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At least 433 records · Page 24Linked to original sources
PubMed2005

Ventilatory support during training improves training benefit in severe chronic airway obstruction.

BACKGROUND: One mechanism that may limit training effect in chronic obstructive pulmonary disease is the ventilatory limitation and associated dyspnea. OBJECTIVES: To minimize ventilatory limitation during training of patients with severe COPD by applying bi-level positive pressure ventilation during training in order to augment training intensity (and effect). METHODS: The study group comprised 19 patients (18 males, 1 female) with a mean age of 64 +/- 9 years. Mean forced expiratory volume in 1 second was 32 +/- 4% of predicted, and all were ventilatory-limited (exercise breathing reserve 3 +/- 9 L/min, normal > 15 L/min). The patients were randomized: 9 were assigned to training with BiPAP and 10 to standard training. All were trained on a treadmill for 2 months, twice a week, 45 minutes each time, at maximal tolerated load. Incremental maximal unsupported exercise test was performed before and at the end of the training period. RESULTS: BiPAP resulted in an increment of 94 +/- 53% in training speed during these 2 months, as compared to 41 +/- 19% increment in the control group (P < 0.005). Training with BiPAP yielded an average increase in maximal oxygen uptake of 23 +/- 16% (P < 0.005), anaerobic threshold of 11 +/- 12% (P < 0.05) and peak O2 pulse of 20 +/- 19% (P < 0.05), while peak exercise lactate concentration was not higher after training. Interestingly, in the BiPAP group, peak exercise ventilation was also 17 +/- 20% higher after training (P < 0.05). Furthermore, contrary to our expectation, at any given work rate, ventilation (and tidal volume) in the BiPAP group was higher in the post-training test as compared to the pre-training test, and the end tidal partial pressure of CO2 at 55 watts was lower, 40 +/- 4 and 38 +/- 4 mmHg respectively (P < 0.05). No improvement in exercise capacity was observed after this short training period in the control group. CONCLUSION: Pressure-supported ventilation during training is feasible in patients with severe COPD and it augments the training effect. The improved exercise tolerance was associated with higher ventilatory response and therefore lower P(ET)CO2 at equal work rates after training.

Exercise Therapy↗
PubMed1996

Effects of carbohydrate (CHO) and fat supplementation on CHO metabolism during prolonged exercise.

The aim of the study was to examine carbohydrate (CHO) utilization in subjects receiving CHO or CHO + medium-chain triglycerides (MCT) supplements during 180 minutes of exercise at 50% maximal aerobic work rate ([Wmax] 57% maximal oxygen consumption [VO2max]). In a double-blind crossover design, nine trained athletes cycled four times. Subjects received a bolus of 4 mL x kg(-1) at the start and 2 mL x kg(-1) every 20 minutes during exercise of either a 150-g x L(-1) CHO solution (CHO trial), an equicaloric 70 energy% (en%) CHO-30 en% MCT suspension containing 29 g MCT (CHO + MCT trial), or a 150-g x L(-1) CHO (high-CHO [HCHO]) solution plus 20 g MCT (HCHO + MCT trial). A fourth trial consisted of a 13C-background control trial (CON). The four trials were randomized. Before and after the exercise bout, muscle biopsies were taken from the quadriceps muscle and muscle glycogen levels were determined. During exercise, breath samples were collected for estimation of exogenous and endogenous CHO oxidation. No significant differences were detected in glycogen breakdown among the trials (277 +/- 14 mmol x kg dry weight(-1) CHO, 249 +/- 20 CHO + MCT, and 240 +/- 18 HCHO + MCT) or in the respiratory exchange ratio during exercise. Mean exogenous CHO oxidation rates during the final hour of exercise were 0.79, 0.63, and 0.73 g x min(-1), respectively. No differences were observed between the trials regarding exogenous or endogenous CHO oxidation. Plasma free fatty acid (FFA) concentrations were elevated during exercise to a level of approximately 500 micromol x L(-1) and were comparable in all trials, whereas plasma ketone concentrations significantly increased after MCT ingestion as compared with the CHO trial. It is concluded that 29 g MCT co-ingested with CHO during 180 minutes of exercise does not influence CHO utilization or glycogen breakdown.

Adult↗
PubMedDate not supplied

Preadmission self-instruction booklets, postadmission exercise performance, and teaching time.

The relative effects of preadmission self-instructional information on levels of performance and time needed to achieve level of mastery of exercise behaviors were examined using a sample of 130 presurgical cholecystectomy and herniorrhaphy patients. Experimental interventions were (1) no preadmission information, (2) specific preadmission instructions, and (3) nonspecific preadmission instructions. Preadmission instructions consisting of either a specific or nonspecific booklet mailed to patients focused on techniques for coughing, deep breathing exercises leg movements, and ambulatory behaviors. During hospitalization, patients' exercise behaviors and the length of teaching time required for patients to perform the exercise steps were measured. Findings showed that subjects in the specific exercise instruction group performed significantly more of the exercise behaviors common to both booklets than subjects in the nonspecific exercise instruction group. Subjects in the specific instruction group also performed significantly more of the behaviors available to them than the nonspecific instruction group. Required postadmission teaching time did not differ significantly between the specific and nonspecific information groups, but both the groups required significantly less teaching time in the hospital than the no-preadmission instruction group.

Adult↗
PubMed1983

The use of relaxation exercises in the treatment of reading disability.

An adult nonreader, in therapy for serious emotional problems, began to read, at first during the therapy sessions, and then on his own, following treatment that involved a mix of psychodynamic exploration and behavioral interventions. The inability to read was addressed directly, first by having him imagine reading, and then by having him attempt to read, after achieving a state of increased relaxation through the use of muscle and breathing exercises. This result suggests that relaxation exercises should be tried in cases of reading disability at least whenever they are associated with emotional problems. Furthermore, inasmuch as anxiety and stress do not always manifest themselves in ways that are obvious to an observer, the case raises the possibility that relaxation exercises might be helpful even when there are no obvious symptoms of emotional disorder.

Adult↗
PubMed1984

Respiratory water loss as a stimulus to exercise-induced bronchoconstriction.

Exercise and the resultant hyperpnea increase the magnitude of many stimuli delivered to the airways. Thus clinical "exercise-induced" bronchoconstriction can probably be initiated by a number of stimuli including, for example, sulfur dioxide, which is present in polluted air. In the laboratory, when subjects perform exercise breathing clean air, the water content of the inspired air is a major determinant of the bronchoconstriction induced, whereas in our hands, the temperature of the inspired air is of little or no importance, even over a range associated with significant differences in airway cooling. These observations support the view that water loss is an important stimulus to exercise-induced bronchoconstriction, perhaps as a result of a transient increase in the osmolarity of airway surface liquid.

Asthma↗
PubMed2003

Preoperative pulmonary assessment of the older adult.

Postoperative pulmonary complications in the elderly are common and are a significant source of morbidity, mortality, and prolonged length of stay. Risk factors differ from the well-known risk factors for cardiac complications and can be divided into patient- and procedure-related factors. Patient-related factors include COPD, recent cigarette use, poor general health status as defined by Goldman or ASA class, dependent functional status, and laboratory parameters including abnormal chest radiograph, renal insufficiency, and low serum albumin. Age is a minor risk factor when adjusted for comorbidities and confers approximately a two-fold increase in risk. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on age and concern for postoperative pulmonary complications. The surgical site is the single most important predictor of pulmonary complications. High-risk surgeries include thoracic, upper abdominal, aortic, neurosurgery, and peripheral vascular. Other procedure-related risk factors include surgery lasting longer than 3 hours, the use of general anesthesia, pancuronium use, and emergency surgery. Clinicians should not recommend routine preoperative spirometry before high-risk surgery because it is no more accurate in predicting risk than clinical evaluation. Patients who might benefit from preoperative spirometry include those who have unexplained dyspnea or exercise intolerance and those who have COPD or asthma in whom uncertainty exists as to the status of airflow obstruction when compared with baseline. After identifying patients at risk for postoperative pulmonary complications, clinicians can recommend strategies to reduce risk throughout the operative period. In addition to minimizing or avoiding the above risk factors, optimization of COPD or asthma, deep breathing exercises, incentive spirometry, and epidural local anesthetics reduce the risk of postoperative pulmonary complications in elderly surgical patients.

Age Factors↗
PubMed2006

Influence of diaphragm and rib cage muscle fatigue on breathing during endurance exercise.

Inspiratory muscle fatigue (IMF) can develop during exhaustive exercise and cause tachypnea or rapid shallow breathing. We assessed the effects of rib cage muscle (RCM-F) and diaphragm fatigue (DIA-F) on breathing pattern and respiratory mechanics during high-intensity endurance exercise. Twelve healthy subjects performed a constant-load (85% maximal power) cycling test to exhaustion with prior IMF and a cycling test of similar intensity and duration without prior IMF (control). IMF was induced by resistive breathing and assessed by oesophageal and gastric twitch pressure measurements during cervical magnetic stimulation. Both RCM-F and DIA-F increased RCM and abdominal muscle force production during exercise compared to control. With RCM-F, tidal volume decreased while it increased with DIA-F. RCM-F was associated with a smaller increase in end-expiratory oesophageal pressure (i.e. decrease in lung volume) than DIA-F. These results suggest that RCM-F and not DIA-F is associated with rapid shallow breathing and that lowering the operating lung volume with DIA-F may help to preserve diaphragmatic function.

Adult↗
PubMed2003

Use of inspiratory strength training to wean six patients who were ventilator-dependent.

BACKGROUND AND PURPOSE: Patients who are unable to wean from mechanical ventilation (MV) after resolution of critical illness or surgery risk increased morbidity and death and consume a disproportionate amount of intensive care unit resources. Decreased inspiratory muscle strength is often cited as a major factor contributing to prolonged MV. The purpose of this case report is to describe the rationale and application of inspiratory strength training (IST) as an adjunct to lengthen unassisted breathing trials and to ultimately wean patients with chronic mechanical ventilator dependency. CASE DESCRIPTION: Six patients who had been ventilator-dependent for 18 to 221 days (mean of 72 days) after surgery and were diagnosed with "failure to wean" performed low-repetition, high-resistance breathing exercises that were coupled with increasing time off the ventilator. OUTCOMES: All 6 patients were weaned from the ventilator in 9 to 28 days (mean of 17 days). The patients' training pressure increased from a mean of 9.3 cm/H2O to 27.5 cm/H2O, for an increase of 195%. The volitional maximum inspiratory pressure (MIP) increased from a mean of 22.5 cm/H2O to 54 cm/H2O, for a 140% gain in pressure. DISCUSSION: Although it is not clear why the patients appeared to benefit from IST, possible explanations include: (1) addressing inspiratory muscle pump dysfunction, (2) standardization of breathing patterns, 3) routinization of the patients' unassisted breathing trials, and (4) nonspecific training effects. Future research should address these possibilities when attempting to understand the effects of IST in the weaning of patients with chronic ventilator dependency.

Adult↗
PubMed1994

Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery.

One hundred twenty patients undergoing coronary artery surgery completed a randomized controlled study designed to investigate whether prophylactic chest physiotherapy affected the incidence of postoperative pulmonary complications. Group 1 patients received no preoperative or postoperative chest physiotherapy. Group 2 patients received preoperative education and instruction in breathing and coughing exercises and postoperative supervision and assistance in performing the same. These exercises were supervised by a physiotherapist twice per day on the first 2 postoperative days and once per day on the 3rd and 4th postoperative days. Physiotherapy for group 3 patients was the same as for group 2 patients except that patients were seen by a physiotherapist 4 times per day on the first 2 postoperative days and twice per day on the 3rd and 4th postoperative days. Group 2 and 3 patients were instructed to practice breathing and coughing exercises every hour. Overall, an incidence of clinically significant postoperative pulmonary complications of 7.5 percent was demonstrated. In general, these patients demonstrated lower levels of preoperative pulmonary function and very low early postoperative oxygenation compared with those who did not develop pulmonary complications. There was no indication that the incidence or severity of fever, hypoxemia, chest roentgenologic abnormalities or clinically significant postoperative pulmonary complications was different between groups. These results suggest that the necessity for prophylactic chest physiotherapy after routine coronary artery surgery should be reviewed.

Breathing Exercises↗
PubMed2002

Combined spinal and epidural anesthesia for abdominal aortic aneurysm surgery in patients with severe chronic pulmonary obstructive disease.

BACKGROUND: The presence of chronic obstructive pulmonary disease (COPD) should not be considered a contraindication to operation but should rather identify those patients that require special preoperative and postoperative pulmonary care. The purpose of this paper is to report our experience in the use of combined spinal and epidural anesthesia (CSEA) for open AAA repair in such patients. METHODS: From April 1997 to November 1998, three patients with severe COPD underwent elective open infrarenal AAA repair under CSEA. All the patients satisfied one or more of the following criteria: a room air PaO2 =or<60 mmHg, PaCO2 =or>45 mmHg, FEV1 =or<50% of predicted, and/or FVC =or<75% of predicted, and one of them was on home oxygen preoperatively. Preoperative preparation of the patients consisted of breathing exercises with incentive espirometry, elimination of underlaying pulmonary infections and usage of bronchodilator therapy. RESULTS: All the patients tolerated surgery safely. None of them developed postoperative complications, including pneumonia and other respiratory conditions. No significant changes in room air arterial blood gas or pulmonary function was recognized before and after surgery. CONCLUSIONS: CSE anesthesia is a viable anesthetic option for conventional AAA surgery in patients with severe COPD since it can preserve spontaneous breathing and provide additional respiratory benefits over general anesthesia.

Aged↗
PubMed1997

Measurement of coronary blood flow velocity during handgrip exercise using breath-hold velocity encoded cine magnetic resonance imaging.

Coronary blood flow velocity was measured during handgrip exercise using breath-hold velocity encoded cine magnetic resonance imaging. Peak diastolic coronary flow velocity in the left anterior descending artery was 20.6 +/- 9.3 cm/s (mean +/- SD) at baseline and increased significantly to 31.1 +/- 16.4 cm/s after exercise (50.7 +/- 31.3% increase, p <0.01).

Adult↗
PubMed1990

Effect of acute hypercapnia on limb muscle contractility in humans.

The effect of acute hypercapnia on skeletal muscle contractility and relaxation rate was investigated. The contractile force of fresh and fatigued quadriceps femoris (QF) and adductor pollicis (AP) was studied in normal humans by use of electrical stimulation. Maximum relaxation rate from stimulated contractions was measured for both muscles. Acute hypercapnia led to a rapid substantial reduction of contraction force. The respiratory acidosis after 9% CO2 was breathed for 20 min [mean venous blood pH 7.26 and end-tidal PCO2 (PETCO2) 65.1 Torr] reduced 20- and 100-Hz stimulated contractions of QF to 72.8 +/- 4.4 and 80.0 +/- 5.1% of control values, respectively. After 8 and 9% CO2 were breathed for 12 min, AP forces at 20- and 50-Hz stimulation were also reduced. Twitch tension of AP was reduced by a mean of 25.5% when subjects breathed 9% CO2 for 12 min [mean arterialized venous blood pH (pHav) 7.25 and PETCO2 66 Torr]. Over the range of 5% (pHav 7.38 and PETCO2 47 Torr) to 9% CO2, there was a linear relationship between twitch tension loss and pHav, arterialized venous blood PCO2, and PETCO2. Acute respiratory acidosis (mean PETCO2 61 Torr) increased the severity of low-frequency fatigue after intermittent voluntary contractions of AP. At 20 min of recovery, twitch tension was 63.2 +/- 13.4 and 46.8 +/- 16.4% of control value after exercise breathing air and 8% CO2, respectively. Acute hypercapnia (mean PETCO2 65.1 and 60.5 Torr) did not alter the maximum relaxation rate from tetanic contractions of fresh QF and from twitch tensions of AP.

Acidosis, Respiratory↗
PubMed2001

Respiratory biofeedback-assisted therapy in panic disorder.

The authors describe a new methodologically improved behavioral treatment for panic patients using respiratory biofeedback from a handheld capnometry device. The treatment rationale is based on the assumption that sustained hypocapnia resulting from hyperventilation is a key mechanism in the production and maintenance of panic. The brief 4-week biofeedback therapy is aimed at voluntarily increasing self-monitored end-tidal partial pressure of carbon dioxide (PCO2) and reducing respiratory rate and instability through breathing exercises in patients' environment. Preliminary results from 4 patients indicate that the therapy was successful in reducing panic symptoms and other psychological characteristics associated with panic disorder. Physiological data obtained from home training, 24-hour ambulatory monitoring pretherapy and posttherapy, and laboratory assessment at follow-up indicate that patients started out with low resting PCO2 levels, increased those levels during therapy, and maintained those levels at posttherapy and/or follow-up. Partial dissociation between PCO2 and respiratory rate questions whether respiratory rate should be the main focus of breathing training in panic disorder.

Adult↗
PubMed1990

Attenuated Hering-Breuer inflation reflex 4 years after pulmonary vagal denervation in ponies.

The purpose of this study was to determine whether there was any recovery of the Hering-Breuer inflation reflex in ponies between 2-4 wk and 3-4 yr after hilar nerve denervation (HND). Under anesthesia and before HND, airway occlusion after a 3-liter lung inflation lengthened the subsequent occluded breath by nearly 10 times the control breath duration. Between 2 wk and 3-4 yr after HND, this maneuver increased the duration of the occluded breath by only 2.5 times the control breath duration. Also under anesthesia, the airway was occluded at end expiration. This maneuver increased the duration of the subsequent inspiratory effort by 71% in hilar nerve intact ponies but by only 20-25% 2-4 wk and 3-4 yr after HND. For both tests, the pre- and post-HND differences were statistically significant (P less than 0.05), but there were no significant differences (P greater than 0.10) between 2-4 wk and 3-4 yr post-HND. In awake ponies, at rest and during mild and moderate treadmill exercise, breathing frequency was generally lower and inspiratory time was greater after relative to before HND. The inspiratory time-to-total cycle duration ratio was consistently increased by 0.10-0.15 after HND (P less than 0.05). There was no significant change in this ratio between 2-4 wk and 3-4 yr post-HND (P greater than 0.10). We conclude that the surgical procedure for HND used in this study does not permit any significant reinnervation, and there are no significant changes within the ventilatory control system to compensate for loss of hilar nerve afferents.

Animals↗
PubMed2026

Effectiveness of exercise-based prehabilitation on pre and postoperative outcomes of patients undergoing cardiac surgery-An umbrella review of systematic reviews.

AIMS: Individuals undergoing cardiac surgery are becoming older, frailer, and less mobile. Prehabilitation has shown to improve postoperative outcomes by optimizing preoperative physical function. This umbrella review aims to pool the systematic reviews assessing the effectiveness of exercise-based prehabilitation in cardiac surgery. METHODS AND RESULTS: The review followed the PRIOR checklist. PubMed, Embase, CINAHL, Cochrane library, Scopus, Web of science, ProQuest NAHD, ProQuest HMC, Open Grey and MedNar were searched using relevant keywords from inception to 16th December, 2024. Two reviewers screened and extracted data from the included reviews and assessed primary study overlap with the corrected covered area. Methodological quality of the reviews was evaluated with the A MeaSurement Tool to Assess systematic Reviews-2 scale. Certainty of evidence was assessed using a previously developed criteria for overview of reviews. Six systematic reviews with 30 unique trials and 6705 participants were included. The interventions assessed included breathing exercises, inspiratory muscle training, and exercise training. Prehabilitation reduced length of hospital stay, postoperative pulmonary complications, and clinically improved functional capacity with a very low to moderate certainty of evidence. However, there was uncertainty regarding the effects pertaining to adverse events and quality of life. The methodological quality of all reviews was critically low. The primary trials scored poorly in the domains of selection and detection bias. CONCLUSION: Exercise-based prehabilitation might reduce length of hospital stay and postoperative complications, and improve functional capacity. However, the quality of evidence is poor, and individual discretion is required before implementing them into practice. REGISTRATION: PROSPERO: CRD42023480100.

Humans↗
PubMed1993

Italian experience of electromyographic-biofeedback treatment of episodic common migraine: preliminary results.

Electromyographic biofeedback is commonly used successfully to treat tension-type headache, while thermal biofeedback is considered the best behavioral therapy for migraine. Ten female patients with episodic common migraine (age 20-35 years, age of disease onset 16.2 +/- 5.1 years, illness duration 13.6 +/- 10.7 years) were treated by 16 twice-weekly electromyographic biofeedback and relaxation training sessions with breathing exercises. Follow-up sessions were held 1,3,6 and 12 months after the end of treatment. A significant decrease in migraine episodes was noted after therapy. More importantly, pain episodes continued to decline up to the last follow-up 12 months later. Electromyographic activity was within the normal range throughout treatment and follow-up, and there was no relationship between electromyographic activity and pain index. It is concluded that the results, particularly after a year's follow-up, are encouraging for the use of this technique to treat migraine. However, the behavioral changes and increased well-being did not correlate with muscular tension. Control of breathing, peripheral temperature and muscle activity are probably important common factors mediating learned ability to influence sympathetic activity; it is probably the latter which leads to reduced pain in migraine patients.

Adult↗
PubMed1990

[Perioperative respiratory therapy and postoperative pain therapy].

Especially patients with preexisting bronchopulmonary diseases or those undergoing operations in the upper abdomen or thoracotomies are susceptible to post-operative pulmonary complications. All patients at risk should learn the prophylactic respiratory maneuvers preoperatively. Perioperative use of incentive spirometers, breathing exercises or IPPB seems to reduce the incidence of postoperative pulmonary complications. Opioids are used usually for postoperative pain management, but unfortunately they are given mainly as i.m. injections, although an i.v. administration would be far better. If given in an equipotent dose, nearly every opioid provides sufficient postoperative analgesia. Wide interindividual variation in the needed dose requires that opioids be titrated intravenously.

Combined Modality Therapy↗