Effects of exercise training on cognition in chronic obstructive pulmonary disease:A systematic review

Background As exercise may mitigate cognitive decline in individuals with chronic obstructive pulmonary disease (COPD), its effect has been evaluated in a number of clinical trials. The objective of the present systematic review was to describe the impact of exercise training on cognition in COPD. Methods Electronic searches of four databases were performed from inception until March 24, 2015 and last updated 23rd October 2017. Included studies reported on at least one cognitive outcome before and after a formal exercise-training program in individuals with COPD. Two reviewers independently rated study quality using the Downs and Black checklist. The protocol was registered on PROSPERO (CRD42015017884). Results Seven articles, representing six exercise interventions in 293 individuals with COPD (55% males, mean age 67 ± 2 year) were included. Although each study documented a significant pre-post training improvement in at least one cognitive domain, the heterogeneity in study design, exercise intervention and cognitive outcome measures among studies precluded a meta-analysis. The only randomized controlled trial available reported an improvement on a letter verbal fluency task in the exercise group only. Conclusions Exercise training may positively impact cognition in COPD patients, but current evidence is limited by the heterogeneity of study design, exercise intervention and cognitive outcome measures. Future studies should emphasize comprehensive reporting of intervention parameters, including program length, type(s) of exercise, and duration of individual sessions, in order to facilitate applied insights to inform replication and/or program development

Amplitude of the rest–activity cycle in chronic obstructive pulmonary disease: an exploratory study

In chronic obstructive pulmonary disease (COPD), there is large individual variability in the progression of the disease. Low amplitude of rest–activity rhythms has been associated with worse prognosis in a variety of diseases, but it has not been investigated in COPD. The first aim of this exploratory study was to compare disease severity and prognosis indicators between COPD patients with relatively high or low amplitude of their rest–activity cycle, as measured with actigraphy. As a second objective, 24-hour profiles of both activity levels and nighttime-sleep quality were compared between the two subgroups to assess the relative contribution of day- and night-activity levels to high and low rest–activity rhythm amplitude in this population. Rest–activity rhythms were measured with 8–14 days of wrist actigraphy in 14 patients (nine men), aged 58–79 years, suffering from moderate-to-severe COPD. Relative amplitude of 24-hour activity profiles ranged from 0.72 to 0.98. Participants were divided at the median into high-amplitude (mean ± standard deviation 0.9±0.04) and low-amplitude (0.79±0.05) subgroups. There was no significant difference between the two subgroups for pulmonary function or exercise capacity. However, the low-amplitude group had more severe symptoms of dyspnea and worse prognostic scores than the high-amplitude group (P<0.05). The 24-hour activity profiles revealed higher levels of activity in the high-amplitude group for the 12–3 pm interval (P<0.05). There was no significant difference between the two groups for subjective or actigraphic estimates of sleep quality, sleep duration, or proportion of daytime sleep. This exploratory study is a first step toward the identification of larger rest–activity rhythm amplitude as a marker of better prognosis in COPD and as another potential target for exercise-based rehabilitation programs in this population

Sex Differences in the Effects of Inhaled Corticosteroids on Weight Gain among Patients with Asthma

Background. Studies have shown that asthma and asthma exacerbations are related to body weight and that this relationship might be sex-specific. While oral corticosteroids have been associated with weight gain, little is known about the effect of inhaled corticosteroid (ICS) use on short-term weight gain. The purpose of the present study was to examine whether ICSs would be associated with weight gain among asthmatic patients. Methods. A total of 180 adult patients with physician-diagnosed asthma provided details of their medical history and demographic information, along with height and weight at baseline and at one year. Weight change was defined as follow-up minus baseline weight. General linear models were used to assess the relationship between ICS dose (fluticasone propionate equivalent) and sex. Results. Significant main effects of sex

Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

Pulmonary rehabilitation is widely recognized in the management of respiratory diseases. A key component to successful pulmonary rehabilitation is adherence to the recommended exercise training. The purpose of the present protocol is to describe how continuous data tracking technology can be used to precisely measure adherence to a prescribed aerobic training intensity

Association between patterns of leisure time physical activity and asthma control in adult patients

Background Physical activity has been shown to have various health benefits in patients with asthma, especially in children. However, there are still limited data on the nature of the association between physical activity and asthma control in adults. Objective The objective of the current study was to determine the nature of the association between physical activity and asthma control, with particular emphasis on the intensity of the activity and seasonal variations. Methods 643 adult patients with objectively confirmed asthma (mean age (SD)=53 (15) years, 60% women) were interviewed by telephone. Patients completed the asthma control questionnaire (ACQ), the asthma quality of life questionnaire, and a 1-year physical activity recall questionnaire to assess leisure time physical activity (LTPA). Results Total LTPA was related to control (β (95% CI)=−0.013 (−0.030 to 0.006)), with those doing recommended levels of LTPA being nearly 2.5 times more likely to have good control compared with inactive patients. Analysis of seasonal exercise habits found that winter LTPA (β=−0.027 (−0.048 to −0.006)) was more strongly associated with ACQ scores than summer LTPA (β=−0.019 (−0.037 to −0.001)). Adjustment for age, sex, season of assessment, inhaled corticosteroid (ICS) dose, body mass index, and current smoking status reduced the strength of the relationships. Conclusions Data indicate that higher levels of LTPA are associated with better levels of asthma control in adult patients with asthma, and that this seems to be more pronounced among asthmatics who do the recommended levels of exercise

Amplitude of the rest-activity cycle in chronic obstructive pulmonary disease: an exploratory study

In chronic obstructive pulmonary disease (COPD), there is large individual variability in the progression of the disease. Low amplitude of rest–activity rhythms has been associated with worse prognosis in a variety of diseases, but it has not been investigated in COPD. The first aim of this exploratory study was to compare disease severity and prognosis indicators between COPD patients with relatively high or low amplitude of their rest–activity cycle, as measured with actigraphy. As a second objective, 24-hour profiles of both activity levels and nighttime-sleep quality were compared between the two subgroups to assess the relative contribution of day- and night-activity levels to high and low rest–activity rhythm amplitude in this population. Rest–activity rhythms were measured with 8–14 days of wrist actigraphy in 14 patients (nine men), aged 58–79 years, suffering from moderate-to-severe COPD. Relative amplitude of 24-hour activity profiles ranged from 0.72 to 0.98. Participants were divided at the median into high-amplitude (mean ± standard deviation 0.9±0.04) and low-amplitude (0.79±0.05) subgroups. There was no significant difference between the two subgroups for pulmonary function or exercise capacity. However, the low-amplitude group had more severe symptoms of dyspnea and worse prognostic scores than the high-amplitude group (P<0.05). The 24-hour activity profiles revealed higher levels of activity in the high-amplitude group for the 12–3 pm interval (P<0.05). There was no significant difference between the two groups for subjective or actigraphic estimates of sleep quality, sleep duration, or proportion of daytime sleep. This exploratory study is a first step toward the identification of larger rest–activity rhythm amplitude as a marker of better prognosis in COPD and as another potential target for exercise-based rehabilitation programs in this population

A Randomized Trial of Exercise Training Versus Relaxation for the Treatment of Chronic Insomnia in Obstructive Sleep Apnea

Background: Obstructive Sleep Apnea Syndrome (OSA) is a common sleep disorder characterized by partial or complete blockage of the pharyngeal airway during sleep, posing as a significant public health concern. OSA is often comorbid with chronic insomnia (COMISA). Insomnia disorder involves a difficulty initiating sleep, maintaining sleep and/or early awakenings, despite time and opportunity for sleep, causing impairments in daytime functioning and significant distress. Individuals with COMISA suffer from worse sleep and daytime functioning, compared to individuals presenting with either disorder in isolation. Due to their insomnia complaints, these individuals tend to be less compliant with continuous positive airway pressure (CPAP) therapy, the gold standard treatment for OSA. Cognitive behavioural therapy for insomnia (CBTi) has shown promising results in this population but can be difficult for individuals to access, and alone, cannot improve OSA severity. This unique group requires a therapy targeted to both disorders, which would potentially improve apnea-hypopnea index (AHI) and/or insomnia symptomology for a better sleep. Currently, no effective therapy tailored to these individuals has been found. Exercise is a potential non-pharmacological therapy that would simultaneously improve symptoms of both disorders. Studies examining the effects of exercise as a therapy for COMISA are lacking, and research examining exercise as a therapy for either of the two disorders alone yield mixed results likely due to variation in methodology and treatment approach. Objectives: (1) To determine if an 8-week exercise intervention would improve insomnia severity in patients with comorbid OSA and insomnia when compared to an 8-week active control condition of relaxation therapy. (2) To examine the effects of the exercise and relaxation interventions on cardiorespiratory fitness both within-groups and between-groups. (3) To examine if improvements in cardiorespiratory fitness would be associated with improved changes in objective and subjective sleep quality. Methods: Sixteen participants (10 female, 54.9 13.4 years of age) were randomised to 3 weekly sessions of exercise training or self-guided relaxation. The exercise sessions consisted of 60 minutes of moderate-intensity aerobic and resistance exercise, with 1 weekly session supervised and the remaining two unsupervised at home or in the community. The protocol included a screening polysomnography (PSG) night, a cardiopulmonary exercise test, and an overnight PSG, as well as questionnaires (including the Insomnia Severity Index (ISI)) before and after the 8 weeks. All PSG recordings were sampled at 512 Hz (Somnomedics, Germany) and sleep stages were scored offline according to AASM guidelines. ISI and sleep efficiency (SE) (extracted from PSG) were assessed as primary outcomes. VO2peak (ml/kg/min), VO2 at the ventilatory threshold (VT), heart rate (HR) at 50% isotime (ISO) pre- and post- intervention were assessed as secondary outcomes. Bivariate correlations were also performed to examine any potential relationships between change in cardiorespiratory fitness and change in subjective and objective sleep parameters. Results: Results revealed a significant effect of time (pre, post 8-weeks) on ISI score (F(1,14)= 12.315; p=.003), but no significant effect of condition (exercise, relaxation) or time*condition interaction. Both exercise and relaxation had large effects on ISI, with exercise showing a larger effect size (Cohen’s d= 3.88) than relaxation (Cohen’s d= 0.184). No significant effects were found for SE. A significant time*condition interaction was found for VO2peak (ml/kg/min) (F(1,15)= 10.724; p=.006), with the exercise condition showing improvements. Spearman correlations indicated a non-significant association for change in ISI and change in VO2peak (ml/kg/min) (r=0.59; p>.05). Conclusions: Both exercise and relaxation reduced insomnia severity in people with COMISA, with exercise having a larger effect. Objective measures of sleep efficiency did not improve significantly in either group. Cardiorespiratory fitness improved with the partly home-based, moderate-intensity aerobic and resistance training intervention used in this study. Larger trials are warranted to confirm these findings. Significance: This is the first randomized controlled trial (RCT) to examine the effects of an exercise intervention on sleep in this specific COMISA population

The effects of a multisite aerobic exercise intervention on asthma morbidity in sedentary adults with asthma: the Ex-asthma study randomised controlled trial protocol

Objective: Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current randomised controlled trial is that aerobic exercise will be superior to usual care in improving asthma control. Key secondary outcomes are asthma quality of life and inflammatory profiles. Design: A total of 104 sedentary adults with physician-diagnosed asthma will be recruited. Eligible participants will undergo a series of baseline assessments including: the asthma control questionnaire; the asthma quality-of-life questionnaire and the inflammatory profile (assessed from both the blood and sputum samples). On completion of the assessments, participants will be randomised (1:1 allocation) to either 12-weeks of usual care or usual care plus aerobic exercise. Aerobic exercise will consist of three supervised training sessions per week. Each session will consist of taking a short-acting bronchodilator, 10 min of warm-up, 40 min of aerobic exercise (50–75% of heart rate reserve for weeks 1–4, then 70–85% for weeks 5–12) and a 10 min cool-down. Within 1 week of completion, participants will be reassessed (same battery as at baseline). Analyses will assess the difference between the two intervention arms on postintervention levels of asthma control, quality of life and inflammation, adjusting for age, baseline inhaled corticosteroid prescription, body weight change and pretreatment dependent variable level. Missing data will be handled using standard multiple imputation techniques. Ethics and dissemination: The study has been approved by all relevant research ethics boards. Written consent will be obtained from all participants who will be able to withdraw at any time. Results: The result will be disseminated to three groups of stakeholder groups: (1) the scientific and professional community; (2) the research participants and (3) the general public. Registration Details: ClinicalTrials.gov Identifier NCT0095334

Physiological Correlates of Endurance Time Variability during Constant-Workrate Cycling Exercise in Patients with COPD

RATIONALE: The endurance time (T(end)) during constant-workrate cycling exercise (CET) is highly variable in COPD. We investigated pulmonary and physiological variables that may contribute to these variations in T(end). METHODS: Ninety-two patients with COPD completed a CET performed at 80% of peak workrate capacity (W(peak)). Patients were divided into tertiles of T(end) [Group 1: <4 min; Group 2: 4-6 min; Group 3: >6 min]. Disease severity (FEV(1)), aerobic fitness (W(peak), peak oxygen consumption [VO2(peak)], ventilatory threshold [VO2(VT)]), quadriceps strength (MVC), symptom scores at the end of CET and exercise intensity during CET (heart rate at the end of CET to heart rate at peak incremental exercise ratio [HR(CET)/HR(peak)]) were analyzed as potential variables influencing T(end). RESULTS: W(peak), VO2(peak), VO2(VT), MVC, leg fatigue at end of CET, and HR(CET)/HR(peak) were lower in group 1 than in group 2 or 3 (p≤0.05). VO2(VT) and leg fatigue at end of CET independently predicted T(end) in multiple regression analysis (r = 0.50, p = 0.001). CONCLUSION: T(end) was independently related to the aerobic fitness and to tolerance to leg fatigue at the end of exercise. A large fraction of the variability in T(end) was not explained by the physiological parameters assessed in the present study. Individualization of exercise intensity during CET should help in reducing variations in T(end) among patients with COPD

From Sea to Sea: Canada's Three Oceans of Biodiversity

Evaluating and understanding biodiversity in marine ecosystems are both necessary and challenging for conservation. This paper compiles and summarizes current knowledge of the diversity of marine taxa in Canada's three oceans while recognizing that this compilation is incomplete and will change in the future. That Canada has the longest coastline in the world and incorporates distinctly different biogeographic provinces and ecoregions (e.g., temperate through ice-covered areas) constrains this analysis. The taxonomic groups presented here include microbes, phytoplankton, macroalgae, zooplankton, benthic infauna, fishes, and marine mammals. The minimum number of species or taxa compiled here is 15,988 for the three Canadian oceans. However, this number clearly underestimates in several ways the total number of taxa present. First, there are significant gaps in the published literature. Second, the diversity of many habitats has not been compiled for all taxonomic groups (e.g., intertidal rocky shores, deep sea), and data compilations are based on short-term, directed research programs or longer-term monitoring activities with limited spatial resolution. Third, the biodiversity of large organisms is well known, but this is not true of smaller organisms. Finally, the greatest constraint on this summary is the willingness and capacity of those who collected the data to make it available to those interested in biodiversity meta-analyses. Confirmation of identities and intercomparison of studies are also constrained by the disturbing rate of decline in the number of taxonomists and systematists specializing on marine taxa in Canada. This decline is mostly the result of retirements of current specialists and to a lack of training and employment opportunities for new ones. Considering the difficulties encountered in compiling an overview of biogeographic data and the diversity of species or taxa in Canada's three oceans, this synthesis is intended to serve as a biodiversity baseline for a new program on marine biodiversity, the Canadian Healthy Ocean Network. A major effort needs to be undertaken to establish a complete baseline of Canadian marine biodiversity of all taxonomic groups, especially if we are to understand and conserve this part of Canada's natural heritage