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BACKGROUND: The clinical relevance of inpatient step counts after lung surgery remains unknown. OBJECTIVE: The aim of this study was to identify those factors related to physical activity measured by step count, during the inpatient stay, and its relationship with symptom severity and perceived health status at hospital admission, discharge, and 1 month after discharge. METHODS: We studied the inpatient step count of 73 participants who underwent lung resection surgery. The number of steps was measured using a triaxial accelerometer. The health status and the severity of symptoms were examined at hospital admission, discharge, and 1 month after discharge. RESULTS: Of the 73 participants, 35 were active and 38 were sedentary during the hospitalization. The mean number of steps walked during 3 inpatient days was 6689 ± 3261 and 523 ± 2273 (P < .001) for the active and sedentary groups, respectively. The dyspnea and fatigue scores in the sedentary group across data collection points (hospital admission, discharge, and follow-up) were significantly worse (P < .01). In regard to pain, the sedentary group presented worse results, than the active group, at discharge and follow-up (P < .01). The correlation analysis indicated significant but weak correlations (r < 0.500) between inpatient steps per day and symptom severity at 1-month follow-up (T2) after surgery. CONCLUSION: Inpatient step count may be a risk factor for symptom severity and perceived health status during hospitalization and within the first month after lung resection surgery. IMPLICATIONS FOR PRACTICE: Nurses should consider recommending physical activity during hospitalization for patients after lung resection.

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PURPOSE: To evaluate the repercussion of different physical therapy interventions on the perceived health status of chronic obstructive pulmonary disease (COPD) patients during acute exacerbation. MATERIALS AND METHODS: Randomized controlled trial. Patients were assigned to: control group (standard medical treatment), controlled breathing + range of motion exercises group or Resistance exercises group. Perceived health status was assessed at baseline and discharge using the EuroQol-5D (EQ-5D) questionnaire. Clinical profile of patients was evaluated at baseline for descriptive purposes. RESULTS: Ninety patients were randomized into the groups. Perceived health status improved significantly in all groups. Significant differences were found in mobility, self-care and usual activities subscales of EQ-5D and Visual Analogue Scale between control and controlled breathing + range of motion exercises group. Significant differences were found in all variables except pain between control group and Resistance exercises group. Finally, usual care and anxiety/depression subscales of EQ-5D showed significant differences between controlled breathing + range of motion exercises group and Resistance exercises group, the improvements being greater in Resistance exercises group. CONCLUSIONS: Physical therapy added to standard medical treatment of acute exacerbated COPD patients achieves a higher improvement in perceived health status than the prescription of standard medical treatment alone. Implications for Rehabilitation Physical therapy added to standard medical treatment in patients hospitalized due to acute exacerbation of chronic obstructive pulmonary disease achieves a higher improvement in the perceived health status than the prescription of standard medical treatment alone. Short duration physical therapy programs added to the standard care appear to be helpful in the management of acute exacerbations of chronic obstructive pulmonary disease patients.

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Introducción. En el anciano institucionalizado con limitación funcional se evidencia una mayor reducción de la funcionalidad de la musculatura respiratoria (MR). Los objetivos de este estudio son evaluar los resultados y costes de una intervención de entrenamiento de la MR mediante Pranayama en población anciana institucionalizada con limitación funcional. Material y métodos. Estudio controlado aleatorizado desarrollado en ancianos institucionalizados con limitación para la deambulación (n = 54). La intervención consistió en el entrenamiento de la MR mediante Pranayama, durante 6 semanas (5 sesiones/semana). Los resultados se midieron en relación con la función de la MR mediante las presiones inspiratoria y espiratoria máximas y la ventilación máxima voluntaria, en 4 tiempos. También se valoró la satisfacción percibida por el grupo experimental (GE) a través de un cuestionario ad hoc. Se estimaron los costes directos e indirectos de la intervención desde la perspectiva social. Resultados. El GE reveló una mejora significativa de la fuerza (presiones inspiratoria y espiratoria máximas) y de la resistencia (ventilación máxima voluntaria) de la MR. Además, un 92% del GE refirió una satisfacción alta. Los costes sociales totales, directos e indirectos, ascendieron a 21.678 Euros. Conclusiones. Esta evaluación revela que los resultados en términos de la función de la MR son significativos, que la intervención es bien tolerada y valorada por el residente, y los costes de la intervención son moderados (AU)

Introduction. The institutionalized elderly with functional impairment show a greater decline in respiratory muscle (RM) function. The aims of the study are to evaluate outcomes and costs of RM training using Pranayama in institutionalized elderly people with functional impairment. Material and methods. A randomized controlled trial was conducted on institutionalized elderly people with walking limitation (n = 54). The intervention consisted of 6 weeks of Pranayama RM training (5 times/week). The outcomes were measured at 4 time points, and were related to RM function: the maximum respiratory pressures and the maximum voluntary ventilation. Perceived satisfaction in the experimental group (EG) was assessed by means of an ad hoc questionnaire. Direct and indirect costs were estimated from the social perspective. Results. The GE showed a significant improvement related with strength (maximum respiratory pressures) and endurance (maximum voluntary ventilation) of RM. Moreover, 92% of the EG reported a high satisfaction. The total social costs, direct and indirect, amounted to Euros 21,678. Conclusions. This evaluation reveals that RM function improvement is significant, that intervention is well tolerated and appreciated by patients, and the intervention costs are moderate (AU)

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INTRODUCTION: The institutionalized elderly with functional impairment show a greater decline in respiratory muscle (RM) function. The aims of the study are to evaluate outcomes and costs of RM training using Pranayama in institutionalized elderly people with functional impairment. MATERIAL AND METHODS: A randomized controlled trial was conducted on institutionalized elderly people with walking limitation (n=54). The intervention consisted of 6 weeks of Pranayama RM training (5 times/week). The outcomes were measured at 4 time points, and were related to RM function: the maximum respiratory pressures and the maximum voluntary ventilation. Perceived satisfaction in the experimental group (EG) was assessed by means of an ad hoc questionnaire. Direct and indirect costs were estimated from the social perspective. RESULTS: The GE showed a significant improvement related with strength (maximum respiratory pressures) and endurance (maximum voluntary ventilation) of RM. Moreover, 92% of the EG reported a high satisfaction. The total social costs, direct and indirect, amounted to Euro 21,678. CONCLUSIONS: This evaluation reveals that RM function improvement is significant, that intervention is well tolerated and appreciated by patients, and the intervention costs are moderate.

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BACKGROUND: In older adults, respiratory function may be seriously compromised when a marked decrease of respiratory muscle (RM) strength coexists with comorbidity and activity limitation. Respiratory muscle training has been widely studied and recommended as a treatment option for people who are unable to participate in whole-body exercise training (WBET); however, the effects of inspiratory muscle training and yoga breathing exercises on RM function remain unknown, specifically in impaired older adults. PURPOSE: To evaluate the effects of inspiratory threshold training (ITT) and yoga respiratory training (YRT) on RM function in institutionalized frail older adults. METHODS: Eighty-one residents (90% women; mean age, 85 years), who were unable to perform WBET (inability to independently walk more than 10 m), were randomly assigned to a control group or one of the 2 experimental groups (ITT or YRT). Experimental groups performed a supervised interval-based training protocol, either through threshold inspiratory muscle training device or yoga breathing exercises, which lasted 6 weeks (5 days per week). Outcome measures were collected at 4 time points (pretraining, intermediate, posttraining, and follow-up) and included the maximum respiratory pressures (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) and the maximum voluntary ventilation (MVV). RESULTS: Seventy-one residents completed the study: control (n = 24); ITT (n = 23); YRT (n = 24). The treatment on had a significant effect on MIP YRT (F(6,204) = 6.755, P < .001, η2 = 0.166), MEP (F(6,204) = 4.257, P < .001, η2 = 0.111), and MVV (F(6,204) = 5.322, P < .001, η2 = 0.135). Analyses showed that the YRT group had a greater increase of RM strength (MIP and MEP) and endurance (MVV) than control and/or ITT groups. CONCLUSION: Yoga respiratory training appears to be an effective and well-tolerated exercise regimen in frail older adults and may therefore be a useful alternative to ITT or no training, to improve RM function in older population, when WBET is not possible.

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BACKGROUND: Since anthropometric variables are critical to the creation of pulmonary nomograms for FVC, FEV1, and other volumes and capacities, it is logical that anthropometric variables also influence the values of the maximal respiratory pressures (MRPs). Since nomograms are race-specific, it is important that tribe-specific tables of normal maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) be developed. To date normal tables for MRPs do not exist for Navajo children. OBJECTIVE: Therefore the purpose of this study was to derive MRP normative reference values for Navajo children in the age range of 6-14 years. METHODS-PARTICIPANTS AND MEASUREMENTS: A cross-sectional study was undertaken with a representative sample of 534 healthy children, ages 6-14 years, attending Navajo Nation elementary schools in Arizona. MIP and MEP were measured. RESULTS: Test results from 275 girls and 259 boys met American Thoracic Society quality control standards and showed that MRPs all increased with height. Mean MIP in cm H2 O was 77 for boys and 67 for girls with lower limits of 44 and 40, respectively. Mean MEP in cm H2 O was 75 for boys and 66 for girls with the lower limits of 42 and 38, respectively. CONCLUSION: Since the data were collected from the population of interest, the resulting MIP and MEP reference equations should be used when testing Navajo children ages 6-14 years.

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Introducción: En el anciano de edad avanzada (> 80 años) la función respiratoria puede verse afectada cuando a la presencia de comorbilidad y la pérdida de movilidad se suma el descenso de la fuerza de la musculatura respiratoria (MR). La literatura médica ha mostrado que el entrenamiento de la MR puede ser una intervención efectiva para mejorar la funcionalidad y prevenir el deterioro clínico, especialmente en la población con debilidad de la MR. El objetivo del estudio fue evaluar la efectividad del entrenamiento de la MR en la fuerza y resistencia de esta musculatura, en ancianas institucionalizadas con limitación funcional. Método: Se asignaron aleatoriamente 54 residentes con limitación para deambular (media 85 años, DE 6,7) a un grupo control (n = 27) y entrenado (n = 27). Se desarrolló un programa de entrenamiento supervisado, mediante Threshold ®IMT, 5 días por semana durante 6 semanas. Las variables principales fueron: la presión inspiratoria máxima (PImáx), la presión espiratoria máxima (PEmáx) y la ventilación voluntaria máxima (MVV), medidas en las semanas 0, 4, 7 y 10.ResultadosLos análisis estadísticos no revelaron cambio en la PImáx (F3,114 = 1,04, p = 0,368, R2 = 0,027), PEmáx (F3,114 = 1,86, p = 0,14, R2 = 0,047) y MVV (F3,114 = 1,74, p = 0,162, R2 = 0,044) entre ambos grupos tras la intervención. No obstante, la carga de trabajo mejoró significativamente con el entrenamiento (F5,100 = 72,031, p < 0,001, R2 = 0,791). Conclusión: El dispositivo de entrenamiento umbral en un programa interválico de 6 semanas no produce una mejora significativa de los parámetros relacionados con la fuerza y la resistencia de la MR, en la población estudiada(AU)

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness. The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10.ResultsStatistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population(AU)

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INTRODUCTION: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness. The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. METHOD: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold(®)IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PI(max)), maximum expiratory pressure (PE(max)) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. RESULTS: Statistical analysis revealed no significant differences in PI(max) (F(3,114)=1.04, p=0.368, R(2)=0.027), PE(max) (F(3,114)=1.86, p=0.14, R(2)=0.047) and MVV (F(3,114)=1.74, p=0.162, R(2)=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F(5,100)=72.031, p<0.001, R(2)=0.791). CONCLUSION: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.

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