Physiospot CardioRespiratory

The immediate effect of musculoskeletal physiotherapy techniques and massage on pain and ease of breathing in adults with cystic fibrosis.

 

Lee A, Holdsworth M, Holland A, Button B

The optimal treatment approach to musculoskeletal pain in cystic fibrosis remains unclear. This study aimed to examine the effect of a combination of musculoskeletal physiotherapy techniques and massage therapy on musculoskeletal pain and ease of breathing.

A single treatment session was associated with reduction in pain and improvement in ease of breathing in adults with cystic fibrosis.

Journal of Cystic Fibrosis, 2008 Aug, online article ahead of print

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Group-based Aerobic Training in Patients With Chronic Heart Failure: Norwegian Ullevaal Model

Nilsson BB, Hellesnes B, Westheim A, Risberg MA

This case report describes the responses of four patients with chronic heart failure (NYHA III), to a group-based, high-intensity, interval training rehabilitation programme that included aerobic, resistance, flexibility and balance actvities. The four patients each experienced improvements in physical capacity and quality of life with no adverse events. This study adds support to the growing body of evidence that high-intensity interval training should be included into programmes for people with chronic heart failure.

Physical Therapy 2008; 88: 523 – 535

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Predictive Utility of the 6-Minute Walk Distance on Survival in Patients Awaiting Lung Transplantation

Tuppin MP, Paratz JD, Chang AT, Seale HE, Walsh JR, Kermeeen FD, McNeil KD, Hopkins PM

This study aimed to determine the hazard function associated with the 6MWD, and its utility relative to other prognostic variables in all patients on the lung transplant list. A retrospective chart review was conducted on 163 patients who were listed for single or double LT, and either survived to transplant or died while on the waiting list. Patients included had either a diagnosis of COPD, Cystic Fibrosis or Interstitial Lung Disease.

The 6MWD proved to be the most predictive variable of outcome (survival), demonstrating that those with a greater 6MWD have a lower risk of death. A protective effect for each unit increase in the 6MWD was also demonstrated. This research demonstrates that the 6MWD is useful for stratifying patients on the lung transplant waiting list by identifying those patients with a significantly higher risk of mortality.

The Journal of Heart and Lung Transplantation 2008; 27: 729 – 734

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Noninvasive ventilation in acute cardiogenic pulmonary edema.

Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J

This large multicenter, randomized, controlled trial set out to establish whether; noninvasive ventilation (continuous positive airway pressure (CPAP) or noninvasive intermittent positive-pressure ventilation (NIPPV)) reduces mortality and if there are important differences in outcome associated with the method of treatment, in a group of patients with acute cardiogenic pulmonary oedema.

Their findings included no significant difference in; 7-day mortality between patients receiving standard oxygen therapy and those undergoing noninvasive ventilation, or in the combined end point of death or intubation within 7 days between the two groups of patients undergoing noninvasive ventilation. Noninvasive ventilation was associated with greater mean improvements at 1 hour after the beginning of treatment in patient-reported dyspnea, heart rate, acidosis and hypercapnia. There were no treatment-related adverse events.

New England Journal of Medicine 2008; 359: 142-51.

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Whole body vibration: a new therapeutic approach to improve muscle function in cystic fibrosis?

Rietschel E, Koningsbruggen S, Fricke O, Semlar O, Schoenau E

This study aimed to evaluate the effects of Whole Body Vibration (WBV) on muscle function in patients with Cystic Fibrosis (CF). The theory behind WBV is that it stimulates muscle contractions via stretch reflexes, thereby improving muscle activity.

During treatment with WBV the following tests were carried out; Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV), BMI, chair rising test, one and two leg jump test and grip strength.

The most significant improvements were noted in BMI and weight. FVC and FEV showed improvements but these were not significant. The authors state that the outcomes of the study support the use of WBV to improve muscle function in patients with CF.

International Journal of Rehabilitation Research, 2008, 31(3), 253-256

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During exercise non-invasive ventilation in chronic restrictive respiratory failure.

Borel JC, Wuyam B, Chouri-Pontarollo N, Deschaux C, Levy P, Pépin JL

The objective of this study was to investigate exercise endurance and associated physiological responses with non-invasive ventilation (NIV) during exercise in restrictive CRF patients. Eighteen patients performed maximal exercise in spontaneous breathing conditions (MWLE) and during two constant workload exercise (CWLE) tests at 75% Pmax, with or without NIV in random order.  For the whole group, CWLE duration when using NIV increased which correlated with reduction in heart rate and oxygen desaturation, and dyspnea relief during exercise. NIV responders showed more severe lung restriction.  At the end of MWLE, responders had a lower Vt, a higher dead-space ratio and lower oxygen pulse.

In severely restrictive patients, NIV during exercise significantly improved exercise duration and tolerance and increased alveolar ventilation.

Respiratory Medicine, 2008, 102(5), 711-9

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The metabolic response during resistance training and neuromuscular electrical stimulation (NMES) in patients with COPD, a pilot study.

Sillen MJ, Janssen PP, Akkermans MA, Wouters EF, Spruit MA

The purpose of this study was to compare the metabolic response during resistance training and during neuromuscular electrical stimulation (NMES) of the quadriceps femoris muscles in patients with COPD entering pulmonary rehabilitation. Pulmonary function, body composition, peak aerobic capacity, the Medical Research Council dyspnoea grade, the one-repetition maximum strength assessment were evaluated in 13 COPD patients. The median peak oxygen uptake and median peak minute ventilation during the resistance training session were significantly higher compared to the NMES session. Additionally, these higher metabolic responses were accompanied by higher symptom Borg scores for dyspnoea and leg fatigue.

The metabolic response was significantly lower during a NMES session compared to a resistance exercise training session in patients with COPD. Nevertheless, both modalities seem to result in an acceptable metabolic response accompanied by a clinically acceptable sensation of dyspnoea and leg fatigue.

Respiratory Medicine, 2008, 102(5), 786-9

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Effect of Intensity of Aerobic Training on VO2max

Gormley SE, Swain DP, High R, Spina RJ, Dowling EA, Kotipalli US, Gandrakota R

The main aim of this study was to determine whether various intensities of aerobic training differentially affect aerobic capacity in 61 healthy adults aged between 21 and 44 years. A secondary purpose of the study was to examine the effects of training intensity on resting HR and resting BP.

The main finding of the study was that when the volume of exercise is controlled higher intensities of exercise elicit greater improvements in VO2max than lower intensities of exercise over a 4 to 6 week training period in healthy, young adults. Unlike VO2max, there were no changes observed in resting HR and resting BP after training.

Medicine and Science in Sports and Exercise 2008; 40: 1336-1343.

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Determinants of lung volumes in chronic spinal cord injury.

Stepp EL, Brown R, Tun CG, Gagnon DR, Jain NB, Garshick E.

Determinants of lung volumes in 330 white males with chronic spinal cord injuries (SCI) were sought using questionnaire outcomes and spirometry measurements. When adjusted for SCI severity and stature, greater body mass index (BMI) was associated significantly with lower total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), and expiratory reserve volume (ERV). The effect of BMI on RV was most pronounced in quadriplegia. Lifetime smoking was associated with a greater FRC and RV. Time since injury, independent of age, was associated with a decrease in TLC, FRC, ERV, and RV. Age was not a predictor of TLC once time since injury was considered.

The authors conclude that determinants of FRC, TLC, ERV, and RV in chronic SCI include factors related and unrelated to SCI. By addressing modifiable factors such as obesity, muscle stiffness, and smoking, respiratory morbidity and mortality in SCI may be reduced by improving pulmonary function.

Archives of Physical Medicine and Rehabilitation 2008; 89: 1499-506

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Influence of spontaneous pursed lips breathing on walking endurance and oxygen saturation in patients with moderate to severe chronic obstructive pulmonary disease

Faager, G., Stahle, A., Larsen, F.

The objective of this study was to evaluate how spontaneously used pursed lips breathing influences walking endurance, oxygen saturation and dyspnoea in patients with moderate to severe chronic obstructive pulmonary disease.  Thirty-two patients with moderate to severe chronic obstructive pulmonary disease performed two endurance shuttle walking tests in random order. During endurance shuttle walking test I a mouthpiece was used in order to prevent spontaneous pursed lips breathing. During endurance shuttle walking test II spontaneous pursed lips breathing was used freely. When spontaneous pursed lips breathing was used the patients walked on an average for 37 seconds longer than when pursed lips breathing was prevented. The patients desaturated considerably during both walking tests but the average drop in oxygen saturation was 1.2% less when spontaneous pursed lips breathing was employed.

Spontaneous pursed lips breathing can be a useful technique to increase walking endurance and reduce oxygen desaturation during walking in patients with moderate to severe chronic obstructive pulmonary disease.

Clinical Rehabilitation, 2008, 22(8), 675-683

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