Application of the Modified Incremental Step Test for Pulmonary Rehabilitation

2021 ◽  
Author(s):  
A T Burge ◽  
J C Rodrigues ◽  
M J Abramson ◽  
N S Cox ◽  
J Bondarenko ◽  
...  
Keyword(s):  
Exercise Training ◽  
Exercise Capacity ◽  
Effect Size ◽  
Pulmonary Rehabilitation ◽  
Exercise Prescription ◽  
Intraclass Correlation ◽  
Step Test ◽  
Home Based ◽  
Walking Tests ◽  
Incremental Step

Abstract Objective A modified incremental step test (MIST) performed in the home may facilitate entirely home-based pulmonary rehabilitation programs. The aims of this study were to investigate the reliability and responsiveness, and the utility of the MIST for exercise prescription in people with stable chronic lung disease. Methods The MIST was undertaken at the centre and home in random order, before and after pulmonary rehabilitation, with two tests at each time point. Reliability was assessed using intraclass correlation coefficient. Responsiveness was evaluated as effect size. The minimal important difference was appraised using distribution and anchor-based methods. In a sub-study, physiological responses to MIST were measured by a portable metabolic system, followed by a constant step rate test at 60% of peak oxygen uptake (v̇O2peak), to evaluate utility for exercise prescription. Results Forty-six participants were recruited (29% of eligible candidates). There was excellent reliability for number of steps recorded in home and centre-based settings (intraclass correlation coefficient 0.954, 95%CI 0.915 to 0.976). A small-moderate effect size was demonstrated following pulmonary rehabilitation (0.34) and the minimal detectable change was 7 steps. All participants in the sub-study achieved 60% of v̇O2peak and achieved steady state by the 4th minute, with 60% of v̇O2 peak corresponding to mean 37% (95%CI 29 to 44) of the MIST final level. Conclusions The MIST is reliable and responsive to pulmonary rehabilitation in people with stable chronic respiratory disease. It provides new opportunities to assess exercise capacity, prescribe exercise training and reassess exercise program outcomes in environments where established field walking tests are not feasible. Impact Pulmonary rehabilitation is a highly effective treatment that is underutilised worldwide. Home-based pulmonary rehabilitation may improve access for patients and deliver equivalent clinical outcomes, but is limited by the availability of a robust exercise test that can be used at home to assess exercise capacity and prescribe training intensity. This study tested the clinimetric properties of the modified incremental step test and demonstrated a new way to assess exercise capacity, prescribe exercise training of an appropriate intensity and reassess exercise capacity in environments where established field walking tests are not feasible.

scholarly journals A home-based pulmonary rehabilitation mHealth system to enhance the exercise capacity of patients with COPD: development and evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ning Deng ◽  
Leiyi Sheng ◽  
Wangshu Jiang ◽  
Yongfa Hao ◽  
Shuoshuo Wei ◽  
...  
Keyword(s):  
Behavior Change ◽  
Technology Acceptance ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Exercise Prescription ◽  
Chronic Obstructive ◽  
Pilot Studies ◽  
Home Based ◽  
Copd Patients ◽  
Significant Difference

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) experience deficits in exercise capacity and physical activity as their disease progresses. Pulmonary rehabilitation (PR) can enhance exercise capacity of patients and it is crucial for patients to maintain a lifestyle which is long-term physically active. This study aimed to develop a home-based rehabilitation mHealth system incorporating behavior change techniques (BCTs) for COPD patients, and evaluate its technology acceptance and feasibility. Methods Guided by the medical research council (MRC) framework the process of this study was divided into four steps. In the first step, the prescription was constructed. The second step was to formulate specific intervention functions based on the behavior change wheel theory. Subsequently, in the third step we conducted iterative system development. And in the last step two pilot studies were performed, the first was for the improvement of system functions and the second was to explore potential clinical benefits and validate the acceptance and usability of the system. Results A total of 17 participants were enrolled, among them 12 COPD participants completed the 12-week study. For the clinical outcomes, Six-Minute Walk Test (6MWT) showed significant difference (P = .023) over time with an improvement exceeded the minimal clinically important difference (MCID). Change in respiratory symptom (CAT score) was statistically different (P = .031) with a greater decrease of − 3. The mMRC levels reduced overall and showed significant difference. The overall compliance of this study reached 82.20% (± 1.68%). The results of questionnaire and interviews indicated good technology acceptance and functional usability. The participants were satisfied with the mHealth-based intervention. Conclusions This study developed a home-based PR mHealth system for COPD patients. We showed that the home-based PR mHealth system incorporating BCTs is a feasible and acceptable intervention for COPD patients, and COPD patients can benefit from the intervention delivered by the system. The proposed system played an important auxiliary role in offering exercise prescription according to the characteristics of patients. It provided means and tools for further individuation of exercise prescription in the future.

A home-based pulmonary rehabilitation mHealth system to enhance the exercise capacity of patients with COPD: Development and evaluation (Preprint)

2021 ◽  
Author(s):  
Ning Deng ◽  
Leiyi Sheng ◽  
Yongfa Hao ◽  
Wangshu Jiang ◽  
Qingdong Huang ◽  
...  
Keyword(s):  
Technology Acceptance ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Research Council ◽  
Medical Research Council ◽  
Exercise Prescription ◽  
Home Based ◽  
Copd Patients ◽  
Significant Difference ◽  
Over Time

BACKGROUND Patients with Chronic Obstructive Pulmonary Disease (COPD) experience deficits in exercise capacity and physical activity as their disease progresses. Pulmonary rehabilitation (PR) can enhance exercise capacity of patients and it is crucial for patients to maintain a long-term physically active lifestyle. OBJECTIVE This study aimed to develop a home-based rehabilitation mHealth system incorporating Behavior Change Techniques (BCTs) for COPD patients, and evaluate its technology acceptance and feasibility. METHODS Guided by the Medical Research Council (MRC) framework the process of this study is divided into four steps. In the first step the prescription was constructed. The second step is to formulate specific intervention functions based on the Behavior Change Wheel (BCW) theory. Subsequently, in the third step iterative system development was conducted. And in the last step two polit studies were performed, the first is for the improvement of system functions and the second is to validate the acceptance and usability. Primary outcomes were the exercise capacity measured by Six-Minute Walk Test (6MWT). Secondary clinical outcomes included changes in disease specific health status measured by COPD Assessment Test (CAT), measure of breathlessness indicated by mMRC (modified British medical Research Council) and indicators of mental health such as Hospital Anxiety and Depression Scale (HAD). Compliance, technology acceptance, and feasibility of the system were also used as outcome indicators. RESULTS Two-stage study was conducted to evaluate the proposed system. A total of 17 patients was enrolled. 12 patients completed the 12-week study. At the end of the first study, the 6MWT showed significant increase over time (P=0.028). Participants reported that this app had a positive effect on promoting exercise at home. The results of the second stage study is the final result of this study. For the clinical outcomes, 6MWT scores showed significant difference (P=.023) over time with an improvement exceeded the Minimal Clinically Important Difference (MCID). Change in respiratory symptom (CAT score) was statistically different (P=.023) with a greater decrease of -3.17 points that exceeded the MCID. The mMRC levels reduced overall and showed significant difference. HAD did not show statistically significant difference in this study but non-inferiority. The overall compliance of this study reached 82.20% (±1.68%). CONCLUSIONS This study developed a home-based PR mHealth system for COPD patients. The use of BCW in the intervention developing process offers a systematic method for designing a theory-driven intervention. The pilot study in Yinchuan verified the technical acceptance and availability of the system, and demonstrated the benefits of applying mHealth technology and BCT to Home-based PR for COPD patients. The proposed system plays an important auxiliary role in the process of prescribing exercise prescription according to the characteristics of patients. And it provides means and tools for further individuation of exercise prescription in the future.

Home-Based Exercise Training as Maintenance after Outpatient Pulmonary Rehabilitation

Respiration ◽  
2008 ◽  
Vol 77 (2) ◽  
pp. 139-145 ◽  
Author(s):  
Marcel du Moulin ◽  
Karin Taube ◽  
Karl Wegscheider ◽  
Michaela Behnke ◽  
Hendrik van den Bussche
Keyword(s):  
Exercise Training ◽  
Pulmonary Rehabilitation ◽  
Home Based

scholarly journals Home-based pulmonary rehabilitation in people with bronchiectasis, a randomised controlled trial

2021 ◽  
pp. 00021-2021
Author(s):  
Anderson José ◽  
Anne E. Holland ◽  
Jessyca P. R. Selman ◽  
Cristiane Oliveira de Camargo ◽  
Diogo Simões Fonseca ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Muscle Strength ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Quadriceps Muscle ◽  
Step Test ◽  
Control Group ◽  
Test Quality ◽  
Incremental Step

AimTo investigate the short- and long-term effects of Home-based Pulmonary Rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnea and daily physical activity in people with bronchiectasis.MethodsRandomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids, and biceps brachii with elastic bands). The control group received recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later.ResultsAfter the intervention, the HBPR group had increased the distance in ISWT compared with the control group with between-group difference: 87.9 m (95% CI 32.4 to 143.5). Between-group differences was found in ESWT, incremental step test, quality of life and quadriceps muscle strength in favor to HBPR group too. After 6 months, no differences were observed between the groups.ConclusionHBPR is an effective alternative for offering pulmonary rehabilitation for people with bronchiectasis. However, the program was not effective in maintaining the benefits after 6 months of follow-up.

Between-day reliability of a novel incremental step test to assess exercise capacity in COPD patients

2021 ◽  
Author(s):  
Rui Vilarinho ◽  
Lúcia Serra ◽  
Cátia Esteves ◽  
Cátia Caneiras ◽  
António Mesquita Montes
Keyword(s):  
Exercise Capacity ◽  
Step Test ◽  
Copd Patients ◽  
Incremental Step

Does modified incremental step test evaluate maximal exercise capacity in moderate to severe subjects with asthma?

2019 ◽  
Author(s):  
Renata Barbosa ◽  
Ronaldo Silva ◽  
Simone Camargo ◽  
Simone Dal Corso ◽  
João Marcos Salge ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Maximal Exercise ◽  
Step Test ◽  
Incremental Step ◽  
Maximal Exercise Capacity

scholarly journals Home-Based Exercise Training for Heart Failure Patients: a Systematic Review

Jurnal NERS ◽  
2020 ◽  
Vol 14 (3) ◽  
pp. 155
Author(s):  
Roby Aji Permana ◽  
Wikan Purwihantoro Sudarmaji ◽  
Wahyu Sukma Samudera ◽  
Agostinha Soares ◽  
Yanuar Aga Nugraha
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Search Algorithm ◽  
Rehabilitation Program ◽  
Heart Failure Patients ◽  
Home Based

Exercise training is one of the recommendations for a cardiac rehabilitation program to increase exercise capacity and thus quality of life, decreasing both readmission and mortality in terms of heart failure. In spite of the evidence on the benefits and safety of cardiac rehabilitation, the uptake and participation of cardiac rehabilitation by patients with heart failure is currently poor. This study aimed to systematically review the effect of home-based exercise training on heart failure patients. The studies were systematically identified by searching through the chosen electronic databases (Scopus, Science Direct, Proquest, Pubmed, and CINAHL) for articles from the 5 last years. The search algorithm identified a total 164 articles and 15 articles were selected based on the inclusion and exclusion criteria. For the 15 articles, 13 were RCTs, 1 was quasi-experimental and 1 was a retrospective study. The major result of this review shows that home-based exercise has an effect on functional and exercise capacity, quality of life and a decreased rate of readmission within 2-12 months follow up. Home-based exercise has a long-term effect that is more effective than exercise that is hospital-based.

scholarly journals P1397 Rehabilitation in pulmonary arterial hypertension: REHAB-HTP

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Missana ◽  
M Azzolini Jacquin ◽  
D Baudouy ◽  
C Sanfiorenzo ◽  
S Leroy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Arterial Hypertension ◽  
Exercise Training ◽  
Arterial Hypertension ◽  
Exercise Capacity ◽  
Exercise Test ◽  
Pulmonary Rehabilitation ◽  
Contractile Reserve ◽  
Pulmonary Arterial

Abstract BACKGROUND Pulmonary arterial hypertension (PAH) is a life-threatening condition. Current ESC guidelines recommend exercise training and rehabilitation in clinically stable PAH patients. PURPOSE To assess the beneficial effect of exercise training on exercise capacity, quality of life and cardiac function as assessed by echocardiography and cardio-pulmonary exercise test. METHODS We prospectively included 12 clinically stable PAH patients over a 6 months period. Exercise stress echocardiography (ESE), cardio-pulmonary exercise test (CPET), SF-12 quality of life health survey, 6 minute walking test distance (6MWD), BNP and clinical assessment were performed before and after cardio-pulmonary rehabilitation. Patients underwent 8 weeks of exercise training (3 times a week of aerobic training and at home daily prescribed exercises). RESULTS All patients underwent ESE and CPET without any complication. 6 patients experienced a reduction in WHO functional class whereas 6 remained stable. Patients significantly improved their physical quality of life (p = 0.006). They also improved their exercise capacity according to maximum workload during CPET (p = 0.008) and CPET duration (p = 0.001) whereas a trend toward an improved 6MWD was observed (+58m, p = 0.10). Anaerobic threshold and peak VO2 (+1.7 ± 2.7 mL/kg/min) improved significantly (p = 0.01 and 0.03). Regarding imaging data, at rest peak strain improved after rehabilitation (p = 0.05) whereas the RV became more dilated. RV contractile reserve, defined by the change in peak systolic longitudinal RV strain between rest and maximum exercise, significantly improved (-3.9 ± 4.7%, p = 0.03) CONCLUSION In this preliminary study, cardio-pulmonary rehabilitation led to an improved quality of life and exercise capacity in PAH. The increased in RV contractile reserve post-rehabilitation might explain, in association with the peripheral muscular effects of exercise training, the clinical benefits of rehabilitation in PAH. Abstract P1397 Figure. echography peak/rest in a PAH patient

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