ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The National Emphysema Treatment Trial is a multicenter, randomized clinical trial of medical therapy vs medical therapy plus lung volume reduction surgery (LVRS) for the treatment of patients with severe bilateral emphysema. LVRS will be accomplished by bilateral stapled excision via median sternotomy or video-assisted thoracoscopic surgery. Every patient will complete 6 to 10 weeks of pulmonary rehabilitation prior to randomization and will participate in a maintenance program of pulmonary rehabilitation after randomization. The primary outcome to be assessed by the trial is survival. Additional outcomes to be assessed are maximum exercise capacity, pulmonary function, oxygen requirement, distance walked in 6 min, quality of life, respiratory symptoms, and health-care utilization and costs. In addition, selected clinics will evaluate lung mechanics and respiratory muscle function, partial and maximal flow-volume curves, gas exchange during maximal exercise, and right heart function. The trial is targeted to enroll patients with severe emphysema who have no significant comorbid conditions; each patient will be randomized to one of the two treatment groups. The study duration is 4.5 years with a close-out period of 6 months.

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose.The effects of a long-term treatment of autogenic drainage (AD) and the active cycle of breathing techniques (ACBT) were evaluated in patients with chronic obstructive pulmonary disease (COPD).Methods.Thirty clinically stable male COPD patients were randomly assigned to AD or the ACBT treatment for a 20-day treatment period. Patients were assessed through pulmonary function tests, arterial blood gases, a 6-minute walking test, and a modified Borg Scale before, and immediately after the walking test.Results.Autogenic drainage improved forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow rate, forced expiratory volume from 25 to 75%, chronic hypercapnia, arterial oxygenation, exercise performance, and dyspnea perception during exercise. The ACBT increased forced vital capacity, peak expiratory flow rate, arterial oxygenation and exercise performance. Peak expiratory flow rate increased in AD more than in ACBT. In AD treatment, the increase in oxygen saturation was significantly higher than in ACBT treatment. Chronic hypercapnia improved significantly in AD treatment than in ACBT. No differences were found in other lung function parameters.Conclusions.Autogenic drainage is as effective as the ACBT in cleaning secretions and improving lung functions. These techniques can be used in stable COPD patients according to the patients' and the physiotherapists' preferences.

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.The most common effect of postmyocardial infarction (post MI) rehabilitation is an increase of peak maximal oxygen consumption correlated with changes in calf muscle metabolism, but there are few data on follow-up after rehabilitation on skeletal muscle and maximal oxygen consumption. The purpose of this study was to investigate the respective modifications in skeletal muscle metabolism and peak oxygen consumption (VO2) occurring during a supervised rehabilitation program and 1 year after MI in patients free of heart failure.Methods.Fifteen outpatients were studied prospectively after the acute phase of the MI, at the end of the rehabilitation program (2 months after the MI), and 1 year after. The rehabilitation comprised 20 sessions with three sessions per week. The program consisted of exercise training with bicycle, arm ergometer, and treadmill. The program also included respiratory exercises, psychological support, and counseling for secondary prevention of cardiovascular diseases. At each visit, a stress test on a bicycle ergometer was performed and the peak VO2was measured. Phosphorus magnetic resonance spectroscopy of the gastrocnemius muscle was performed at rest and during a plantar flexion-type exercise against an adjustable load. Data were analyzed using analysis of variance and post-hoc test when appropriate.Results.The mechanical power output measured during the bicycle exercise increased from 111 ± 28 watts at the post MI test to 136 ± 40 watts after rehabilitation (post rehab) and decreased to 125 ± 36 watts at 1 year. The peak VO2increased significantly (P< 0.05) from 22 ± 7 ml/kg−1/min−1(post MI) to 27 ± 9 ml/kg−1/min−1(post rehab), and decreased significantly to 24 ± 8 ml/kg−1/min−1(1 year). The mechanical power output measured in the magnet during the stress test increased from 2.22 ± 0.13 watts (post MI) to 2.85 ± 1.24 (post rehab), and stabilized at 2.78 ± 1.10 watts at 1 year. At the highest workload attained in the three successive tests, the phosphocreatine/(phosphocreatine + inorganic phosphate) ratio rose significantly (P< 0.05) from 0.46 ± 0.13 (post MI) to 0.51 ± 0.13 (post rehab) and remained at 0.51 ± 0.13 at 1 year.Conclusion.The improvement of the peak VO2after training post MI is not maintained 1 year later. This decline is not accompanied by muscular metabolic abnormalities. This suggests that the muscle metabolism after MI remains normal, and that the long-term decrease of the peak VO2reflects a global deconditioning that should be avoided by maintaining a long-term phase III rehabilitation program.

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Previous research indicates that patients exiting a 12-week cardiac rehabilitation program (CRP) have difficulty maintaining an adequate exercise program. Thus, the authors' purpose was to determine if a home-based exercise program would enable patients to maintain/improve their blood lipids, body composition, and functional capacity after exiting the CRP.Methods.Thirty-one patients exiting an initial 12-week CRP were assigned randomly to the home-based (HB) intervention or the standard care (SC) condition. After one home visit, the HB participants (n= 16) were contacted by telephone every other week by CRP staff and completed and returned weekly exercise logs. The SC participants (n= 15) had no contact with the CRP other than to schedule follow-up tests. A third group (n= 17), randomly selected from patients that elected to remain in the center-based CRP (CB) for the same duration, also were examined. All groups underwent exercise testing, fasting blood lipid analysis, and body composition assessment before starting CRP (0M), after 3 months (3M) in a standard CRP, and after 9 months (12M) in either HB, SC, or CB condition (12 months after starting CRP).Results.Analysis of variance indicated that there were significant increases in metabolic equivalents and high-density lipoprotein, in all three groups, over time. However, analysis of covariance revealed no significant differences between the HB, SC, and CB groups at 12M for any variable.Conclusions.These data indicate that the HB program was as effective as the CB program at improving/maintaining functional capacity, blood lipids, and body weight/composition. The similar success of the SC group is likely due to their prior experience in CRP and knowledge of follow-up testing. Home-based maintenance program could be offered as a low-cost alternative to CB programs.

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Recent and dramatic therapeutic advances, aggressive care of the elderly, and a heightened awareness of secondary prevention have had a significant, albeit incompletely described, impact on cardiac rehabilitation (CR) programs. The authors did a retrospective analysis on 1,848 patients from their phase II CR program that were treated over the past decade. The authors sought to identify and analyze how advances in cardiovascular care might be related to temporal changes in demographics, medical comorbidities, coronary artery disease risk factors, and cardiovascular history among individuals with cardiac disease who have completed the phase II CR program over a 10-year period.Methods.Cardiac rehabilitation records were reviewed from 1986 to 1996 at Akron City Hospital. The data were compiled prospectively by nurses and exercise physiologists and were subsequently analyzed. The charts reviewed were from 1,848 patients who completed outpatient phase II CR.Results.The program began in 1986 with 53 patients completing CR and evolved to 309 in 1996. There has been an increase in the number of elderly patients referred to and completing the program. The number of participants older than 65 years of age increased from 28.3% in 1986 to 52.1% in 1996. Cardiac rehabilitation participants reflect the known demographics of patients with clinical coronary artery disease. Men outnumber women and, on average, the female participants are older than the male participants. There has been a statistically significant increase in medical comorbidities over the course of the study. Although the absolute number of patients entering CR after coronary artery bypass graft survey has remained fairly constant, there has been a dramatic increase in the absolute number of patients entering CR after percutaneous transluminal coronary angioplasty (with the latter recently comprising a majority of CR participants).Conclusion.There is a significant trend in the attendance and completion of CR programs by older individuals, which suggests a greater awareness of patients and their physicians. The growth of the program is fueled by high-risk patients with more comorbidities who potentially are the group of patients able to obtain the greatest absolute benefit from CR.

ISSN:0883-9212    

出版商:OVID    

年代:2000

数据来源: OVID