmonary disease (COPD). Randomized controlled trials evaluating the effects of exercise-based interventions on limbs muscle power and rate of force development in COPD patients were investigated. Five international databases were searched until October 2022. Meta-analyses were performed calculating the mean difference or standardized mean difference. Risk of bias in studies was assessed using Cochrane Risk of Bias tool 2.0. A total of nine studies were included in the analysis. There were concerns about risk of bias in seven out of nine studies. Comparison of exercising and non-exercising groups showed a significant effect of exercise in improving muscle power (P=0.0004) and rate of force development (P&lt;0.001), in five and three trials, respectively. Four studies comparing different trainings showed no significant results on muscle power (P=0.45). Eight to 16 weeks of exercise-based intervention versus no intervention might be beneficial to enhance upper and lower limbs muscle power and rate of force development in people with COPD. In contrast, muscle power did not improve when different training modalities were compared. Future studies performing power training in COPD patients are encouraged