Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. A randomised controlled trial to investigate the use of high-frequency airway oscillations as training to improve dyspnoea in COPD Clinical outcomes of expiratory muscle training in severe COPD patients. Short-term preoperative exercise therapy does not improve long-term outcome after lung cancer surgery: a randomized controlled study† Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial The immediate effect of soft tissue manual therapy intervention on lung function in severe chronic obstructive pulmonary disease Maximum Exercise as an Outcome in COPD: Minimal Clinically Important Difference Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial. Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial. Fibre types in skeletal muscles of chronic obstructive pulmonary disease patients related to respiratory function and exercise tolerance. The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy Preoperative Pulmonary Rehabilitation for Lung Transplant: Effects on Pulmonary Function, Exercise Capacity, and Quality of Life; First Results in Turkey. Polyunsaturated fatty acids improve exercise capacity in chronic obstructive pulmonary disease. Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy. How should we train the upper limbs? Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial Study Design of VESUTO®: Efficacy of Tiotropium/Olodaterol on Lung Hyperinflation, Exercise Capacity, and Physical Activity in Japanese Patients with Chronic Obstructive Pulmonary Disease Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial Tai chi Qigong improves lung functions and activity tolerance in COPD clients: a single blind, randomized controlled trial. Safety and Feasibility of an Exercise Intervention for Patients Following Lung Resection
OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy Introduction Chronic obstructive pulmonary disease ( COPD ) is characterised by expiratory flow limitation result ing in symptomatic dyspnoea , sputum retention and ventilation heterogeneity . Changes in breathing mechanics affect the ability of respiratory muscles to respond to the ventilatory dem and s , increasing the sensation of dyspnoea . A high-frequency airway oscillating device has been developed to combine respiratory muscle training and oscillations to improve dyspnoea and sputum retention within COPD . Methods and analysis Patients with symptomatic COPD ( Medical Research Council Breathlessness scale grade ≥2 ) will be recruited to a double-blind , r and omised , sham-controlled trial . Both groups will follow an 8-week intervention phase using the device three times per day for 5 min at a time . This will be recorded in a self-reported diary . The device applies a flow resistive load and oscillations for combined training . Those receiving the sham device will follow the same protocol ; however , the mechanism of action will be removed from the device . Improvements in the Chronic Respiratory Question naire-Dyspnoea domain will be the primary outcome measure . Secondary outcomes will explore respiratory muscle function , health-related quality of life , exercise capacity and physical activity . The Lung Clearance Index will be an exploratory outcome . Outcomes will be explored using the most appropriate statistical test , dependent on the sample distribution . Focus groups will be an exploratory outcome and analysed by thematic analysis . Ethics and dissemination Ethical approval has been obtained from the East Midl and s-Leicester South Research Ethics Committee and the trial has been registered through the IS RCT N Registry . The study results will be disseminated to the appropriate stakeholders through presentations , conferences and peer- review ed journals . A double-blind , placebo-controlled , r and omised trial investigating the effects of high-frequency airway oscillations  on dyspnoea , sputum , quality of life and exercise capacity in # COPD . UNLABELLED The most common symptoms in chronic obstructive pulmonary disease ( COPD ) patients are breathlessness and exercise limitation . Although both general and inspiratory muscle training have shown clinical benefits , the effects of specific expiratory muscle training remain controversial . OBJECTIVE To investigate the effects of expiratory training on lung function , exercise tolerance , symptoms and health-related quality of life in severe COPD patients . METHODS Sixteen patients ( FEV(1 ) , 28+/-8 % pred . ) were r and omised to either expiratory muscle or sham training groups , both completing a 5-week programme ( 30 min sessions breathing through an expiratory threshold valve 3 times per week ) ( 50 % of their maximal expiratory pressure ( MEP ) vs. placebo , respectively ) . Lung function , exercise capacity ( bicycle ergometry and walking test ) , and clinical outcomes ( dyspnoea and quality of life ( St. George Respiratory Question naire ( SGRQ ) ) were evaluated both at baseline and following the training period . RESULTS Although lung function remained roughly unchanged after training , exercise capacity , symptoms and quality of life significantly improved . The improvement in both walking distance and the SGRQ score significantly correlated with changes in MEP . CONCLUSION Our results confirm that a short outpatient programme of expiratory training can improve symptoms and quality of life in severe COPD patients . These effects could be partially explained by changes in expiratory muscle strength OBJECTIVES Poor aerobic fitness is a potential modifiable risk factor for long-term survival and quality of life in patients with lung cancer . This r and omized trial evaluates the impact of adding rehabilitation ( Rehab ) with high-intensity interval training ( HIIT ) before lung cancer surgery to enhance cardiorespiratory fitness and improve long-term postoperative outcome . METHODS Patients with operable lung cancer were r and omly assigned to  usual care ( UC , n = 77 ) or to intervention group ( Rehab  , n = 74 ) that entailed HIIT that was implemented only preoperatively .  Cardiopulmonary exercise testing ( CPET ) and pulmonary functional tests ( PFTs ) including forced vital capacity ( FVC ) , forced expiratory volume ( FEV 1 ) and carbon monoxide transfer factor ( KCO ) were performed before and 1 year after surgery . RESULTS During the preoperative waiting time ( median 25 days ) , Rehab patients participated to a median of 8 HIIT sessions ( interquartile [ IQ ] 25 - 75 % , 7 - 10 ) . At 1 year follow-up , 91 % UC patients and 93 % Rehab patients were still alive ( P = 0.506 ) . Pulmonary functional changes were non-significant and comparable in both groups ( FEV 1 mean -7.5 % , 95 % CI , -3.6 to -12.9 and in KCO mean 5.8 % 95 % CI 0.8 - 11.8 ) Compared with preoperative CPET results , both groups demonstrated similar reduction in peak oxygen uptake ( mean -12.2 % 95 % CI -4.8 to -18.2 ) and in peak work rate ( mean -11.1 % 95 % CI -4.2 to -17.4 ) . CONCLUSIONS Short-term preoperative rehabilitation with HIIT does not improve pulmonary function and aerobic capacity measured at 1 year after lung cancer resection . TRIAL REGISTRY Clinical Trials.gov ; No. NCT01258478 ; www . clinical trials.gov BACKGROUND The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated . METHODS A prospect i ve observational study was design ed . Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test . In such conditions , maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated ; when this result ed as being < or = 15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered . Twelve patients fulfilled inclusion criteria , completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery . The postoperative record of these patients was collected . RESULTS On completion of pulmonary rehabilitation , the resting pulmonary function test and diffuse lung capacity of patients was unchanged , whereas the exercise performance was found to have significantly improved ; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min ( p<0.01 ) . Eleven patients underwent lobectomy ; no postoperative mortality was noted and mean hospital stay was 17 days . Postoperative pulmonary complication was recorded in 8 patients . CONCLUSIONS Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are c and i date s for lung resection for non-small cell lung cancer Complete surgical resection is the most effective curative treatment for lung cancer . However , many patients with lung cancer also have severe COPD which increases their risk of postoperative complications and their likelihood of being considered " inoperable . " Preoperative pulmonary rehabilitation ( PR ) has been proposed as an intervention to decrease surgical morbidity but there is no established protocol and no r and omized study has been published to date . We tested two preoperative PR interventions in patients undergoing lung cancer resection and with moderate-severe COPD in a r and omized single blinded design . Outcomes were length of hospital stay and postoperative complications . The first study tested 4 weeks of guideline -based PR vs. usual care : that study proved to be very difficult to recruit as patients and providers were reluctant to delay surgery . Nine patients were r and omized and no differences were found between arms . The second study tested ten preoperative PR sessions using a customized protocol with nonst and ard components ( exercise prescription based on self efficacy , inspiratory muscle training , and the practice of slow breathing ) ( n=10 ) vs. usual care ( n=9 ) . The PR arm had shorter length of hospital stay by 3 days ( p=0.058 ) , fewer prolonged chest tubes ( 11 % vs. 63 % , p=0.03 ) and fewer days needing a chest tube ( 8.8 vs. 4.3 days p=0.04 ) compared to the controlled arm . A ten-session preoperative PR intervention may improve post operative lung reexpansion evidence d by shorter chest tube times and decrease the length of hospital stay , a crude estimator of post operative morbidity and costs . Our results suggest the potential for short term preoperative pulmonary rehabilitation interventions in patients with moderate-severe COPD undergoing curative lung resection . 4 weeks of conventional preoperative PR seems non feasible Objectives : To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery .  Design : R and omized , single-blind controlled trial . Setting : Teaching hospital . Subjects : Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery .  Intervention : Participants were r and omized  to either a prehabilitation group or a control group .  Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week . Main measures : The primary outcome of the study was exercise capacity . Secondary outcomes were muscle strength ( Senior Fitness Test ) , health-related quality of life ( Short-Form 36 ) and the postoperative outcomes . Patients were evaluated at baseline ( before r and omization ) , presurgery ( only the prehabilitation group ) , after surgery and three months post-operatively . Results : A total of 40 patients were r and omized and 22 finished the study ( 10 in the prehabilitation group and 12 in the control group ) . Three patients were lost to follow-up at three months . After the training , there was a statistically significant improvement in exercise tolerance ( + 397 seconds , p = 0.0001 ) , the physical summary component of the SF-36 ( + 4.4 points , p = 0.008 ) and muscle strength ( p < 0.01 ) . There were no significant differences between groups after surgery . However , three months postoperatively , significant differences were found in the mean change of exercise capacity ( p = 0.005 ) , physical summary component ( p = 0.001 ) and upper and lower body strength ( p = 0.045 and p = 0.002 ) . Conclusions : A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients ’ preoperative condition and may prevent functional decline after surgery . Clinical Registration Number : NCT01963923 ( Registration date 10/10/2013 Background and objective In chronic obstructive pulmonary disease ( COPD ) , accessory respiratory muscles are recruited as a compensatory adaptation to changes in respiratory mechanics . This results in shortening and overactivation of these and other muscles . Manual therapy is increasingly being investigated as a way to alleviate these changes . The aim of this study was to measure the immediate effect on lung function of a soft tissue manual therapy protocol ( STMTP ) design ed to address changes in the accessory respiratory muscles and their associated structures in patients with severe COPD . Methods Twelve medically stable patients ( n=12 ) with an existing diagnosis of severe COPD ( ten : GOLD Stage III and two : GOLD Stage IV ) were included .  Residual volume , inspiratory capacity and oxygen saturation ( SpO2 ) were recorded immediately before and after administration of the STMTP . A Student ’s t-test was used to determine the effect of the manual therapy intervention ( P<0.05 ) . Results The mean age of the patients was 62.4 years ( range 46–77 ) . Nine were male .  Residual volume decreased from 4.5 to 3.9 L ( P=0.002 ) , inspiratory capacity increased from 2.0 to 2.1 L ( P=0.039 ) and SpO2 increased from 93 % to 96 % ( P=0.001 ) . Conclusion A single application of an STMTP appears to have the potential to produce immediate clinical ly meaningful improvements in lung function in patients with severe and very severe COPD Limitation of physical activity occupies a central role in the symptom complex of patients with chronic obstructive pulmonary disease ( COPD ) , and improvement in exercise capacity is a key outcome of response to COPD therapy . Maximum exercise capacity testing facilitates assessment of physiologic mechanisms of exercise and allows quantitation of the degree of limitation . This manuscript utilizes published data from the National Emphysema Treatment Trial to investigate the minimal clinical ly important difference ( MCID ) in maximum exercise capacity in patients with severe emphysema . Distribution- and opinion-based methods were used to estimate MCID . Expert clinician opinion yielded a value of 10 Watts as the MCID for change in maximum exercise capacity . Baseline st and ard deviation and error data yielded a one-half st and ard deviation-based estimate of 10.5 Watts and a st and ard error-based estimate of 4.2 Watts . In subjects r and omized to medical therapy , the mean ( ± SD ) 24-month change in maximum exercise capacity following medical therapy was − 9.2 ± 1.2 Watts , whereas among those r and omized to lung volume reduction surgery , mean 24-month change in maximum exercise capacity was 1.7 ± 17.7 Watts , with a mean difference between the groups of 10.9 Watts . The observed difference in maximum exercise capacity after 24 months between subjects r and omized to medical versus surgical therapy conforms to both opinion- and distribution-based estimates of MCID . Further investigation is needed to develop and vali date estimates of MCID for maximum exercise capacity and other key clinical outcomes in COPD BACKGROUND Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer ( NSCLC ) . The best design for exercise interventions in these patients has not been determined yet . AIM To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery . DESIGN Prospect i ve , single-blind , pilot r and omized controlled trial . SETTING Outpatient cardiopulmonary rehabilitation unit of two university hospitals . POPULATION Thirty-seven patients with NSCLC after tumor resection . METHODS Patients were r and omly assigned to exercise training or usual post-operative care . The training program consisted of aerobic exercises and high-intensity respiratory muscle training ( 24 supervised sessions , 3 per week , 8 weeks ) . Primary outcome was exercise capacity assessed with peak oxygen uptake ( VO2peak ) during cardiopulmonary exercise test . Secondary outcomes included changes in respiratory muscle strength , levels of serum insulin growth factor I ( IGF-I ) and IGF binding protein 3 ( IGFBP-3 ) , and quality of life assessed with the European Organization for Research and Treatment of Cancer ( EORTC QLQ-C30 ) question naire . RESULTS The 8-week training program was associated with significant improvement in VO2peak ( 2.13 mL/Kg/min [ 95%CI 0.06 to 4.20 ] ) , maximal inspiratory and expiratory pressures ( 18.96 cmH2O [ 95 % CI 2.7 to 24.1 ] and 18.58 cmH2O [ 95 % CI 4.0 to 33.1 ] , respectively ) and IGFBP-3 ( 0.61 µg/mL [ % 95 CI 0.1 to 1.12 ] ) . No significant differences were observed in the EORTC QLQ-C30 . CONCLUSIONS An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity , respiratory muscle strength , and serum IGFBP-3 levels in NSCLC patients after lung resection . There was no impact on the other outcomes assessed . CLINICAL REHABILITATION IMPACT A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery Introduction The aim of this study was to assess the effects of preoperative pulmonary rehabilitation ( PPR ) on preoperative clinical status changes in patients with chronic obstructive pulmonary disease ( COPD ) and non-small cell lung cancer ( NSCLC ) , and net effects of PPR and cancer resection on residual pulmonary function and functional capacity . Material and methods This prospect i ve single group study included 83 COPD patients ( 62 ±8 years , 85 % males , FEV1 = 1844 ±618 ml , Tiffeneau index = 54 ±9 % ) with NSCLC , on 2–4-week PPR , before resection . Pulmonary function , and functional and symptom status were evaluated by  spirometry , 6-minute walking distance ( 6MWD ) and Borg scale , on admission , after PPR and after surgery . Results Following PPR significant improvement was registered in the majority of spirometry parameters ( FEV1 by 374 ml , p < 0.001 ; VLC by 407 ml , p < 0.001 ; FEF50 by 3 % , p = 0.003 ) , 6MWD ( for 56 m , p < 0.001 ) and dyspnoeal symptoms ( by 1.0 Borg unit , p < 0.001 ) . A positive correlation was identified between preoperative increments of FEV1 and 6MWD ( r s = 0.503 , p = 0.001 ) . Negative correlations were found between basal FEV1 and its percentage increment ( r s = –0.479 , p = 0.001 ) and between basal 6MWD and its percentage change ( r s = –0.603 , p < 0.001 ) during PPR . Compared to basal values , after resection a significant reduction of most spirometry parameters and 6MWD were recorded , while Tiffeneau index , FEF25 and dyspnoea severity remained stable ( p = NS ) . Conclusions Preoperative pulmonary rehabilitation significantly enhances clinical status of COPD patients before NSCLC resection . Preoperative increase of exercise tolerance was the result of pulmonary function improvement during PPR . The beneficial effects of PPR were most emphasized in patients with initially the worst pulmonary function and the weakest functional capacity OBJECTIVES To compare the effects of two similar 6-month protocol s of high-intensity exercise training , in water and on l and , in patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN R and omised controlled trial . SETTING University-based outpatient clinic . PARTICIPANTS Thirty-six patients with predominantly moderate-to-severe COPD completed the study . INTERVENTION Patients were evaluated at baseline , at 3 months and at the end of the programme ( i.e. 6 months ) . For both groups , the 6-month protocol consisted of high-intensity endurance and strength exercises with gradual increase in time and /or workload , totalling 60 sessions . MAIN OUTCOMES Objective monitoring of physical activity in daily life ( PADL , primary outcome ) , lung function , peripheral and respiratory muscle strength , body composition , maximal and submaximal exercise capacity , functional status , quality of life , and symptoms of anxiety and depression . RESULTS After 6 months of training , a significant improvement in PADL was seen for both groups [ mean difference ( 95 % confidence interval ) : l and group 993 ( 358 to 1628 ) steps/day ; water group 1669 ( 404 to 2934 ) steps/day ] . Significant improvements were also seen in inspiratory , expiratory and peripheral muscle strength ; maximal and submaximal exercise capacity ; quality of life and functional status for both groups . There were no significant improvements in lung function , body composition , and symptoms of anxiety and depression for either group . No difference was found in the magnitude of improvement between the two types of training for any outcome . CONCLUSION High-intensity exercise training in water generates similar effects compared with training on l and in patients with moderate-to-severe COPD , rendering it an equally beneficial therapeutic option for this population . CLINICAL TRIAL REGISTRATION NUMBER NCT01691131 This study aim ed to investigate the relationship between skeletal muscle , fibre type composition , functional respiratory impairment and exercise tolerance in patients with moderate to severe chronic obstructive pulmonary disease ( COPD ) . A group of 22 COPD patients and 10 healthy control subjects were studied . In COPD patients , vital capacity ( VC ) and forced expiratory volume in one second ( FEV1 ) were reduced to 79 % and 51 % , respectively . Diffusion indices ( transfer factor of the lung for carbon monoxide ( TL , CO ) and carbon monoxide transfer coefficient ( KCO ) ) were also reduced . Arterial oxygen tension ( Pa , O2 ) was normal or slightly altered . A maximal exercise test was performed and anaerobic threshold was calculated . Muscle sample s from vastus lateralis were obtained by needle biopsy . Myosin heavy chain ( MHC ) and light chain ( MLC ) isoforms were separated by gel electrophoresis and quantified by densitometry . MHC isoforms were considered as molecular markers of fibre types . The proportion of the fast MHC-2B isoform was increased in COPD patients . TL , CO , KCO , VC and FEV1 were positively correlated with slow MHC isoform content . TL , CO and KCO were also negatively correlated with the content of the fast MHC-2B isoform . No correlation was found between exercise parameters and MHC isoform composition . The co-ordinated expression between MHC and MLC isoforms was altered in COPD patients . We conclude that reduced oxygen availability , probably in combination with muscle disuse , may determine muscle alterations in chronic obstructive pulmonary disease patients . The altered correlations between myosin heavy chain and light chain isoforms suggest that co-ordinated protein expression is lost in chronic obstructive pulmonary disease muscles Introduction . Patients with advanced-stage lung cancer face poor survival and experience co-occurring chronic physical and psychosocial symptoms . Despite several years of research in exercise oncology , few exercise studies have targeted advanced lung cancer patients undergoing chemotherapy . The aim of the present study was to investigate the benefits of a 6-week supervised group exercise intervention and to outline the effect on aerobic capacity , strength , health-related quality of life ( HRQoL ) , anxiety , and depression . Methods . VO2peak was assessed using an incremental exercise test .  Muscle strength  was measured with one repetition maximum test ( 1RM ) . HRQoL , anxiety , and depression were assessed using Functional Assessment of Cancer Therapy – Lung ( FACT-L ) scale and the Hospital Anxiety and Depression Scale ( HADS ) . Results . One hundred and forthteen patients with advanced stage lung cancer were recruited . Forty-three patients dropped out . No serious adverse events were reported . Exercise adherence in the group training was 68 % . Improvements in VO2peak ( P < .001 ) and 6-minute walk distance ( P < .001 ) and muscle strength measurements ( P < .05 ) were seen . There was a reduction in anxiety level ( P = .0007 ) and improvement in the emotional well-being parameter ( FACT-L ) but no statistically significant changes in HRQoL were observed . Conclusion . The results of the present study show that during a 6-week hospital-based supervised , structured , and group-based exercise program , patients with advanced-stage lung cancer ( NSCLC IIIb-IV , ED-SCLC ) improve their physical capacity ( VO2peak , 1RM ) , functional capacity , anxiety level , and emotional well-being , but not their overall HRQoL. A r and omized controlled trial testing the intervention including 216 patients is currently being carried out OBJECTIVES The frequency and success rates of lung transplant in patients with end-stage lung disease are increasing . In our study , we investigated the effects of preoperative pulmonary rehabilitation on pulmonary function , exercise capacity , and quality of life in patients who are c and i date s for lung transplant . MATERIAL S AND METHODS This prospect i ve study included 39 consecutive patients who were c and i date s for lung transplant . All patients underwent preoperative pulmonary rehabilitation for at least 3 weeks . RESULTS Our patient group included 25 male and 14 female patients with a mean age of 36 years ( range , 15 -68 y ) . Although no significant improvement was shown in the forced expiratory volume in 1 second after pulmonary rehabilitation , significant improvements were observed in the Modified Medical Research Council dyspnea scores ( P = .001 ) and 6-minute walk distance ( P = .001 ) . We also observed statistically significant improvements in the Short-Form 36 Quality of Life Question naire 's physical function ( P = .01 ) and emotional role ( P = .02 ) subparameters . We also found a significant improvement in the Beck Depression Inventory score ( P = .004 ) . There was no correlation between Beck Depression Inventory scores before and after rehabilitation and 6-minute walk distance , Short-Form 36 , and Modified Medical Research Council dyspnea scores . CONCLUSIONS Our results suggest that preoperative pulmonary rehabilitation improves exercise capacity , reduces the sensation of dyspnea and muscle strength loss , and has a positive effect on the psychologic state of patients who are c and i date s for lung transplant BACKGROUND Muscle wasting and decreased muscle oxidative capacity commonly occur in patients with chronic obstructive pulmonary disease ( COPD ) .  Polyunsaturated fatty acids ( PUFA ) have been shown to mediate several inflammatory and metabolic pathways which may be involved in the pathogenesis of muscle impairment in COPD . The aim of this study was to investigate the effect of PUFA modulation on systemic inflammation , reversal of muscle wasting , and functional status in COPD . METHODS Eighty patients with COPD ( 57 men ) with forced expiratory volume in 1 second ( FEV1 ) 37.3 (13.8)% predicted received 9 g PUFA or placebo daily in a double blind r and omised fashion during an 8 week rehabilitation programme . Body composition ( bioelectrical impedance ) , functional capacity ( lung function , incremental cycle ergometry test , submaximal cycle test , isokinetic quadriceps strength ) and inflammatory markers ( C-reactive protein ( CRP ) , interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha ) were assessed at baseline and after 8 weeks . RESULTS Both groups had similar increases in weight , fat-free mass ( FFM ) , and muscle strength . The peak load of the incremental exercise test increased more in the PUFA group than in the placebo group ( difference in increase 9.7 W ( 95 % CI 2.5 to 17.0 ) , p = 0.009 ) even after adjustment for FFM . The duration of the constant work rate test also increased more in patients receiving PUFA ( difference in increase 4.3 min ( 95 % CI 0.6 to 7.9 ) , p = 0.023 ) . The positive effects of PUFA could not be attributed to a decrease in systemic levels of CRP , IL-6 and TNF-alpha . CONCLUSIONS This is the first study to show beneficial effects of PUFA on exercise capacity in patients with COPD BACKGROUND AND PURPOSE Previous investigations have demonstrated that a regimen of high-intensity inspiratory muscle training ( IMT ) result ed in changes in ventilatory function and exercise capacity in patients with chronic lung disease , although the effect of high-intensity IMT in subjects who are healthy is yet to be determined . The purpose of this study , therefore , was to examine whether high-intensity IMT result ed in changes in ventilatory function and exercise capacity in subjects who were healthy . SUBJECTS Twenty subjects were r and omly assigned to 2 groups . METHODS The training group completed an 8-week program of IMT set at 80 % of maximal effort . The control group did not participate in any form of training . Baseline and posttraining measures of body composition , pulmonary function , inspiratory muscle function ( including maximal and sustained maximal inspiratory pressures [ MIP and SMIP ] ) , relaxed and contracted diaphragm thickness and thickening ratio ( Tdi.rel , Tdi.cont , and TR ) , and exercise capacity were determined . RESULTS The training group demonstrated significant increases in MIP , SMIP , Tdi.cont , TR , VC , total lung capacity , and exercise capacity compared with the control group , which demonstrated no change from baseline measurements at 8 weeks . DISCUSSION AND CONCLUSION The findings of this study suggest that high-intensity IMT results in increased contracted diaphragm thickness and increased lung volumes and exercise capacity in people who are healthy The article by McKeough and colleagues in this issue of Chronic Respiratory Disease is the first study to compare different modes of upper extremity training in individuals with chronic obstructive pulmonary disease ( COPD ) . Limitations during exercise and daily activity in individuals with COPD are not limited to lower extremity activities such as walking or stair climbing ; most of the patients experience difficulty during activities that involve their arms due to the sensation of dyspnea and /or arm fatigue . Upper extremity training for patients with COPD is an important component of pulmonary rehabilitation ( PR ) , result ing in improvements in arm exercise capacity , arm function and muscle strength . However , there is limited evidence on what type of training should be performed . The study by McKeough and colleagues adds to the growing body of evidence in the area of upper extremity training in COPD and provides support for the inclusion of arm endurance and strength training as a part of PR . The study is a r and omized controlled trial ( RCT ) that aim ed to compare the effects of arm endurance training ; arm strength training , a combination of arm endurance and strength training ; and no arm training ( control group ) on endurance arm exercise capacity , functional arm exercise capacity and health-related quality of life ( HRQL ) in individuals with mild-tovery severe COPD . The authors found a significant improvement in arm endurance time ( arm endurance capacity ) between the endurance group and control group . There were nonsignificant trends in arm endurance time favoring the strength training and combined groups compared with the control group . In terms of symptoms , the authors demonstrated that the combined group had a significantly greater reduction in dyspnea and rate of perceived exertion at the end of the functional arm exercise test compared with the control and with each of the intervention groups . When the combined group was compared with the other two intervention groups , the improvement in HRQL ( measured using the St George ’s Respiratory Question naire ) exceeded the minimum clinical ly important difference of 4 units , although it did not reach statistical significance . Until the beginning of the century , several RCTs had been conducted to examine the effects of upper extremity training in individuals with COPD . However , there were considerable variations in the exercise protocol s rendering it impossible to determine the optimal training regimen for these patients . Moreover , the impact of upper extremity training on other clinical outcomes besides arm exercise capacity was unclear as shown consistently by four systematic review s. More recently , four RCTs examining the effects of arm exercise training in individuals with COPD have been published . Holl and and colleagues compared the effects of unsupported upper limb endurance training with lower extremity training alone . The authors found that unsupported upper limb endurance training improved upper limb exercise capacity but had no additional effects on the symptoms or HRQL compared with lower extremity training alone . Costi and colleagues examined the effects of upper extremity resistance training in patients with COPD compared with st and ard PR . The authors demonstrated improvement in arm functional exercise capacity ( measured using the 6-minute pegboard and ring test ) and in performance during activities of daily living ( ADL ) measured by an ADL field test . In addition , the authors found a decrease in arm fatigue at the end of the ADL test in the intervention group . Introduction Pulmonary rehabilitation ( PR ) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease ( COPD ) with the goal of improving the functional capacity and quality of life , as well as maintaining the clinical stability of COPD sufferers . However , not all patients are available for such a program despite discomfort with their condition . The aim of this study was to evaluate the effects of a home-based PR ( HBPR ) program on functional ability , quality of life , and respiratory muscle strength and endurance . Patients and methods Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were r and omized ( double-blind ) into two groups . One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group ; the other group received only instructions to perform breathing and stretching exercises , characterizing it as the control group ( CG ) . We assessed the following variables at baseline and 2 months : exercise tolerance ( incremental shuttle walk test and upper limb test ) , respiratory muscle ( strength and endurance test ) , and health-related quality of life ( Airways Question naire 20 ) . Results There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life . However , the intervention group had improved respiratory endurance compared with the CG , while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR . Conclusion A program of HBPR with biweekly supervision ( although not enough to provide significant improvements in physical capacity or quality of life ) played an important role in maintaining the stability of the clinical features of patients with COPD ; the patients had no worsening of symptoms during the intervention period according to the daily log Introduction The superiority of tiotropium/olo date rol is demonstrated in improvement of lung function , dyspnea , lung hyperinflation , and quality of life compared with either monotherapy in patients with chronic obstructive pulmonary disease ( COPD ) . Japanese Respiratory Society Guidelines for COPD management include improvement of exercise tolerance and daily physical activity as the treatment goals ; however , there is limited evidence in Japanese patients with COPD . Methods A protocol is developed for the VESUTO ® study that investigates the efficacy of tiotropium/olo date rol fixed-dose combination ( FDC ) compared with tiotropium alone on inspiratory capacity ( IC , volume from functional residual capacity to total lung capacity ) , exercise capacity , and daily physical activity in Japanese patients with COPD . Results A total of 180 Japanese patients with COPD , aged ≥40 years will be enrolled into the double-blind , multicenter , active-controlled , crossover study ( NCT02629965 ) and will be r and omized to receive either tiotropium/olo date rol FDC or tiotropium for 6 weeks each [ two puffs via RESPIMAT ® ( Boehringer Ingelheim , Ingelheim , Germany ) inhaler in the morning ] . The primary endpoint is IC at rest measured at 60 min post-dose after 6 weeks treatment . The secondary endpoints include the 6-min walk distance ( 6MWD ) at 90 min post-dose and physical activity measured by the activity monitor in the last 2 weeks of the 6-week treatment periods . Lung function tests will also be assessed after 6 weeks treatment . A mixed-effects model repeated measures approach will be used for the primary and secondary endpoints . Conclusion The VESUTO ® study is the first r and omized interventional study to investigate exercise capacity ( 6MWD ) and physical activity measured by a 3-axis accelerometer in Japanese patients with COPD . The study could provide additional evidence of long-acting muscarinic antagonist ( LAMA ) + long-acting β2-agonist ( LABA ) combination therapy on patients ’ physical activities as well as lung function . Trial registration Clinical Trials.gov : NCT02629965 ( registered on December 1 , 2015 ) . Funding The VESUTO study was funded by Nippon Boehringer Ingelheim Co. , Ltd. , Tokyo , Japan Background Patients with COPD present a major recruitment of the inspiratory muscles , predisposing to chest incoordination , increasing the degree of dyspnea and impairing their exercise capacity . Stretching techniques could decrease the respiratory muscle activity and improve their contractile capacity ; however , the systemic effects of stretching remain unknown . Objective The aim of this study was to evaluate the effects of aerobic training combined with respiratory muscle stretching on functional exercise capacity and thoracoabdominal kinematics in patients with COPD . Design This study was a r and omized and controlled trial . Participants A total of 30 patients were allocated to a treatment group ( TG ) or a control group ( CG ; n=15 , each group ) . Intervention The TG was engaged in respiratory muscle stretching and the CG in upper and lower limb muscle stretching . Both groups performed 24 sessions ( twice a week , 12 weeks ) of aerobic training . Evaluations Functional exercise capacity ( 6-minute walk test ) , thoracoabdominal kinematics ( optoelectronic plethysmography ) , and respiratory muscle activity ( surface electromyography ) were evaluated during exercise . Analysis of covariance was used to compare the groups at a significance level of 5 % . Results After the intervention , the TG showed improved abdominal ( ABD ) contribution , compartmental volume , mobility , and functional exercise capacity with decreased dyspnea when compared with the CG ( P<0.01 ) . The TG also showed a decreased respiratory muscle effort required to obtain the same pulmonary volume compared to the CG ( P<0.001 ) . Conclusion Our results suggest that aerobic training combined with respiratory muscle stretching increases the functional exercise capacity with decreased dyspnea in patients with COPD . These effects are associated with an increased efficacy of the respiratory muscles and participation of the ABD compartment OBJECTIVE To evaluate the effectiveness of a Tai chi Qigong ( TCQ ) program in enhancing respiratory functions and activity tolerance in clients with chronic obstructive pulmonary disease ( COPD ) . DESIGN A single-blind , r and omized controlled trial . SETTING Five general outpatient clinics in Hong Kong . INTERVENTION In total , 206 COPD clients were r and omly assigned into one of the three groups , namely , TCQ , exercise , and control group . Subjects in the TCQ group received a TCQ program consisting of two 60-min sessions each week for three months . Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise . Subjects in the control group were instructed to maintain their usual activities . Data collection was performed at baseline and at the 6-week and 3-month marks . OUTCOMES Lung functions , 6-min walk test , and COPD exacerbation rate . RESULTS Results of repeated measures of analysis of covariance demonstrated that there were significant interaction effects between time and group in forced vital capacity ( p=.002 , η(2)=.06 ) , forced expiratory volume in 1s ( p<.001 , η(2)=.02 ) , walking distance ( p<.001 ) , and exacerbation rate ( p=.006 , η(2)=.06 ) at 3 months . Improvements were noted in the TCQ group . No changes were observed in the exercise group , while a decline in lung functions was noticed in the control group . CONCLUSION Tai chi Qigong was able to improve respiratory functions and activity tolerance level in COPD clients . The breathing and walking exercise helped maintain lung functions and slow down disease progression Purpose . Following surgical lung resection , patients frequently suffer functional decline and reduced activity levels . Despite this exercise interventions are not routinely provided . This study aim ed to establish the safety and feasibility of exercise administered following lung resection in an Australian setting . Method . Pilot r and omized controlled trial . Fifteen individuals ( 53 % male ) , mean ± st and ard deviation age 65.5 ± 16.1 years , undergoing surgery for suspected lung cancer . R and omization occurred postoperatively . Control arm received protocol ized inpatient respiratory physiotherapy . Intervention arm additionally received twice daily exercise until discharge home and twice weekly as outpatient for 8 weeks . Outcome measures ( safety , feasibility , functional capacity , functional mobility , and health-related quality of life [ HRQoL ] ) were assessed preoperatively and 2 and 12 weeks postoperatively . Results . Fifteen participants ( lung cancer n = 10 ) were assigned to control ( n = 8) and intervention ( n = 7 ) groups . Inpatient exercise was delivered on 71 % of occasions ( 35 out of 49 planned sessions ) . Four participants attended outpatient exercise sessions and these participants attended sessions on 81 % of occasions ( 52 out of 64 planned sessions ) . No adverse events occurred . There was a significant between group difference in 6-Minute Walk Test ( 6MWT ; P = .024 ) . In both groups the 6MWT declined from baseline to 2 weeks postoperative and then improved up to 12 weeks ; improvements were greater in the intervention group . Intervention was associated with positive trends of improvement in some HRQoL domains . Conclusions . Exercise intervention performed in the inpatient and outpatient setting s for individuals following lung resection  was safe and feasible . The uptake rate for outpatient exercise was 57 % , similar to previous trials ; however , adherence was excellent within the subgroup of participants who attended . Further research is required to investigate the best setting of exercise delivery and explore ways to improve the uptake rate
No significant difference in pulmonary function was observed between the two groups .
However , 6MWD and VO2 peak were significantly improved after exercise training .
Conclusion Preoperative exercise training may reduce PPCs for lung cancer patients .
Rehabilitation exercise strengthens muscle capacity , but does not improve impaired pulmonary function , which emphasizes the possible mechanism of the protocol design
Objectives This meta- analysis aim ed to demonstrate the impact of preoperative exercise therapy on surgical outcomes in patients with lung cancer and COPD .
Pulmonary function and muscle capacity were investigated to explore their potential links with outcome improvements after exercise .