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Biomedical subjects

Rik Gosselink

Publications and source records attributed to Rik Gosselink.

At least 19 recordsLinked to original sources
PubMed2006

Respiratory muscle training in persons with spinal cord injury: a systematic review.

The purpose of this paper was to review the effectiveness of respiratory muscle training (RMT) on respiratory muscle strength and endurance, pulmonary function, quality of life, respiratory complications and exercise performance in persons with spinal cord injury. A MEDLINE (National Library of Medicine, Bethesda, MD, USA) database was used for selection of the literature (from 1980 to November 2004), and relevant references from peer-reviewed articles were retrieved as well. Studies investigating the effects of RMT (i.e. resistive breathing weight lifting or normocapnic hyperpnea) in persons with spinal cord injury were selected. Two independent reviewers investigated controlled studies for methodological quality by using a modification of the framework for methodological quality. Methodological quality ranged between 15 and 29 (maximal feasible score=40). Twenty-three papers were retrieved and six controlled trials were kept for further analysis. A meta-analysis and calculation of effect-size of each individual study and weighted summary effect-size was intended. However, unreported data and heterogeneity in outcome variables did not allow performing a meta-analysis. From the systematic review it is concluded that RMT tended to improve expiratory muscle strength, vital capacity and residual volume. Insufficient data was available to make conclusions concerning the effects on inspiratory muscle strength, respiratory muscle endurance, quality of life, exercise performance and respiratory complications.

Exercise Therapy↗
PubMed2006

Physical activity and hospitalization for exacerbation of COPD.

BACKGROUND: Acute exacerbations (AEs) have a negative impact on various aspects of the progression of COPD, but objective and detailed data on the impact of hospitalizations for an AE on physical activity are not available. Objective and measurements: We aimed to investigate physical activity using an activity monitor (DynaPort; McRoberts; the Hague, the Netherlands), pulmonary function, muscle force, 6-min walking distance, and arterial blood gas levels in 17 patients (mean age, 69 +/- 9 years [+/- SD]; body mass index, 24 +/- 5 kg/m(2)) at the beginning and end of a hospitalization period for an AE and 1 month after discharge. RESULTS: Time spent on weight-bearing activities (walking and standing) was markedly low both at day 2 and day 7 of hospitalization (median, 7%; interquartile range [IQR], 3 to 18% of the time during the day; and median, 9%; IQR, 7 to 21%, respectively) and 1 month after discharge (median, 19% [IQR, 10 to 34%]; Friedman test, p = 0.13). Time spent on weight-bearing activities was positively correlated to quadriceps force at the end of the hospitalization period (r = 0.47; p = 0.048). Patients with hospitalization for an AE in the previous year had an even lower activity level when compared to those without a recent hospitalization. In addition, patients with a lower activity level at 1 month after discharge were more likely to be readmitted in the following year. CONCLUSIONS: Patients with COPD are markedly inactive during and after hospitalization for an AE. Efforts to enhance physical activity should be among the aims of the disease management during and following the AE periods.

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PubMed2005

High-dose lidocaine reduces airway mucus transport velocity in intubated anesthetized dogs.

BACKGROUND: Assessment of mucociliary clearance with displacement of charcoal markers in the central airways needs a bronchoscopic procedure and thus local anesthesia of the upper airways. However, the effects of lidocaine administration on mucus transport in airways are inconclusive. Therefore, detailed information is needed to establish the effects of high- and low-dose lidocaine administration. OBJECTIVES: To study the dose-dependent effect of instillation of lidocaine on mucus transport velocity (MTV) in intubated, anaesthetized dogs. METHODS: Displacement of a charcoal spot in time was studied with a bronchoscope in 10 anaesthetized dogs before and after administration of respectively 5 and 10 ml of either 2% lidocaine (n=5) or NaCl 0.9% (n=5). In addition, mucus viscoelastic properties were determined. RESULTS: No significant differences in MTV were observed after administration of 5 ml of NaCl (8.2+/-3.2 mm/min) or 2% lidocaine (6.7+/-3.8 mm/min) compared to baseline values. By contrast, MTV was reduced after administration of 10 ml of 2% lidocaine (1.9+/-1.0 mm/min; P<0.05 vs. baseline and 5 ml of 2% lidocaine vs. controls, P=0.0035), but not after 10 ml of NaCl (6.2+/-2.1 mm/min). A trend towards an increased mucociliary clearability index was observed for the lidocaine-treated group as compared to the control group (P=0.07). The cough clearability index was not different between groups (P=0.89). CONCLUSIONS: High-dose lidocaine reduces MTV. Therefore, only low-dose lidocaine administration should be applied in the bronchoscopic procedure for assessment of MTV.

Anesthetics, Local↗
PubMed2005

Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.

Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p < 0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p < 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 < r < 0.64, p < 0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.

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PubMed2005

Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease.

OBJECTIVES: To characterize patients referred for pulmonary rehabilitation on a large number of psychologic and sociodemographic variables and to determine the contribution of these variables on the response to rehabilitation. DESIGN: Cross-sectional, explorative. SETTING: University hospital and outpatient clinic. PARTICIPANTS: Eighty-one consecutive patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 second, 40%+/-16% of predicted) were included in outpatient pulmonary rehabilitation. INTERVENTION: Multidisciplinary rehabilitation program. MAIN OUTCOME MEASURES: Pulmonary function, exercise capacity (Wmax, 6-minute walk test [6MWT]), Chronic Respiratory Disease Questionnaire (CRDQ), Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) were assessed before and after 3 months rehabilitation. In addition, psychosocial adjustment, social support, marital status, mode of transportation, education, employment, and smoking status were assessed at the start of the rehabilitation. RESULTS: Rehabilitation improved exercise performance (Wmax, 6+/-12W; P<.01; 6MWT, 41+/-72 m; P<.001), quality of life (CRDQ score, 12+/-13 points; P<.001), functional status (PFSDQ-M activity score, -8+/-11 points; PFSDQ-M dyspnea score, -6+/-12 points; PFSDQ-M fatigue score, -4+/-8 points; all P<.01), HADS anxiety score (-2+/-3 points, P<.01), and HADS depression score (-3+/-3 points, P<.001). In single regression analysis, only baseline depression was weakly negatively correlated with the change in maximal workload. No other relations of initial psychologic or sociodemographic variables with outcome were observed. CONCLUSIONS: The effects of rehabilitation are not affected by baseline psychosocial factors. Patients with less favorable psychologic or sociodemographic conditions can also benefit from pulmonary rehabilitation. The multidisciplinary approach of the rehabilitation program might have contributed to this improvement.

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PubMed2005

Activity monitoring for assessment of physical activities in daily life in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To investigate the degree of agreement between different methods of assessing physical activities in daily life in patients with chronic obstructive pulmonary disease (COPD): video recordings (criterion standard), the DynaPort Activity Monitor (DAM), and patient self-report. DESIGN: Study A: outcomes from video recordings were compared with DAM outcomes and with patient estimation of time spent on each activity after a 1-hour protocol including walking, cycling, standing, sitting, and lying. Study B: DAM outcomes and patient self-report were compared during 1 day in real life. SETTING: Outpatient clinic in a university hospital. PARTICIPANTS: Study A: 10 patients with COPD (mean age, 62+/-6 y; forced expiratory volume in the first second [FEV1]=40%+/-16% of predicted). Study B: 13 patients with COPD (mean age, 61+/-8 y; FEV1=33%+/-10% of predicted). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time spent on different activities and movement intensity during walking and cycling. RESULTS: Study A: time estimated by the patients in the sitting position was significantly lower than the time showed by the video recordings and the DAM (both P<.001). For the other variables, there were no statistically significant differences (all P>.05). However, Bland and Altman plots and intraclass correlation coefficients showed large disagreement between video recordings and patients' estimations, in contrast to the high degree of agreement between video recordings and DAM. Changes in walking speed correlated highly to changes in DAM movement intensity (r=.81, P<.01). Study B: patients significantly overestimated walking time (22+/-47 min, P=.04) and underestimated standing time (-45+/-71 min, P=.04). CONCLUSIONS: The DAM showed high accuracy in objectively assessing time spent on different activities and changes in walking speed in patients with COPD. Patients' estimations of time spent on physical activities in daily life disagreed with objective assessment.

Activities of Daily Living↗
PubMed2005

Low-grade systemic inflammation and the response to exercise training in patients with advanced COPD.

STUDY OBJECTIVE: Low-grade systemic inflammation may cause a chronic catabolic state that may affect trainability in patients with COPD as has been seen previously in healthy elderly. Therefore, the aim of the present study was to study the relationship between baseline circulating levels of inflammatory markers and the response to exercise training in clinically stable patients with COPD. DESIGN: An open prospective intervention study. SETTING: Tertiary care setting, University Hospital Gasthuisberg, Leuven, Belgium. PATIENTS: Seventy-eight clinically stable outpatients with COPD. INTERVENTION: A 12-week outpatient exercise-training program consisting of strengthening and endurance types of exercises. MEASUREMENTS AND RESULTS: Circulating levels of inflammatory markers were assessed at baseline. Moreover, lung function, quadriceps force (QF), peak and functional exercise capacity, and health-related quality of life were determined at baseline and after the intervention. Sixty-five of the 78 consecutive outpatients completed the study protocol. QF, peak and functional exercise capacity and health-related quality of life improved significantly compared to baseline. The absolute changes in health-related quality of life showed weak relationships with baseline circulating levels of interleukin-8 (CXCL8) in the whole group (n = 65; r= -0.26; p = 0.04). In addition, soluble tumor necrosis factor receptor p55 was strongly and positively related to the absolute changes in QF in the female patients only (n = 18; r = 0.81; p = 0.0001), while CXCL8 was inversely related to the absolute change in the total score of the Chronic Respiratory Disease Questionnaire (r= -0.65; p = 0.004). CONCLUSION: Baseline markers of low-grade systemic inflammation did not clearly explain the variances in absolute changes in QF, the distance walked in 6 min, peak external load, or health-related quality of life following a 12-week exercise-training program. Hence, they seem not very constructive in the characterization of patients with advanced COPD who do or do not respond to exercise training.

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PubMed2004

Quadriceps muscle endurance in patients with chronic obstructive pulmonary disease.

The purpose of this study was to compare quadriceps muscle strength (maximal voluntary contraction, MVC), endurance (T(LIM)), and dynamic work capacity (W(LIM)) in 89 patients (57 men and 32 women) with chronic obstructive pulmonary disease (COPD) to 31 healthy controls (20 men and 11 women). Compared with the healthy subjects, COPD patients demonstrated statistically significant (P < 0.05) lower values for MVC, T(LIM) and W(LIM). The MVC was 20-30% lower, whereas T(LIM) and W(LIM) were 70-80% lower in the patients. Stepwise multiple regression analysis revealed that pulmonary function variables contributed only partially to the explanation of variance in MVC, T(LIM), and W(LIM). Our results indicate that in patients with COPD, quadriceps muscle endurance and dynamic work capacity are impaired to a greater extent than is quadriceps muscle strength. For rehabilitation purposes, the findings may lead to more specific exercise programs, further enhancing rehabilitation outcomes in terms of functional abilities and social participation.

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PubMed2004

Exercise training during rehabilitation of patients with COPD: a current perspective.

Patients with chronic obstructive pulmonary disease (COPD) suffer frequently from physiologic and psychological impairments, such as dyspnea, peripheral muscle weakness, exercise intolerance, decreased health-related quality of life (HRQOL) and emotional distress. Rehabilitation programmes have shown to result in significant changes in perceived dyspnea and fatigue, utilisation of healthcare resources, exercise performance and HRQOL. Exercise training, which consists of whole-body exercise training and local resistance training, is the cornerstone of these programmes. Regrettably, the positive effects of respiratory rehabilitation deteriorate over time, especially after short programmes. Hence, attention should be given to the aftercare of these patients to prevent them to revert again to a sedentary lifestyle. On empirical basis three possibilities seem to be clinically feasible: (1) continuous outpatient exercise training; (2) exercise training in a home-based or community-based setting; or (3) exercise training sessions in a group of asthma and COPD patients.

Aftercare↗
PubMed2004

Mechanisms of improvement in exercise capacity using a rollator in patients with COPD.

STUDY OBJECTIVE: We analyzed the effects of the use of a rollator on walking distance and physiologic variables: pulmonary gas exchange, heart rate, minute ventilation (Ve), oxygen saturation, and symptoms during the 6-min walk test (6MWT) in patients with COPD. SETTING: Outpatient clinic at university hospital. PATIENTS: Fourteen patients with COPD in stable clinical condition. One patient had mild COPD, five patients had moderate COPD, six patients had severe COPD, and two patients had very severe COPD. INTERVENTIONS: Two 6MWTs were performed with a portable metabolic system (VmaxST 1.0; Viasys Healthcare; MEDA; Aartselaar, Belgium) with a rollator and without a rollator, in random order. In addition, maximal voluntary ventilation (MVV) was measured with and without a rollator, randomly. RESULTS: The median 6MWT distance increased significantly with a rollator: 416 m without a rollator (interquartile range [IQR], 396 to 435 m), vs 462 m with a rollator (IQR, 424 to 477 m) [p = 0.04]. Significant increases were also seen in oxygen uptake (0.04 L/min [IQR, - 0.002 to 0.09 L/min]); tidal volume (0.06 L/min [IQR, - 0.001 to 0.11 L/min]); and Ve (0.95 L/min [IQR, - 0.67 to 7.1 L/min]), recorded in the last minute of the 6MWT; as well as in MVV (3 L/min [IQR, 0 to 12 L/min]) [p < 0.05 for all]. Borg dyspnea scores tended to be lower with a rollator: 6 (IQR, 4 to 7) without a rollator, vs 5 (IQR, 4 to 7) with a rollator (p = 0.10). The variation in the 6MWT was explained by individual changes in walking efficiency (partial R(2) = 0.31) and changes in Ve (partial R(2) = 0.36) [p model < 0.04]. CONCLUSION: The use of a rollator improves walking distance of patients with COPD through an increased ventilatory capacity and/or better walking efficiency.

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PubMed2003

Recovery of upper limb function after axillary dissection.

BACKGROUND AND OBJECTIVES: After surgery for breast cancer, data on the long-term impairment of upper limb activities of daily living (ADL) are scarce. The purpose of this study was to investigate the short- and long-term recovery of upper limb ADL function after surgery for breast cancer. METHODS: Seventy-six patients, who underwent either a breast-conserving procedure with axillary dissection (BCP, n = 45) or a modified radical mastectomy (MRM, n = 31), were included. The patients were assessed on the fourth postoperative day, after 3 weeks, and after 3 months. Shoulder mobility, arm circumference, and upper limb ADL (score from 1 to 7) were evaluated. RESULTS: In the early postoperative phase, a considerable decrease in shoulder mobility and the ability to perform upper limb ADL were observed. After 3 months, MRM patients had more limitations in shoulder mobility than BCP patients (shoulder flexion: 150 degrees vs. 126 degrees, respectively, P = 0.0001). In addition, upper limb ADL was still significantly impaired: MRM patients suffered from greater functional disabilities than BCP patients, ADL score 2.7 and 1.8, respectively (P = 0.037). Patients with axillary radiation experienced greater disability of shoulder mobility and ADL. CONCLUSIONS: Three months after surgery for breast cancer, impaired shoulder mobility, and ADL persisted in a substantial number of patients. Type of surgery and axillary irradiation contributed significantly to upper limb recovery. This observation warrants considering continuation of physiotherapy aiming to improve restoration of upper limb function.

Activities of Daily Living↗
PubMedDate not supplied

The acute effects of noninvasive ventilatory support during exercise on exercise endurance and dyspnea in patients with chronic obstructive pulmonary disease: a systematic review.

PURPOSE: The objective of this study was to review studies systematically, in which the acute effects of noninvasive ventilatory support (NIVS) during exercise were evaluated in patients with chronic obstructive pulmonary disease (COPD). In addition, a quantitative analysis was performed on the effects of NIVS on exertional dyspnea and exercise endurance. METHODS: Literature was searched in electronic databases, and by scanning lists of references of studies and abstract books of annual congresses of the American Thoracic Society and European Respiratory Society. Preliminary data of a study by our own group into the effects of NIVS on exercise endurance in patients with COPD were added. The systematic review was carried out on the basis of a validated methodological screening list. For the quantitative analysis, Glass delta of individual studies were pooled to aggregate a summary effect size. RESULTS: Fifteen studies were identified. Seven of these studies met the inclusion criteria, including a total of 65 patients with COPD. The methodological quality of the included studies varied from 31% to 54% of the maximum score of 13 points. Statistically significant summary effect sizes were found in the analysis of exertional dyspnea (P <.05) as well as in the analysis of exercise endurance (P <.001), indicating improvements in these outcomes in favor of NIVS. CONCLUSIONS: The present systematic review suggests that NIVS during exercise may acutely reduce exertional dyspnea and improve exercise endurance, in patients with COPD.

Chi-Square Distribution↗
PubMedDate not supplied

Constant-load cycle endurance performance: test-retest reliability and validity in patients with COPD.

The purpose of this study was to evaluate the rest-retest reliability and validity of a constant-load endurance exercise test on a cycle ergometer with a workload of 75% of maximal work capacity (W(max)) in patients with moderate to severe chronic obstructive pulmonary disease (COPD). In 60 patients with COPD (FEV(1) 40 +/- 15% pred), exercise endurance time was measured with a constant-load endurance exercise tests at 75% of W(max), on two different occasions. In a subgroup of 20 patients, test-retest reliability of the measurement of end-exercise ventilatory and metabolic responses was assessed. Validity of the cycle endurance test was assessed comparing endurance time and total work performed during the cycle endurance test to peak oxygen uptake (VO(2peak)) and the 12-minute walking distance (12MWD). Test and retest assessments of cycle endurance time did not differ statistically significantly (P =.40). Highly significant intraclass correlation coefficients (ICC > or = 0.85; P <.001) were found between test and retest of assessment of endurance time as well as of end-exercise ventilatory and metabolic responses. In addition, statistically significant correlation coefficients were found between VO(2peak) and endurance time (r = 0.50; P =.001) and total work performed (r = 0.72; P <.001) during the constant-load cycle test. Significant correlation coefficients of the same magnitude were found between 12MWD and endurance time (r = 0.58; P =.001) and total work performed (r = 0.72; P <.001) during the constant-load cycle test. It is concluded that constant-load exercise testing on a cycle ergometer with a workload of 75% of maximal work capacity is a reliable and valid method to assess exercise endurance in patients with COPD.

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