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Special Issue "Pulmonary Rehabilitation, Exercise Training and Physical Activity Coaching for Chronic Lung Disorders"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 15 July 2019

Special Issue Editor

Guest Editor
Prof. Dr. Martijn A. Spruit

Department of Research and Education, CIRO +, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands; UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium
Website | E-Mail
Interests: pulmonary rehabilitation, exercise training, physical activity coaching, extra-pulmonary treatable traits, COPD, asthma, ILD

Special Issue Information

Dear Colleagues,

Patients with chronic lung disorder may suffer from daily symptoms (such as dyspnea and/or fatigue), which can limit physical functioning. Besides the primary lung function impairment, extra-pulmonary features, such as inactivity-induced loss of lower-limb muscle mass and function can also play an important role in the loss of physical functioning. Comprehensive rehabilitation programs, exercise training programs and/or physical activity coaching programs can, at least in part, reverse the devastating effects of physical inactivity. Moreover, it may also have a positive effect on mood status and quality of life in patients with chronic lung disorders. Despite the positive effects of these non-pharmacological interventions, only 1 to 2% of the patients with a chronic lung disorder are referred by their physician. The goal of this Special Issue would be to update the practicing clinician and provide a comprehensive collection of original articles and state-of-the-art reviews.

To this end, we would like to invite original research for inclusion in this issue. Examples include well-powered, randomized controlled trials studying the (cost-)effectiveness of pulmonary rehabilitation, exercise training or physical activity coaching in patients with chronic lung disorders; observational studies assessing the underlying factors of physical inactivity, including common comorbidities, pain and fatigue; a state-of-the-art review summarizing behavioral theories which can be used to improve the movement behavior of patients with chronic lung disorders; and novel data/concepts on the integration of personalized medicine in pulmonary rehabilitation, exercise training or physical activity coaching.

This Special Issue aims to present the most recent advances in the field of pulmonary rehabilitation, exercise training or physical activity coaching for patients with chronic lung disorders, as well as their implications for future integrated respiratory care. We look forward to your submissions!

Prof. Dr. Martijn A. Spruit
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pulmonary rehabilitation
  • exercise training
  • physical activity
  • sedentarism
  • personalized medicine
  • COPD
  • asthma
  • ILD
  • physiotherapy

Published Papers (6 papers)

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Research

Open AccessArticle
Maintenance Negative Pressure Ventilation Improves Survival in COPD Patients with Exercise Desaturation
J. Clin. Med. 2019, 8(4), 562; https://doi.org/10.3390/jcm8040562
Received: 16 April 2019 / Revised: 21 April 2019 / Accepted: 22 April 2019 / Published: 25 April 2019
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Abstract
Negative pressure ventilation (NPV), when used as an adjuvant to pulmonary rehabilitation, improves lung function, increases exercise capacity, and reduces exacerbations. The aim of this study was to determine whether maintenance NPV improves long-term clinical outcomes and reduces mortality in patients with chronic [...] Read more.
Negative pressure ventilation (NPV), when used as an adjuvant to pulmonary rehabilitation, improves lung function, increases exercise capacity, and reduces exacerbations. The aim of this study was to determine whether maintenance NPV improves long-term clinical outcomes and reduces mortality in patients with chronic obstructive pulmonary disease (COPD). Between 2003 and 2009, 341 patients were treated for COPD either with or without hospital-based NPV. We measured forced expiratory volume in one second (FEV1), 6-min walking distance (6MWD), and oxygen saturation by pulse oximetry (SpO2) during a 6-min walk test (6MWT) every 3–6 months. Desaturation (D) during the 6MWT was defined as a reduction in SpO2 of ≥10% from baseline. The NPV group had a better survival outcome than the Non-NPV group. The 8-year survival probabilities for the NPV and Non-NPV groups were 60% and 20%, respectively (p < 0.01). Baseline desaturation was a significant risk factor for death, and the risk of death increased with desaturation severity (SpO2 80~89: hazard ratios (HR) 2.7, 95% confidence interval (CI) 1.4–5.3; SpO2 < 80: HR 3.1, 95% CI 1.3–7.4). The NPV group had a slower decline in lung function and 6MWD. The NPV + D and Non-NPV+D had a threefold and fourfold increase in the risks of all-cause mortality compared with the NPV-ND, respectively. Maintenance non-invasive NPV reduced long-term mortality in COPD patients. The desaturating COPD patients had an increased mortality risk compared with non-desaturating COPD patients. Full article
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Open AccessArticle
The Effects of High- Versus Moderate-Intensity Exercise on Fatigue in Sarcoidosis
J. Clin. Med. 2019, 8(4), 460; https://doi.org/10.3390/jcm8040460
Received: 28 February 2019 / Revised: 25 March 2019 / Accepted: 2 April 2019 / Published: 5 April 2019
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Abstract
Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from [...] Read more.
Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from a single session of moderate-intensity continuous training (MICT). Methods: Forty-one patients with pulmonary sarcoidosis were recruited to a cross-over study. All patients completed one treadmill session of HIIT (85% of peak heart rate (HRpeak)) and one of MICT (70% of HRpeak). Fatigue was assessed with the Visual Analogue Scale 0–100 mm, before (T0), after (T1), and 24 hours after (T2) each exercise session. Paired sample t-test was used to compare changes in fatigue from T0 to T1 and from T0 to T2 between HIIT and MICT. Results: No statistically significant difference in fatigue levels was found between HIIT and MICT, either at T1 (3.6 (13.5) and 1.4 (13.5)) or at T2 (8.2 (17.0) and 2.1 (17.1)). Conclusions: A single session of HIIT did not affect fatigue differently than a single session of MICT. These preliminary findings support the need for further research on the long-term effect of HIIT on fatigue in patients with sarcoidosis. Full article
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Open AccessArticle
Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD
J. Clin. Med. 2019, 8(4), 459; https://doi.org/10.3390/jcm8040459
Received: 17 March 2019 / Revised: 27 March 2019 / Accepted: 3 April 2019 / Published: 5 April 2019
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Abstract
Pulmonary rehabilitation (PR) improves lower-limb muscle function in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear whether patients improve gait characteristics, in particular stride-to-stride fluctuations that are associated with fall risks. This study aims to identify whether, and to what [...] Read more.
Pulmonary rehabilitation (PR) improves lower-limb muscle function in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear whether patients improve gait characteristics, in particular stride-to-stride fluctuations that are associated with fall risks. This study aims to identify whether, and to what extent, PR affects positively gait characteristics in COPD. In this prospective observational study, 44 COPD patients (aged: 62 ± 7 years; Forced expiratory volume in 1 s 56 ± 20% predicted) performed self-paced, treadmill 6-min-walk tests (Gait Real-time Analysis Interactive Lab) before and after PR, while spatiotemporal parameters and center of mass position were recorded (100 Hz, Vicon Nexus). Standard deviation, coefficient of variation, predictability (sample entropy), and consistency in organization (local divergence exponent) were calculated. Sub-analysis was performed to identify gait differences between good and poor responders (<30 m change in a 6-min-walk distance). Patients demonstrated shorter stride times (p = 0.001) and improved lower-limb muscle function (p < 0.001) following PR. The good responders had a greater increase in stride length (p < 0.001) and a greater decrease in stride time (p < 0.001) compared to the poor responders. Current PR improved stride time in patients, while movement patterns within stride-to-stride fluctuations did not change. Training programs specifically targeting balance issues and gait function may be beneficial in improving gait characteristics in COPD. Full article
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Open AccessArticle
Effects of a Combined Community Exercise Program in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial
J. Clin. Med. 2019, 8(3), 361; https://doi.org/10.3390/jcm8030361
Received: 23 January 2019 / Revised: 9 March 2019 / Accepted: 10 March 2019 / Published: 14 March 2019
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Abstract
Physical activity is associated with a decreased prevalence of obstructive sleep apnea and improved sleep efficiency. Studies on the effects of a comprehensive exercise program in a community setting remain limited. Our objective was to investigate the effects of a combined physical and [...] Read more.
Physical activity is associated with a decreased prevalence of obstructive sleep apnea and improved sleep efficiency. Studies on the effects of a comprehensive exercise program in a community setting remain limited. Our objective was to investigate the effects of a combined physical and oropharyngeal exercise program on the apnea-hypopnea index in patients with moderate to severe obstructive sleep apnea. This was a randomized clinical trial where the intervention group followed an eight-week urban-walking program, oropharyngeal exercises, and diet and sleep recommendations. The control group followed diet and sleep recommendations. A total of 33 patients were enrolled and randomized and, finally, 27 patients were included in the study (IG, 14; CG, 13) Obstructive sleep apnea patients were analyzed with a median age of 67 (52–74) and median apnea-hypopnea index of 32 events/h (25–41). The apnea-hypopnea index did not differ between groups pre- and post-intervention. However, in intervention patients younger than 60 (n = 6) a reduction of the apnea-hypopnea index from 29.5 (21.8–48.3) to 15.5 (11–34) events/h (p = 0.028) was observed. While a comprehensive multimodal program does not modify the apnea-hypopnea index, it could reduce body weight and increase the walking distance of patients with moderate to severe obstructive sleep apnea. Patients younger than 60 may also present a decreased apnea-hypopnea index after intervention. Full article
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Open AccessArticle
“Can do” versus “do do”: A Novel Concept to Better Understand Physical Functioning in Patients with Chronic Obstructive Pulmonary Disease
J. Clin. Med. 2019, 8(3), 340; https://doi.org/10.3390/jcm8030340
Received: 5 February 2019 / Revised: 1 March 2019 / Accepted: 4 March 2019 / Published: 11 March 2019
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Abstract
Background: Physical capacity (PC) and physical activity (PA) represent associated but separate domains of physical function. It remains unknown whether this framework may support a better understanding of the impaired physical function in patients with chronic obstructive pulmonary disease (COPD). The current study [...] Read more.
Background: Physical capacity (PC) and physical activity (PA) represent associated but separate domains of physical function. It remains unknown whether this framework may support a better understanding of the impaired physical function in patients with chronic obstructive pulmonary disease (COPD). The current study had two aims: (1) to determine the distribution of patients with COPD over the PC-PA quadrants, and (2) to explore whether differences exist in clinical characteristics between these quadrants. Methods: In this retrospective study, PC was measured using the six-minute walk distance (6MWD), and PA was assessed with an accelerometer. Moreover, patients’ clinical characteristics were obtained. Patients were divided into the following quadrants: (I) low PC (6MWD <70% predicted), low PA, using a step-defined inactivity index (<5000 steps/day, ”can’t do, don’t do” quadrant); (II) preserved PC, low PA (“can do, don’t do” quadrant); (III) low PC, preserved PA (“can’t do, do do” quadrant); and (IV) preserved PC, preserved PA (“can do, do do” quadrant). Results: The distribution of the 662 COPD patients over the quadrants was as follows: “can’t do, don’t do”: 34%; “can do, don’t do”: 14%; “can’t do, do do”: 21%; and “can do, do do”: 31%. Statistically significant differences between quadrants were found for all clinical characteristics, except for educational levels. Conclusions: This study proves the applicability of the PC-PA quadrant concept in COPD. This concept serves as a pragmatic clinical tool, that may be useful in the understanding of the impaired physical functioning in COPD patients and therefore, may improve the selection of appropriate interventions to improve physical function. Full article
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Open AccessArticle
Intermittent Use of Portable NIV Increases Exercise Tolerance in COPD: A Randomised, Cross-Over Trial
J. Clin. Med. 2019, 8(1), 94; https://doi.org/10.3390/jcm8010094
Received: 18 December 2018 / Revised: 26 December 2018 / Accepted: 14 January 2019 / Published: 15 January 2019
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Abstract
During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip [...] Read more.
During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip breathing (PLB) on exercise tolerance. Twenty-four COPD patients were randomised to a high-intensity (HI: 2-min at 80% peak work rate (WRpeak) alternated with 2-min recovery; n = 13), or a moderate-intensity (MOD: 6-min at 60% WRpeak alternated with 2-min recovery; n = 11) protocol, and within these groups two tests were performed using pNIV and PLB during recovery in balanced order. Upon completion, patients were provided with pNIV; use over 12 weeks was assessed. Compared to PLB, pNIV increased exercise tolerance (HI: by 5.2 ± 6.0 min; MOD: by 5.8 ± 6.7 min) (p < 0.05). With pNIV, mean inspiratory capacity increased and breathlessness decreased by clinically meaningful margins during recovery compared to the end of exercise (HI: by 140 ± 110 mL and 1.2 ± 1.7; MOD: by 170 ± 80 mL and 1.0 ± 0.7). At 12 weeks, patients reported that pNIV reduced anxiety (median: 7.5/10 versus 4/10, p = 0.001) and recovery time from breathlessness (17/24 patients; p = 0.002); 23/24 used the device at least weekly. pNIV increased exercise tolerance by reducing dynamic hyperinflation and breathlessness in COPD patients. Full article
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J. Clin. Med. EISSN 2077-0383 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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