DNA reactions, mutagenic action and stealth properties of polycyclic aromatic hydrocarbon carcinogens (review)

OBJECTIVE: To present a critical review and meta-analysis of studies evaluating the long-term effects of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease (COPD). DATA SOURCES: A database of articles published over the last 45 years, compiled by using medical subject heading key words pulmonary, obstructive, rehabilitation, and exercise. Articles not written in English, Dutch, or German and abstracts were excluded. STUDY SELECTION: Selected studies (1) evaluated the effects of pulmonary rehabilitation, (2) included patients with asthma or COPD older than 18 years, (3) evaluated outcome measures of exercise capacity or health related quality of life (HRQL), and (4) included a control condition lacking exercise training. DATA EXTRACTION: Independent extraction by two reviewers. DATA SYNTHESIS: For each outcome, summary effects were computed by pooling standardized mean differences as well as raw mean differences. Significant improvements were found for all outcomes (p < .001). Sensitivity analyses for methodological quality of the selected studies did not change summary effect sizes. Effect sizes were significantly heterogeneous for the outcome endurance time (p < .0001). Pooling raw mean differences revealed overall effects in 6-minute walking distance (49+/-26 m) and all 4 dimensions of the chronic respiratory questionnaire (range, 0.5+/-0.3 to 0.8+/-0.3 points), indicating substantial improvements in these outcomes. Significant summary effect sizes were found up to 9 months after finishing rehabilitation for maximal exercise capacity (p < .003) and 6-minute walking distance (p < .005). CONCLUSIONS: Patients with asthma and COPD benefit from pulmonary rehabilitation.     

A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months

AIM: In this study, the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program (HRP) are compared with those of a 12-week home-care rehabilitation program (HCRP) in COPD patients. A control group received no rehabilitation therapy. METHODS: After randomization and stratification, effects on lung function, exercise performance (4-min walking test and cycle ergometer test), dyspnea, and leg effort during exercise, and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation (mean [SD] FEV1 percent predicted, 42.8 [8.4]). RESULTS: After HRP and HCRP, at 3 to 6 months after the start of the study, equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test. However, whereas after HRP at longer term values tended to return to baseline outcome, after HCRP a further ongoing significant improvement in exercise capacity was observed, while Borg dyspnea scores remained significantly improved over 18 months. Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP. Lung function, arterial oxygen saturation, and heart frequency during exercise did not change. A significant improvement in well-being was maintained over 18 months in both rehabilitation groups. CONCLUSION: Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation. Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting.     

Experimental evaluation of rehabilitation in chronic obstructive pulmonary disease: Short-term effects on exercise endurance and health status.

Assigned 119 adults (mean age 62.6 yrs) with chronic obstructive pulmonary disease to an 8-wk comprehensive rehabilitation program (CRP) or to an 8-wk education control program (ECP). The CRP included education, physical and respiratory therapy instruction, psychosocial support, and supervised exercise training. The ECP included biweekly classroom instruction and discussions on respiratory therapy, medical aspects of lung disease, clinical pharmacology, and diet, but no exercise training. Ss received physiological and psychosocial evaluation before and after intervention. Six months after enrollment, Ss in the CRP showed significant increases in exercise endurance, whereas Ss in the ECP showed nonsignificant increases. Ss in the CRP also showed related improvements in self-efficacy for walking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Proxy Efficacy: Implications for Self-Efficacy and Exercise Intentions in Cardiac Rehabilitation.

Objective: To examine relations among proxy efficacy, exercise self-efficacy, and exercise in cardiac rehabilitation. Participants and Study Design: Twenty-nine cardiac rehabilitation outpatients (24 men and 5 women) enrolled in a 12-week hospital-based program. Measures of proxy efficacy and exercise self-efficacy, obtained in Week 3, were used to predict program attendance and exercise self-efficacy at Week 10. Late program (i.e.. Week 10) exercise self-efficacy and proxy efficacy were also used to predict postprogram exercise intentions. Results: Early program proxy efficacy and attendance predicted late program exercise self-efficacy (adjusted K2 = .71, p     

Exercise training in COPD patients: the basic questions

Pulmonary rehabilitation programmes aim at improving exercise capacity, activities of daily living, quality of life and perhaps survival in patients with chronic obstructive pulmonary disease (COPD). Recently, well-designed studies investigated and confirmed the efficacy of comprehensive pulmonary rehabilitation programmes, including exercise training, breathing exercises, optimal medical treatment, psychosocial support and health education. In the present overview, the contribution of exercise training in clinical practice to the demonstrated effects of pulmonary rehabilitation is discussed by means of six basic questions. These include: 1) the significance of exercise training; 2) the optimal intensity for exercise training; 3) prescribing training modalities; 4) the effects of exercise training combined with medication, nutrition or oxygen; 5) how training effects should be maintained; and 6) where the rehabilitation programme should be performed: in-patient, out-patient or homecare? First, exercise training has been proven to be an essential component of pulmonary rehabilitation. Training intensity is of key importance. High-intensity training (>70% maximal workload) is feasible even in patients with more advanced COPD. In addition, the effects on peripheral muscle function and ventilatory adaptations are superior to low-intensity training. There is, however, no consensus on the optimal training modalities. Both walking and cycling improved exercise performance. Since peripheral muscle function has been recognized as an important contributor to exercise performance, specific peripheral muscle training recently gained interest. Improved submaximal exercise performance and increased quality of life were found after muscle training. The optimal training regimen (strength or endurance) and the muscle groups to be trained, remain to be determined. Training of respiratory muscles is recommended in patients with ventilatory limitation during exercise. The additional effects of anabolic-androgenic drugs, oxygen and nutrition are not well-established in COPD patients and need further research. In order to maintain training effects, close attention of the rehabilitation team is required. The continuous training frequency necessary to maintain training effects remains to be defined. At this point in time, out-patient-based programmes show the best results and guarantee the best supervision and a multidisciplinary approach. Future research should focus on the role of homecare programmes to maintain improvements.     

Effects of psychotherapy in moderately severe COPD: a pilot study

Anxiety is common in the "pink puffer" syndrome associated with chronic obstructive pulmonary disease (COPD). The degree of anxiety correlates well with perceived dyspnoea. This pilot study examines the effect of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life. Ten patients with moderately severe, stable COPD (mean forced expiratory volume in one second (FEV1)-1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly intervals. Patients completed the Hospital Anxiety and Depression Scale (HADS), Medical Research Council Questionnaire (MRCQ) and St George's Respiratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, forced vital capacity (FVC), slow vital capacity (SVC), blood gas tensions and 6 min walking distance (6MWD) were measured. Eight control patients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy. Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise there were no differences in lung function, blood gas tensions, 6MWD, or the other questionnaire scores between groups. After treatment, the physiological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psychotherapy group only, from 351 to 423 m (p<0.001), an increase of 24%. Three months after treatment, the 6MWD was still 16% above the baseline value (p=0.02). In conclusion, six sessions of cognitive and behavioural psychotherapy produced a sustained improvement in exercise tolerance in a group of 10 anxious patients with severe chronic obstructive pulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers".     

Rehabilitation of patients admitted to a respiratory intensive care unit

OBJECTIVE: Pulmonary rehabilitation has been shown to be of benefit to clinically stable patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of pulmonary rehabilitation on some physiologic variables in COPD patients recovering from an episode of acute respiratory failure. DESIGN: A prospective, randomized study. SETTING: A respiratory intensive care unit (RICU). PATIENTS: Eighty COPD patients recovering from an episode of acute respiratory failure were randomized in a 3:1 fashion to receive stepwise pulmonary rehabilitation (group A, n=60 patients) or standard medical therapy (group B, n=20 patients). MAIN OUTCOME MEASURES: Improvements in exercise tolerance, sense of breathlessness, respiratory muscle function, and pulmonary function test values were measured, respectively, by exercise capacity (6-minute walking distance [6MWD]), dyspnea score (Visual Analog Scale [VAS]), maximal inspiratory pressure (MIP), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). INTERVENTIONS: Group A received pulmonary rehabilitation that consisted of passive mobilization (step I), early deambulation (step II), respiratory and lower skeletal muscle training (step III), and if the patients were able, complete lower extremity training on a treadmill (step IV). Group B received standard medical therapy plus a basic deambulation program. RESULTS: Sixty-one of 80 patients were mechanically ventilated at admission to the unit and most of them were bedridden. Twelve of the 60 group A patients and 4 of the 20 group B patients died during their RICU stay, and 9 patients required invasive mechanical ventilation at home after their discharge. The total length of RICU stay was 38+/-14 days for patients in group A versus 33.2+/-11 days for those in group B. Most patients from both groups regained the ability to walk, either unaided or aided. At discharge, 6 MWD results were significantly improved (p < .001) in Group A only. MIP improved in Group A only (p < .05), while VAS scores improved in both groups, but the improvement was more marked in group A (p < .001) than in group B (p < .05). CONCLUSIONS: COPD patients who were admitted to a RICU in critical condition after an episode of acute respiratory failure and who, in most cases, required mechanical ventilation benefited from comprehensive early pulmonary rehabilitation, compared with patients who received standard medical therapy and progressive ambulation.     

Training with supplemental oxygen in patients with COPD and hypoxaemia at peak exercise

Supplemental oxygen has acute beneficial effects on exercise performance in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to investigate whether oxygen-supplemented training enhances the effects of training while breathing room air in patients with severe COPD. A randomized controlled trial was performed in 24 patients with severe COPD who developed hypoxaemia during incremental cycle exercise (arterial oxygen saturation (Sa,O2) <90% at peak exercise). All patients participated in an in-patient pulmonary rehabilitation programme of 10 weeks duration. They were assigned either to general exercise training while breathing room air (GET/RA group: forced expiratory volume in one second (FEV1) 38% of predicted; arterial oxygen tension (Pa,O2) 10.5 kPa at rest; Pa,O2 7.3 kPa at peak exercise), or to GET while breathing supplemental oxygen (GET/O2 group: FEV1 29% pred; Pa,O2 10.2 kPa at rest; Pa,O2 7.2 kPa at peak exercise). Sa,O2 was not allowed to fall below 90% during the training. The effects on exercise performance while breathing air and oxygen, and on quality of life were compared. Maximum workload (Wmax) significantly increased in the GET/RA group (mean (SD) 17 (15) W, p<0.01), but not in the GET/O2 group (7 (25) W). Six minute walking distance (6MWD), stair-climbing, weight-lifting exercise (all while breathing room air) and quality of life significantly increased in both groups. Acute administration of oxygen improved exercise performance before and after training. Training significantly increased Wmax, peak carbon dioxide production (V'CO2) and 6MWD while breathing oxygen in both groups. Differences between groups were not significant. Pulmonary rehabilitation improved exercise performance and quality of life in both groups. Supplementation of oxygen during the training did not add to the effects of training on room air.     

Common and specific process factors in cardiac rehabilitation: Independent and interactive effects of the working alliance and self-efficacy.

Objective: Therapeutic processes in cardiac rehabilitation programs are virtually unexamined. Models were tested by which changes in the working alliance between patient and staff (agreement on goals/tasks; emotional bond) may affect outcomes in conjunction with changes in patient self-efficacy to change their diets and increase exercise. Design: Cardiac patients (n = 79) participated in a 12-week program, and completed assessments at early, mid, and late treatment. Main Outcome Measures: Changes in cardiac depression, physical health, perceived exertion during exercise, rate/pressure product at submaximal exercise tolerance, weight loss, return to work, total fat intake. Results: Early-treatment changes in agreement on goals/tasks were related to changes in psychosocial factors and perceived exertion during exercise independent of effects of changes in self-efficacy. Early-treatment changes in goals/tasks and self-efficacy interacted to predict changes in cardiorespiratory fitness, weight loss, and return to work such that patients high on both goals/tasks and self-efficacy showed the most gains. Conclusion: Sound therapeutic relationships between patients and staff may play an important role in facilitating the achievement of a wide-range of salutary outcomes during cardiac rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical fitness and psychological benefits of strength training in community dwelling older adults

Previous studies concerning psychological benefits of exercise among the elderly has focused predominantly on the effects of aerobic exercise. In the present study, psychological and behavioral adaptations in response to 12-weeks of strength training were examined in medically healthy but sedentary 42 older adults (mean age = 68 years). The purpose of this study was to evaluate the effects of high and low intensity resistance training intensity on a) muscular fitness, b) psychological affect, and c) neurocognitive functioning. Subjects were randomly assigned to high intensity/low volume (EXH: 2 sets of 8 to 10 repetitions for 75 to 85% of 1 RM), low intensity/high volume (EXL: 2 sets of 14 to 16 repetitions for 55 to 65% of 1 RM), or no exercise control programs. Prior to and following the 12-week program, subjects underwent comprehensive physiological and psychological evaluations. Physiological assessment included measurements of blood pressure, heart rate, arm and leg muscle strength, body composition, and oxygen consumption (VO2max). Psychological measures included evaluations of mood, anxiety, and physical self-efficacy as well as cognitive functioning. The results of this study indicated that both high and low intensity strength programs were associated with marked improvements in physiological fitness and psychological functioning. Specifically, subjects in the strength training programs increased overall muscle strength by 38.6% and reduced percent body fat by 3.0%. Favorable psychological changes in the strength-trained subjects included improvements in positive and negative mood, trait anxiety, and perceived confidence for physical capability. The treatment effects of neurocognitive functioning were not significant. In summary, this study demonstrated that participation in 12-weeks of high or low intensity strength training can improve overall physical fitness, mood, and physical self-efficacy in older adults while cognitive functioning remains constant.     

Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease.

Exercise rehabilitation is recommended increasingly for patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of exercise and education on 79 older adults (M age?=?66.6 ± 6.5 years; 53% female) with COPD, randomly assigned to 10 weeks of (a) exercise, education, and stress management (EXESM; n?=?29); (b) education and stress management (ESM; n?=?25); or (c) waiting list (WL; n?=?25). EXESM included 37 sessions of exercise, 16 educational lectures, and 10 weekly stress management classes. ESM included only the 16 lectures and 10 stress management classes. Before and after the intervention, assessments were conducted of physiological functioning (pulmonary function, exercise endurance), psychological well-being (depression, anxiety, quality of life), and cognitive functioning (attention, motor speed, mental efficiency, verbal processing). Repeated measures multivariate analysis of variance indicated that EXESM participants experienced changes not observed among ESM and WL participants, including improved endurance, reduced anxiety, and improved cognitive performance (verbal fluency). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy

PURPOSE/OBJECTIVES: To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy. DESIGN: Experimental. SETTING: Breast evaluation clinics of two New England medical centers with comprehensive cancer treatment programs. SAMPLE: 14 women (mean age = 44 years) receiving adjuvant chemotherapy for breast cancer (86% stage II) following surgical treatment. METHODS: Subjects were assigned randomly to the experimental group or the usual care group. Experimental group members began a structured exercise program of walking and attended support group meetings. All subjects were tested before beginning chemotherapy, during the course of chemotherapy, and one month following chemotherapy completion. MAIN RESEARCH VARIABLES: Performance status, physical functioning, psychosocial adjustment, self-concept and body image, and 12 symptoms (e.g., fatigue, nausea, anxiety). FINDINGS: Measures of physical performance, psychosocial adjustment, and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program. CONCLUSIONS: Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: Although more detailed research is necessary to answer some of the questions raised by this study, implementing the walking program and forming a support group are achievable in an outpatient setting.     

The effects of pulmonary rehabilitation combined with inspiratory muscle training on pulmonary function and inspiratory muscle strength in elderly patients with chronic obstructive pulmonary disease]

It has been suggested that pulmonary rehabilitation compined with inspiratory muscle training (IMT) might improve pulmonary function and respiratory muscle strength in elderly patients with chronic obstructive pulmonary disease (COPD). To test this hypothesis, inspiratory muscle strength (PImax), expiratory muscle strength (PEmax) and resting pulmonary function were measured in 13 elderly patients with COPD (aged 70.3 +/- 2.7 years). Inspiratory muscle training (IMT) was performed for 15 min twice a day, using a pressure threshold device, for a total of 12 weeks. The inspiratory threshold was set at 15% of maximal inspiratory pressure (PImax) for each individual. Pulmonary rehabilitation was performed for 12-h sessions over a 12-week period. Patients with COPD were assigned randomly to two groups: pulmonary rehabilitation combined with IMT (group A) (n = 7), and conventional pulmonary rehabilitation only (group B) (n = 6). Functional residual capacity (FRC) decreased significantly from 4.3 +/- 0.4 L at baseline to 3.9 +/- 0.4 L after rehabilitation (p < 0.01), Vp significantly increased from 4.6 +/- 0.8 L/sec at baseline to 5.1 +/- 0.7 L/sec after rehabilitation (p < 0.05) and the PImax increased significantly from 51.5 +/- 5.4 cmH2O at baseline to 80.9 +/- 7.0 cmH2O after rehabilitation (p < 0.02) in group A. However, these variables did not change in group B. There was no improvement in the 10-minutes walking distance of group A, but there was a significant increase in that of group B. It can be concluded that pulmonary rehabilitation combined with IMT improves pulmonary function and inspiratory muscle strength in elderly patients with COPD.     

Association between homeobox-containing gene MSX1 and the occurrence of limb deficiency

Impaired exercise capacity is a common finding in chronic obstructive pulmonary disease (COPD) patients. This reduction is not a simple consequence of airflow limitation. Peripheral muscle weakness, deconditioning and impaired gas exchange, were recognized as important contributors to exercise intolerance. In this overview, the contribution of peripheral muscle function and muscle training to exercise performance is discussed by means of three questions: 1) Is peripheral muscle dysfunction contributing to exercise limitation in COPD? 2) How do we measure peripheral muscle function? 3) Are peripheral muscle training modalities effective? At present, there is substantial evidence for peripheral muscle dysfunction. Both reduced force generating capacity as well as impaired muscle metabolism were observed and these findings contributed substantially to the reduced exercise capacity in COPD. Peripheral muscle strength measurements are feasible with mechanical or electronic devices and revealed muscle weakness in COPD patients. However, this weakness is not uniform for all muscle groups. Upper arm and leg muscles were more affected than hand muscles. This may, at least in part, be related to differences in the levels of inactivity between leg and hand muscles. In addition, muscle weakness is associated with impaired exercise capacity and symptoms of increased exertion during exercise. Endurance exercise training, i.e. cycling and treadmill walking, improved exercise capacity and was associated with alterations in muscle metabolism. Strength training of peripheral muscles showed increases in submaximal exercise performance and quality of life measures. These improvements were observed independently of the degree of airflow obstruction. The optimal training regimen (strength or endurance), and the muscle groups to be trained, remain to be determined.     

Trends along the debt-income axis: implications for medical students'' selections of family practice careers

Even elderly patients > or = 75 years of age with coronary artery disease have modest improvements in lipid levels and marked improvements in exercise capacity, behavioral characteristics, and quality-of-life parameters after cardiac rehabilitation and exercise training programs. These data support that even very elderly patients with coronary artery disease should be routinely referred to and vigorously encouraged to pursue formal outpatient cardiac rehabilitation and exercise training programs following major coronary events.     

The relationship of perceived self-efficacy to quality of life in chronic obstructive pulmonary disease.

From a biomedical perspective, variations in the quality of life of chronic obstructive pulmonary disease (COPD) patients may be attributed to changes in pulmonary function, thus, an increase in lung function should be correlated with an increased score on a health-related quality-of-life measure. However, inconsistent results regarding correlations between various measures of pulmonary function and quality of life have been reported in the literature. The authors evaluated a social cognitive model of quality of life among persons with COPD by analyzing relationships among biomedical measures, self-efficacy measures, and quality-of-life measures in a recursive path model. Path analysis results indicated that the association of pulmonary function and symptoms with quality of life was mediated by perceived self-efficacy for functional activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of proxy efficacy and reliance to home-based physical activity after cardiac rehabilitation.

Objective: To examine cardiac rehabilitation program (CRP) participants' beliefs about their interventionists (proxy efficacy and reliance), self-efficacy, and exercise behavior during transition to home-based exercise. Participants and Design: Participants were 44 (16 women and 28 men) CRP outpatients (Mage = 59.43 ± 13.53 years). The design was prospective, with proxy efficacy and reliance as well as self-efficacy being used to predict two outcomes: self-regulatory self-efficacy and home-based exercise. Results: After self-regulatory efficacy reported earlier in the program was controlled for, proxy reliance predicted later program self-regulatory efficacy for home-based exercise (adjusted R2 = .10, p = .02). Proxy efficacy for self-regulation predicted home-based exercise frequency (adjusted R2 = .18, p = .01). Greater proxy efficacy for self-regulation was associated with higher exercise frequency. Conclusion: CRP participants' beliefs in the capabilities of their exercise consultants to help them develop self-regulatory skills play a role in how much exercise they do after supervised rehabilitation. Yet, individuals who strongly rely on their interventionists to assist them in exercising report weaker self-efficacy for exercising on their own. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of group- versus home-based exercise in the treatment of obesity.

This study examined the effects of 2 aerobic exercise regimens on exercise participation, fitness, eating patterns, treatment adherence, and weight changes in 49 obese women undergoing a year-long behavioral weight loss program. Participants were assigned randomly to weight loss treatment plus either group- or home-based exercise. All participants were instructed to complete a moderate-intensity walking program (30 min/day, 5 days/week). Group exercise participants were provided with 3 supervised group exercise sessions per week for the 1st 26 weeks and with 2 sessions per week thereafter. Home exercise participants were instructed to complete all exercise in their home environment. After 6 months, both conditions displayed significant improvements in exercise participation, fitness, eating patterns, and weight loss. At 12 months, the home-based program showed superior performance to the group condition in exercise participation and treatment adherence; at 15 months, participants in the home program demonstrated significantly greater weight losses than those in the group program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)