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Exercise, rehabilitation, physiology, nutrition , chronic diseases

Daniel Langer
Lung transplantation is an established treatment for patients with end-stage lung disease. It has been observed that despite near-normal lung function, exercise intolerance and reductions in quality of life (QOL) often persist up to years after transplantation. Several modifiable pre- and posttransplant factors are known to contribute to these persisting impairments. Physiological changes associated with severe and chronic lung disease, limb muscle dysfunction, inactivity/deconditioning, and nutritional depletion can affect exercise capacity and physical functioning in candidates for lung transplantation...
2015: Respiration; International Review of Thoracic Diseases
Andrea Corsonello, Simone Scarlata, Claudio Pedone, Silvia Bustacchini, Sergio Fusco, Anna Zito, Raffaele Antonelli Incalzi
The treatment of older and oldest old patients with COPD poses several problems and should be tailored to specific outcomes, such as physical functioning. Indeed, impaired homeostatic mechanisms, deteriorated physiological systems, and limited functional reserve mainly contribute to this complex scenario. Therefore, we reviewed the main difficulties in managing therapy for these patients and possible remedies. Inhaled long acting betaagonists (LABA) and anticholinergics (LAMA) are the mainstay of therapy in stable COPD, but it should be considered that pharmacological response and safety profile may vary significantly in older patients with multimorbidity...
2015: Current Pharmaceutical Design
Gerard J Criner, Francis Cordova, Alice L Sternberg, Fernando J Martinez
The National Emphysema Treatment Trial (NETT) was a multicenter prospective randomized controlled trial that compared optimal medical treatment, including pulmonary rehabilitation, with optimal medical treatment plus lung volume reduction surgery (LVRS). It was the largest and most complete collection of patient demographic, clinical, physiological, and radiographic data ever compiled in severe emphysema. NETT investigated the effects of optimal medical management and LVRS on short- and long-term survival, as well as lung function, exercise performance, and quality of life...
October 1, 2011: American Journal of Respiratory and Critical Care Medicine
Michael J Rennie, Emilie A Wilkes
Although the overall size of the musculoskeletal mass is constrained by genetic limitations, both the day to day maintenance and muscle wasting and rehabilitation are regulated by protein synthesis (particularly the initiation and elongation stages of translation) and by protein breakdown. These are directly influenced by the nutritional state (size and composition of meals) and type, mode and duration of exercise. In the context of food-related changes, recent work has demonstrated that human muscle protein synthesis is almost entirely controlled by the availability of essential amino acids and protein breakdown by availability of insulin...
2005: Annals of Transplantation: Quarterly of the Polish Transplantation Society
P N R Dekhuijzen, I J M Smeele, S M Smorenburg et al.
The non-pharmacological treatment of patients with chronic obstructive pulmonary disease (COPD) comprises a large number of related components. Active case-finding is advocated in (ex-)smokers above the age of 40 who either cough or have 2 respiratory-tract infections per year. Structured self-management programmes may have positive effects; follow-up is of importance to prevent relapse of unhealthy behaviour. Patients with COPD must not smoke. Exercise training is essential in all stages of COPD; an exercise test should be done first, especially in severe COPD...
June 3, 2006: Nederlands Tijdschrift Voor Geneeskunde
Bartolome Celli, Roger Goldstein, José Jardim, Katharine Knobil
The pathophysiology of chronic obstructive pulmonary disease (COPD) is complex. The development of a multidimensional index--such as the BODE index--provides a means of classifying patients with COPD that also correlates with their prognosis. The individual components of the BODE index--body mass index (B), airflow obstruction (O) dyspnoea (D) and exercise capacity (E)--incorporate the pulmonary as well as the systemic effects seen in patients with COPD. Recent research has focussed on examining these impairments (including those of metabolism and inflammation) more carefully, and determining the effects of treatment on both the systemic and physiological aspects of COPD...
December 2005: Respiratory Medicine
Birinder Singh Bobby Cheema, Benjamin Charles Faulknor Smith, Maria A Fiatarone Singh
The purpose of this article is to present a rationale for intradialytic exercise training in patients with end-stage renal disease based on the empirical evidence to date and determine whether this evidence has translated into enhanced renal rehabilitation practices throughout the world. According to the published literature, intradialytic exercise improves exercise adoption and adherence in this cohort, is performed safely, and is feasible to administer. Moreover, intradialytic exercise can improve solute removal, dialysis adequacy, intradialytic protein synthesis, muscular strength, peak oxygen consumption, nutritional status, and quality of life...
May 2005: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
R Antonucci, E Berton, A Huertas, P Laveneziana, P Palange
Multiple mechanisms contribute to exercise limitation in chronic obstructive pulmonary disease (COPD). The ability to increase ventilation during exercise is reduced; the more advanced the disease, the more impaired the exercise tolerance is. However, factors other than ventilatory limitation play an important role in reducing the exercise capacity in COPD. Data implicating peripheral muscle atrophy and muscle weakness as cofactors have been reported in individuals with advanced disease. At this stage daily activities are curtailed to avoid exertional respiratory discomfort...
April 2003: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Eva C Creutzberg, Emiel F M Wouters, Rob Mostert, Clarie A P M Weling-Scheepers, Annemie M W J Schols
OBJECTIVE: Weight loss and muscle wasting adversely affect morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Maintenance systemic glucocorticosteroids, prescribed in a substantial number of patients, further contribute to muscle weakness. We investigated the efficacy of oral nutritional supplementation therapy in depleted patients with COPD. METHODS: The therapy consisted of daily two to three oral liquid nutritional supplements (mean +/- standard deviation: 2812 +/- 523 kJ/24 h) incorporated into an 8-wk inpatient pulmonary rehabilitation program in 64 (49 men) depleted patients with COPD...
February 2003: Nutrition
Pelagia Koufaki, Patrick F Nash, Thomas H Mercer
PURPOSE: The purpose of this study was to evaluate the meaningfulness of exercise training responses in patients with end stage renal disease (ESRD). METHODS: Eighteen ESRD patients [(mean +/- SD); 54.3 +/- 17.1 yr] completed a training regime progressing to accumulate 40 min of stationary cycling, three times per week for 6 months. .VO(2peak) determined via incremental cycle ergometer protocol, and .VO(2) kinetics determined from a transition from unloaded pedalling to an exercise intensity corresponding to 90% of VT, were assessed at baseline and at 3 and 6 months of training...
August 2002: Medicine and Science in Sports and Exercise
K Foglio, L Bianchi, N Ambrosino
STUDY OBJECTIVES: To answer the following questions: in patients with chronic airway obstruction (CAO), (1) can pulmonary rehabilitation lead to similar short-term gains at successive, yearly interventions, and (2) is there any real clinical or physiologic long-term benefit by yearly repetition of pulmonary rehabilitation programs (PRPs)? DESIGN: Randomized, controlled clinical study. SETTING: Pulmonary rehabilitation center. PATIENTS: Sixty-one CAO patients studied 1 year after completing an initial 8-week outpatient PRP (PRP1)...
June 2001: Chest
T Iwanaga, S Inuzuka, N Takahashi, R Kishikawa, T Ikeda, T Hirose, H Tsurutani, S Nishima
Exercise reconditioning has long been considered an essential component of the pulmonary rehabilitation regime. To investigate the long-term effects of exercise training on exercise endurance and dyspnea in patients with chronic pulmonary emphysema (CPE), we developed a supervised exercise program using bicycle ergometers. Nineteen patients (mean age: 67) with moderate to severe airflow limitation (average FEV1/FVC, 39.8%) were enrolled in a predominantly outpatient rehabilitation program. After their lactate thresholds were measured by an incremental symptom-limited maximum test, patients engaged in exercise training 15 to 30 minutes per day in an arbitrary frequency and at a work rate at or below their lactate threshold (average: 20...
August 1998: Nihon Kokyūki Gakkai Zasshi, the Journal of the Japanese Respiratory Society
J R Donado, N S Hill
The successful management of outpatients with COPD requires a multifaceted approach that includes prophylactic, palliative, and life-extending therapies. All patients should undergo smoking cessation, avoid potentially harmful environments, and receive influenza and pneumococcal vaccines at recommended intervals. Although medical therapy may yield only marginal benefits in patients with minimal airway responsiveness, even small improvements may translate into significant functional benefits and will be greatly appreciated...
September 1998: Respiratory Care Clinics of North America
P Painter, G Blackburn
Most patients with chronic disease can benefit from rehabilitation efforts to optimize their functioning within the limitations placed on them by the disease and/or treatment and to increase their responsibility in their health care. Rehabilitation should include education and counseling in nutrition, behavioral change, exercise conditioning, and clinical concerns. The exercise portion can be accomplished in a supervised or unsupervised setting, depending on the patient's clinical status and needs. The exercise prescription must be modified to meet the clinical needs of the patient...
January 1988: Postgraduate Medicine
R M Rogers, M Donahoe, J Costantino
The association between severe nutritional depletion and chronic obstructive pulmonary disease (COPD) has long been recognized. A potential therapeutic benefit to nutritional support was previously suggested by us in a pilot investigation. Subsequent studies have reported conflicting results regarding the role of nutritional therapy in this clinical population. We report a randomized controlled study of nutritional therapy in underweight patients with COPD that combines an initial inpatient investigation (controlled nutritional support) with a prolonged outpatient follow-up interval...
December 1992: American Review of Respiratory Disease
J S Putnam, C R Beechler
Once a diagnosis of COPD is suspected, history, physical examination, pulmonary function tests, chest roentgenogram, sputum analysis, and so forth, are useful to assess the severity of obstructive airways diseases. A comprehensive program of care is then outlined (Table 2). General measures include avoidance of infection and inhalants, humidification, and proper rest and diet. Appropriate medications may include bronchodilators, antibiotics, corticosteroids, cromolyn sodium, digitalis, and diuretics. Inhalation therapy as aerosols, IPPB, and supplemental oxygen may be indicated...
December 1976: Primary Care
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