ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The evidence base for diaphragmatic breathing (DB) as an adjunctive treatment modality for persons with COPD is questionable. This article reviews the literature regarding the efficacy of DB in persons with chronic obstructive pulmonary disease (COPD), and reports on the beneficial and detrimental effects of DB in persons with COPD. Diaphragmatic breathing has been described as breathing predominantly with the diaphragm while minimizing the action of accessory muscles that may assist with inspiration. No single or combined patient characteristic has been identified consistently to help predict which person with COPD may benefit from DB. However, it has been suggested that persons with moderate to severe COPD and marked hyperinflation of the lungs without adequate diaphragmatic movement and increase in tidal volume during DB may be poor candidates for instruction in DB. Conversely, persons with COPD who have elevated respiratory rates, low tidal volumes that increase during DB, and abnormal arterial blood gases with adequate diaphragmatic movement may benefit from DB. Identification of an abdominal paradoxical breathing pattern and worsening dyspnea and fatigue during or after DB are criteria to modify or terminate DB. Persons with COPD demonstrating an abdominal paradox during DB may benefit from a more upright body position or trunk flexion. Several methods to examine diaphragmatic movement and the potential for success with DB will be discussed. Future research is needed to better identify which patients may benefit from DB.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Clinicians, patients, and health policy-makers must judge whether healthcare interventions are worth the side effects, inconvenience, and costs. The number needed to treat (NNT) provides an estimate of the number of patients who need to be treated to attain an additional favorable outcome, or to prevent an additional adverse outcome, and is the reciprocal of the absolute risk reduction. The closer the NNT is to 1.0—meaning that every patient who is treated achieves a benefit—the more effective the treatment. Traditionally, mortality has been considered a primary outcome measure of the effectiveness of cardiac rehabilitation and, if the event rates in two groups (ie, rehabilitation and usual care) are known, the absolute risk reduction can be calculated and the NNT estimated. Mortality data were derived from three meta-analyses of cardiac rehabilitation trials: one published in 1988 (n = 3614), one in 1989 (n = 4247), and one in 2001 (n = 7683). The respective estimated NNT for mortality in the meta-analyses were 32, 46, and 72 (95% confidence intervals [95% CI] 19, 1403).Improved exercise tolerance and patient-perceived health-related quality of life (HRQL) are also considered important and attainable outcomes of cardiac rehabilitation but are continuous, not dichotomous, variables. If the minimal important difference for a continuous outcome is known, then the proportions of patients who improve, remain the same, or deteriorate can be determined and the NNT estimated. Exercise tolerance and HRQL data from two randomized controlled trials of 8 weeks of rehabilitation after myocardial infarction, the Cardiac Rehabilitation in Advanced Age trial (CR-AGE; n = 270) and the McMaster Early Rehabilitation Study (MERS; n = 201) were used to estimate the NNT. In CR-AGE, the improvement in exercise tolerance was significantly greater in the rehabilitation than usual care group and the estimated NNT was 5 (95% CI 3, 13). The generic global HRQL score increased significantly in CR-AGE with rehabilitation with an estimated NNT of 12 (95% CI 5, 26) but, as the subscale group differences were not significant, the NNT was not estimated. The NNT for exercise tolerance was not estimated in MERS, as the group difference was not significant. On the other hand, specific HRQL scores in MERS increased significantly with rehabilitation giving an estimated NNT for global HRQL of 6 (95% CI 3, 21) and 6 to 10 for the HRQL sub-scales.The data and the estimated NNT from the meta-analyses of cardiac rehabilitation in large numbers of patients suggest a limited mortality effect, probably reflecting current cardiology practice. The estimated NNT from the two trials with relatively small numbers of patients suggest inconsistent exercise tolerance effects and a relatively short duration for improved HRQL. Along with the classic reporting scales, information about clinical and laboratory variables, and patient preferences, the NNT is a useful additional measure of effectiveness that provides both clinicians and patients with information about the impact of cardiac rehabilitation as secondary prevention therapy.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEThe purpose of this study was to determine and compare the thermoregulatory and hemodynamic responses to moderate intensity exercise (60% of peak oxygen consumption [&OV0312;O2peak]) in warm (35°C, 45% relative humidity) and cool (18°C, 65% relative humidity) environments in men who had previously undergone coronary artery bypass graft (CABG) surgery and healthy control subjects, matched for age and body composition.METHODSFourteen post-CABG men and 16 healthy control subjects were recruited and walked 40 minutes at a moderate intensity, in randomized order, in warm and cool environments (on separate days). Measures of heart rate, systolic and diastolic blood pressures, rating of perceived exertion, core (rectal)(Tc) and mean skin temperatures (&OV0374;sk), oxygen consumption (&OV0312;O2peak), sweat rate, and blood lactate were taken.RESULTSBoth groups showed a larger increase (P< .05) in Tcand rate-pressure product during exercise in the warm compared with the cool environment. However, Tcand rate pressure product were significantly lower (P< .05), and systolic blood pressure decreased slightly with exercise duration (P< .05) in the CABG group compared with the control group in the warm environment. Heart rate, &OV0374;sk, percent &OV0312;O2peak, blood lactate, sweat rate, and rating of perceived exertion did not differ significantly between the groups in either climate and no subject had ischemia or arrhythmia during test procedures.CONCLUSIONSThese results indicate that clinically stable men with revascularized coronary artery disease are able to cope as well as healthy controls with the thermoregulatory and cardiovascular demands of 40 minutes of moderate intensity exercise in warm and cool environments.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEThe purpose of this study was to evaluate the effects of optimism, depression, and neuroticism on adherence and outcomes among patients in cardiac rehabilitation (CR).METHODSParticipants included 46 patients (34 men) with coronary heart disease (CHD) who completed measures of psychological functioning (optimism, depression, neuroticism), physical functioning (exercise stress test, body mass index, symptom reports), and CHD knowledge during the first week (baseline) and last week of a 12-week CR program.RESULTSBaseline depression scores accounted for 9.5% of the variance associated with change in aerobic capacity (maximum oxygen consumption), when controlling for relevant demographic variables and program attendance. However, optimism and neuroticism were not predictive of CR outcomes. Results also indicated that program dropouts were significantly younger and reported more psychological distress at baseline than did participants who completed the program.CONCLUSIONDepression appears to have a significant influence on adherence and improvement among patients in CR, but optimism and neuroticism were not significant predictors of change.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEFlutter therapy uses a handheld instrument that consists of a pipe-like device with a ball in the central core that oscillates during exhalation, providing oscillating positive expiratory pressure. The purpose of this study was to determine the effect of airflow and the incline of the device at the mouth on expiratory pressure and oscillation frequency.METHODSA Flutter device was attached to a circuit that consisted of a pneumotachograph and a ventilator. The ventilator generated different flows and expiratory pressure was measured with a pressure transducer. The angles considered were +40° to −40° in increments of 10°, with the reference for incline being the horizontal line. Expiratory pressure, airflow, angle of incline, and oscillation frequency were measured.RESULTSThere was a strong and significant correlation between flow and expiratory pressure at each level of incline (P≤ .006; r > 0.93). There also was a significant and strong correlation between expiratory pressure and oscillation frequency (P<.05; r = 0.81–0.97). There was a significant reduction in expiratory pressure at a negative incline of −40°.CONCLUSIONSThe results of this study indicate that a positive incline and a large airflow result in an increase in expiratory pressure. This information will assist clinicians to better understand the effects of the Flutter device.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID