Contrasting the physiological effects of heliox and oxygen during exercise in a patient with advanced COPD

In COPD patients the ergogenic effect of heliox or oxygen breathing might be related both to improvements in ventilatory parameters (that lessen dyspnoea) and to enhanced oxygen delivery to respiratory and locomotor muscles

Contrasting the physiological effects of heliox and oxygen during exercise in a patient with advanced COPD

In COPD patients the ergogenic effect of heliox or oxygen breathing might be related both to improvements in ventilatory parameters (that lessen dyspnoea) and to enhanced oxygen delivery to respiratory and locomotor muscles

Physiological basis of cardiopulmonary rehabilitation in patients with lung or heart disease

Shortness of breath associated with cardiorespiratory abnormalities and peripheral muscle discomfort are the major factors that limit exercise capacity in patients with chronic obstructive pulmonary disease (COPD) and those with congestive heart failure (CHF). Both of these symptoms negatively impact on patients’ daily physical activity levels. In turn, poor daily physical activity is commonly associated with increased rates of morbidity and mortality. Cardiopulmonary rehabilitation programmes partially reverse muscle weakness and dysfunction and increase functional capacity in both COPD and CHF. However, benefits gained from participation in cardiopulmonary rehabilitation programmes are regressing soon after the completion of these programmes. Moreover, several barriers limit access and uptake of cardiopulmonary rehabilitation programmes by eligible patients. A potential solution to the underutilisation of cardiopulmonary rehabilitation is the implementation of tele-rehabilitation interventions at home using information and communications technologies. Thus, tele-rehabilitation may be useful to encourage and educate patients with COPD or CHF on how best to maintain and/or further enhance daily physical activity levels

The physiological demands of 'hiking' on dinghy sailors

The purpose of the studies presented in this thesis was to combine on-water and off-water measurements in order to investigate the physiological demands of the major physical challenge in dinghy sailing: the '"hiking" effort, which is performed in order to counterbalance a dinghy in moderate and stronger winds. This purpose was achieved by:-1) Investigating the course of a number of physiological variables under actual sailing conditions. 2) Using this information to closely simulate sailing in the laboratory. 3) Investigating in the laboratory a number of physiological variables which could not be studied under real sailing conditions. On the basis of the resultant findings sailing-specific training regimes were administered to sailors to assist them in maximising hiking performance. The use of portable telemetry allowed investigation of a number of cardiorespiratory parameters during actual sailing conditions. A series of on- water measurements revealed that aerobic capacity is only moderately taxed in dinghy sailing (39.5 +/- 6.0 % VO2 max at wind-speeds of between 4 and 12 ms-1 in 'Laser' dinghies) whereas the cardiac and respiratory functions are taxed proportionally more, thus leading to a marked tachycardia (74 +/- 10 % HR max) and hyperventilation (VE/VO2: 26.8 +/- 1.6). Blood lactate concentration measurements suggested that anaerobic metabolism plays an increasing role in stronger winds. The causes of tachycardia and hyperventilation were further investigated during simulated hiking. The latter investigation offered evidence of a direct association between the onset and magnitude of fatigue in quadriceps muscle groups and the cardiovascular and ventilatory drives. The development of muscular fatigue, which was mirrored in the progressive increase in the quadriceps EMG activity, is likely to have led, directly or indirectly, to the progressive tachycardia and hyperventilation. These changes in HR, VE and EMG activity occurred in the absence of changes in the lactate concentration. Further EMG measurements carried out during simulated hiking suggests that fatigue in quadriceps is due to the high degree to which these muscles were activated during hiking (approximately 30 % maximum) and that it seems reasonable to believe that local muscular fatigue is the most likely factor to limit hiking performance. Although an improvement in hiking performance was achieved after the administration of different training regimes, the present findings offer no conclusive evidence of the mechanisms responsible for resisting fatigue in quadriceps and thus maximising hiking performance. It was concluded that training regimes for sailors should not emphasise aerobic fitness but the local static endurance of the thigh muscles

Implementation of digital health interventions in respiratory medicine:a call to action by the European Respiratory Society m-Health/e-Health Group

An action plan prepared by @EuroRespSoc Group 01.04 (m-health/e-health) concerning the implementation of digital health interventions in respiratory medicine http://bit.ly/2JeEuox

Patients' perspective on pulmonary rehabilitation: experiences of European and American individuals with chronic respiratory diseases

Despite the fact that pulmonary rehabilitation (PR) is the most powerful nonpharmacological intervention to improve the symptoms, exercise capacity and quality of life of people living with chronic lung disease [1], fewer than 2% of eligible patients enrol [2, 3]. While preparing a joint American Thoracic Society (ATS)/European Respiratory Society (ERS) Policy Statement on pulmonary rehabilitation [4], we developed a survey to better understand patients' perspectives on PR, and to identify challenges faced both by patients who have taken part in PR and those who might be eligible but have not had the opportunity. The survey was disseminated via the European Lung Foundation/ERS and ATS Public Advisory Roundtable professional patient networks, and via the COPD Foundation and Pulmonary Fibrosis Foundation to patients with a wide range of chronic lung diseases. The survey was available online from July, 2014 to November, 2014 in 10 languages (Dutch, English, Flemish, French, German, Greek, Italian, Polish, Portuguese and Spanish). Responses were received from 1685 people (73% female) with self-reported chronic lung disease in 29 countries (USA: 71.1%; Europe: 27.4%; others: 1.5%) and were included in the analyses (table 1)

Interval training induces clinically meaningful effects in daily activity levels in COPD

Mounting evidence suggests that daily activity levels (DAL) in patients with chronic obstructive pulmonary disease (COPD) are markedly low compared with healthy age-matched individuals and are associated with poorer health status and prognosis [1]. COPD severity negatively impacts on DAL since patients with low DAL experience greater ventilatory, central haemodynamic and peripheral muscle oxygenation constraints during activities of daily living when compared with more physically active counterparts [2, 3]. Although exercise training as part of pulmonary rehabilitation has shown to mitigate the aforementioned physiological constraints [4], there is no evidence of clinically meaningful improvements in DAL following pulmonary rehabilitation [5] as manifested by a mean increase of at least 1000 steps·day−1 [6]. This has been attributed to methodological shortfalls, such as lack of adequately controlled studies, small sample size, short duration of pulmonary rehabilitation programmes, application of activity monitors non-validated for COPD patients [5] and insufficient exercise intensities to induce true physiological training effects. Interval exercise training has been shown to allow application of intense loads to peripheral muscles that induce substantial physiological effects manifested by mitigation of respiratory and central haemodynamic limitations and partial restoration of peripheral muscle dysfunction in patients with diverse COPD severity [7, 8]. In this context, it is reasoned that application of this training modality would allow transfer of the aforementioned physiological benefits into clinically meaningful improvements in DAL [2, 3]. Accordingly, the purpose of this randomised controlled study was to investigate the effect of a 12-week high-intensity interval exercise training programme in DAL in addition to usual care in patients with COPD

Limitation in tidal volume expansion partially determines the intensity of physical activity in COPD

open8In patients with Chronic Obstructive Pulmonary Disease (COPD) reduced levels of daily physical activity are associated with the degree of impairment in lung, peripheral muscle and central hemodynamic function. There is however, limited evidence as to whether limitations in tidal volume expansion also, importantly determine daily physical activity levels in COPD. Eighteen consecutive COPD patients [9 active (FEV1:1.59±0.64 liters) with an average daily movement intensity >1.88 m/sec(2) and 9 less active patients (FEV1:1.16±0.41 liters) with an average intensity <1.88 m/sec(2)] underwent a 4-min treadmill test at a constant speed corresponding to each individual patient's average movement intensity, captured by a triaxial accelerometer during a preceding 7-day period. When chest wall volumes, captured by Optoelectronic Plethysmography, were expressed relative to comparable levels of minute ventilation (ranging between 14.5±4.3 to 33.5±4.4 liters/min), active patients differed from the less active ones in terms of the lower increase in end-expiratory chest wall volume (by 0.15±0.17 versus 0.45±0.21 liters), the greater expansion in tidal volume (by 1.76±0.58 versus 1.36±0.24 liters) and the larger inspiratory reserve chest wall volume (IRVcw: by 0.81±0.25 versus 0.39±0.27 liters). IRVcw (r(2)=0.420), expiratory flow (r(2) change=0.174) and Borg dyspnoea score (r(2) change=0.123) emerged as the best contributors accounting for 71.7\% of the explained variance in daily movement intensity. COPD patients exhibiting greater ability to expand tidal volume and to maintain adequate inspiratory reserve volume tend to be more physically active. Thus, interventions aiming at mitigating restrictions on operational chest wall volumes are expected to enhance daily physical activity levels in COPD.openE. A. Kortianou;A. Aliverti;Z. Louvaris;M. Vasilopoulou;I. Nasis;A. Asimakos;S. G. Zakynthinos;I. VogiatzisE. A., Kortianou; Aliverti, Andrea; Z., Louvaris; M., Vasilopoulou; I., Nasis; A., Asimakos; S. G., Zakynthinos; I., Vogiatzi