Comparison of the six-minute walk test with a cycle-based cardiopulmonary exercise test in people following curative intent treatment for non-small cell lung cancer.

This study is aimed to (i) compare both the magnitude of impairment in exercise capacity and exercise responses measured during the six-minute walk test (6MWT) and the cardiopulmonary exercise test (CPET) and (ii) investigate the effect of test repetition on six-minute walk distance (6MWD) in people following curative intent treatment for non-small cell lung cancer (NSCLC). Twenty participants (67 ± 10 years; 14 females), 6–10 weeks following lobectomy, underwent a CPET and two 6MWTs. Peak exercise responses, dyspnoea and leg fatigue, as well as heart rate (HR) and oxygen saturation (SpO2) during the 6MWT, were compared to those during the CPET. Compared with exercise capacity when expressed as peak rate of oxygen consumption (%pred) measured during the CPET, exercise capacity when expressed as 6MWD (%pred) was less impaired (81 ± 10 vs. 63 ± 15 %pred; p < 0.001). Compared with the CPET, the 6MWT elicited lower peak HR (119 ± 15 vs. 128 ± 18 beats minute−1; p = 0.02), lower SpO2 (93 ± 2 vs. 95 ± 3%; p < 0.05), less dyspnoea (3.1 ± 1.6 vs. 6.9 ± 2.6; p < 0.01) and less leg fatigue (2.0 ± 1.9 vs. 6.8 ± 2.4; p < 0.01). The 6MWD increased 19 ± 19 metre (4 ± 4%) with test repetition (p < 0.001). In people following curative intent treatment for NSCLC, the 6MWT appears to elicit sub-maximal exercise responses when compared with the CPET. There is a significant effect of test repetition on 6MWD

Maximum voluntary ventilation is more strongly associated with energy expenditure during simple activities of daily living than measures of airflow obstruction or respiratory muscle strength in patients with COPD

This is a retrospective analysis of data in which we explored the association between energy expenditure (EE) and lung function in patients with chronic obstructive pulmonary disease (COPD). A total of 36 participants (20 males; forced expiratory volume in 1 second (FEV1) of 48 ± 15% predicted) underwent measures of indirect calorimetry whilst performing five simple activities of daily living. Maximal voluntary ventilation was the only lung function parameter associated with EE. These data highlight the limited extent to which the FEV1 is related to the functional performance of patients with COPD

Quantifying the effect of monitor wear time and monitor type on the estimate of sedentary time in people with COPD: Systematic review and meta-analysis

In studies that have reported device-based measures of sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD), we explored if the monitor type and monitor wear time moderated the estimate of this measure. Five electronic databases were searched in January 2021. Studies were included if \u3e70% of participants had stable COPD, and measures of ST (min/day) were collected using wearable technology. Meta-regression was used to examine the influence of moderators on ST, monitor type, and wear time. The studies identified were a total of 1153, and 36 had usable data for meta-analyses. The overall pooled estimate of ST (mean [95% CI]) was 524 min/day [482 to 566] with moderate heterogeneity among effect sizes (I2 = 42%). Monitor wear time, as well as the interaction of monitor wear time and monitor type, were moderators of ST (p \u3c 0.001). The largest difference (−318 min; 95% CI [−212 to −424]) was seen between studies where participants wore a device without a thigh inclinometer for 24 h (and removed sleep during analysis) (675 min, 95% CI [589 to 752]) and studies where participants wore a device with a thigh inclinometer for 12 h only (356 min; 95% CI [284 to 430]). In people with COPD, the monitor wear time and the interaction of the monitor wear time and the monitor type moderated the estimate of ST

Patterns of sedentary behaviour and physical activity in people following curative intent treatment for non-small cell lung cancer

This study aimed to compare patterns of sedentary behaviour (SB) and physical activity (PA) in people following curative intent treatment for non-small cell lung cancer (NSCLC) with healthy controls. Participants 6-10 weeks following lobectomy for NSCLC and healthy controls wore two activity monitors for 7 days. Waking hours were divided into time spent in SB (<1.5 metabolic equivalent of tasks (METs)), light intensity PA (LIPA ≥ 1.5 to <3.0METs) and moderate-to-vigorous intensity PA (≥3.0METs). Daily steps were also recorded. Data were available in 20 participants with NSCLC (13 females; 68 ± 10 years) and 20 healthy controls (13 females; 69 ± 5 years). The NSCLC group accumulated a greater percentage of time in SB in uninterrupted bouts ≥30 minutes (49% vs. 42%; p = 0.048). Further, the NSCLC group spent a lower percentage of waking hours in LIPA (21 ± 9% vs. 26 ± 8%; p = 0.04) and accumulated a lower percentage of time in this domain in uninterrupted bouts ≥10 minutes (13% vs. 19%; p = 0.025). The NSCLC group also had a lower daily step count (8863 ± 3737 vs. 11,856 ± 3024 steps/day; p = 0.009). Time spent in moderate-to-vigorous intensity PA was similar in both groups (p = 0.92). People following curative intent treatment for NSCLC spend more time in prolonged bouts of SB at the expense of LIPA

Effects of high intensity interval training on exercise capacity in people with cystic fibrosis: study protocol for a randomised controlled trial

Background: In people with cystic fibrosis (CF), higher exercise capacity is associated with better health-related quality of life (HRQoL), reduced risk of hospitalisation for a respiratory infection and survival. Therefore, optimisation of exercise capacity is an important treatment goal. The Australian and New Zealand clinical practice guidelines recommend that people with CF complete 30 to 60 min of moderate intensity aerobic exercise on most days of the week. This recommendation can be difficult to achieve by people with CF because of time constraints, and intolerable breathlessness and muscle fatigue during continuous exercise. In contrast, a low-volume, high intensity interval training (HIIT) program may be a more achievable and efficient training method to improve exercise capacity in people with CF. Methods: A randomised controlled trial will be undertaken. Forty people with CF (aged ≥15 years) will be randomly allocated, on a 1:1 ratio, to either the experimental or control group. Regardless of their group allocation, all participants will be asked to continue with their usual daily treatment for the study duration. Those in the experimental group will complete 8 weeks of thrice weekly HIIT on a cycle ergometer. Those in the control group will receive weekly contact with the investigators. The primary outcome of this study is exercise capacity. Secondary outcomes are HRQoL, exercise self-efficacy, feelings of anxiety, depression and enjoyment. These outcomes will be recorded at baseline (i.e. prior to randomisation) and following the 8-week intervention period. The study will also report other outcomes of the HIIT program (cardiovascular responses, symptom response, post-exercise muscle soreness and tolerance) and behaviour change techniques such as reinforcement, feedback and goal setting, used during the HIIT program. Discussion: This study will determine the effects of 8-weeks of supervised, low-volume HIIT, completed on a cycle ergometer on measures of exercise capacity, HRQoL, exercise self-efficacy, feelings of anxiety, depression and enjoyment. If effective, this type of training could be an attractive alternative to traditional continuous training because it may be more achievable and time efficient

Impairments after curative intent treatment for non-small cell lung cancer: A comparison with age and gender-matched healthy controls

Background: The aim of this study was to compare measures of exercise capacity, health-related quality of life (HRQoL), muscle force, lung function and feelings of anxiety and depression in people after curative intent treatment for NSCLC with age and gender-matched healthy controls. Methods: This cross-sectional study included 23 participants (68 ± 10yr; 16 females), 6–10 weeks after lobectomy for NSCLC or, for those who received adjuvant chemotherapy, 4–8 weeks after their last cycle. The study also included 20 age and gender-matched healthy controls (69 ± 5yr; 13 females). All participants underwent measurements of exercise capacity (cycle-ergometry test [CPET] and 6-min walk test [6MWT]), HRQoL (Short-Form 36 general health survey [SF-36]), handgrip force, quadriceps torque, lung function and feelings of anxiety and depression. Results When compared with data collected in healthy controls, those in the NSCLC group demonstrated impairments in the peak rate of oxygen consumption (15 ± 3 versus 24 ± 7 ml kg−1·min−1; p < 0.001) and maximum work rate (75 ± 25 versus 127 ± 51Watts; p < 0.001) measured during the CPET, and 6-min walk distance (494 ± 77 versus 649 ± 61 m; p < 0.001). Similarly, impairments were demonstrated in all domains of the SF-36 (p < 0.01 for all), isometric handgrip force (28 ± 7 versus 34 ± 10 kg; p = 0.02), and all measures of lung function (p ≤ 0.001 for all). A higher score for depression was also seen (3.0 ± 2.5 versus 1.5 ± 1.6; p = 0.03). There was no difference between the groups in isometric quadriceps torque or feelings of anxiety.Conclusions: After curative intent treatment for NSCLC, compared to healthy controls, impairments were demonstrated in laboratory and field-based measures of exercise capacity, HRQoL, isometric handgrip force and lung function. Although people after curative intent treatment for NSCLC reported greater feelings of depression, these levels were below those considered clinically relevant. These findings suggest that people after curative intent treatment for NSCLC may benefit from rehabilitative strategies to optimise exercise capacity and HRQoL

Prevalence of suspected poor bone health in people with chronic obstructive pulmonary disease - A cross-sectional exploratory study

Background: Compared to the general population, adults with chronic obstructive pulmonary disease (COPD) have an increased prevalence of osteoporosis. Despite the known risk factors and potential complications of compromised bone health in COPD, little is known about whether poor bone health is routinely suspected. We measured, in people with COPD, the prevalence of those who had one or more indicators suggestive of suspected poor bone health, and compared the characteristics of those with versus without these indicators. Methods: Data were collected from adults with COPD presenting to three tertiary hospitals. Indicators of suspected poor bone health were defined as any of the following criteria: (i) self-reported problems with bone health, (ii) previous imaging for bone health, (iii) history of fragility fracture or, (iv) advised to use medication/supplements to optimise bone health. Characteristics compared between those with versus without indicators of suspected poor bone health comprised age, sex, body mass index (BMI), FEV1% predicted and recruitment setting. Results: 361 participants were included (age 70 ± 10, BMI 27.9 ± 7.8 kg/m2, FEV1 % predicted 49 ± 20; 161 [45 %] female). Indicators suggestive of suspected poor bone health were present in 53 % (95 % confidence interval [CI] 47-58) of the participants. The odds of this outcome increased with advancing age (odds ratio; OR [95 % CI] 1.05 [1.03 to 1.08]) and being female (OR [95 % CI] 3.4 [2.2 to 5.7]) . Conclusion: In people with COPD, the odds of having indicators suggestive of suspected poor bone health increase with advancing age and in females. Further work is required to promote the importance of bone health in this population