In quality-of-life research, the current challenge is to devise models to clarify the elements of health-related quality of life (HRQOL) and the causal relationships among them. This revision of Wilson and Cleary's model includes a taxonomy of the variables that often have been used to measure HRQoL. This revision should be useful in research and clinical practice.

The inspiratory pressure load is an important variable in inspiratory muscle training (IMT), but previous studies with chronic obstructive pulmonary disease (COPD) patients have not controlled for this variable. We compared the effects of two months of IMT with a pressure threshold breathing device at inspiratory pressure loads equal to either 15 or 30% of each patient's maximal inspiratory pressure (Plmax). This study was double blind and patients were randomly assigned to the treatment groups, 12 in the 15% group and ten in the 30% group. Dependent variables were measured at baseline, and after one and two months of IMT. Patients who exercised with the 30% load improved the following: Plmax by a mean of -12 +/- 9 cm H2O (p less than 0.01), endurance time while breathing against an inspiratory pressure load equal to 66% of Plmax by 5 +/- 9 min (p less than 0.01), and 12-min distance walk (12MD) by 199 +/- 90 feet (p less than 0.01). Patients who exercised with the 15% load demonstrated no improvements in Plmax, endurance time, and 12MD. There were no changes in patients' report of functional impairment (Sickness Impact Profile), mood (Profile of Mood States), health status (Health Perceptions Questionnaire), and pulmonary symptoms (respiratory symptom log). We conclude that the 30% load was more effective than the 15% load in this sample.

Fatigue is an important problem that affects performance of daily activities in people with COPD. The relationships or interactions that exist among fatigue and other symptoms are complex.

Background-Patients receiving high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT) experience considerable reductions in physical activity and deterioration of their health status.

BackgroundWhile the association between inadequate health literacy and adverse health outcomes has been well documented, less is known about the impact of health literacy on health perceptions, such as perceptions of control over health, and preventive health behaviors.MethodsWe identified a subsample of participants (N = 707) from the Health and Retirement Study (HRS), a nationally representative sample of older adults, who participated in health literacy testing. Self-reported health literacy was measured with a literacy screening question, and objective health literacy with a summed score of items from the Test of Functional Health Literacy. We compared answers on these items to those related to participation in health behaviors such as cancer screening, exercise, and tobacco use, as well as self-referencing health beliefs.ResultsIn logistic regression models adjusted for gender, education, race, and age, participants with adequate self-reported health literacy (compared to poorer levels of health literacy) had greater odds of participation in mammography within the last 2 years (Odds ratio [OR] = 2.215, p = 0.01) and participation in moderate exercise two or more times per week (OR = 1.512, p = 0.03). Participants with adequate objective health literacy had reduced odds of participation in monthly breast self-exams (OR = 0.369, p = 0.004) and reduced odds of current tobacco use (OR = 0.456, p = 0.03). In adjusted linear regression analyses, self-reported health literacy made a small but significant contribution to explaining perceived control of health (β 0.151, p = <0.001) and perceived social standing (β 0.112, p = 0.002).ConclusionIn a subsample of older adult participants of the HRS, measures of health literacy were positively related to several health promoting behaviors and health-related beliefs and non-use of breast self-exams, a screening behavior of questionable benefit. These relationships varied however, between self-reported and objectively-measured health literacy. Further investigation into the specific mechanisms that lead higher literacy people to pursue health promoting actions appears clearly warranted.

People with chronic obstructive pulmonary disease (COPD) can experience severe dyspnea, tenacious secretions, and a disruptive cough. They often struggle with daily activities and over time tend to decrease the amount of time they spend outside the home. The functional decline accompanying these changes is not adequately explained by physical changes alone. This descriptive, qualitative study describes social changes and experiences of stigma from the perspective of people with moderate to severe COPD. A total of 16 participants (11 men, 5 women) participated in individual interviews regarding effects of COPD on social relationships and experiences with COPD-related stigma. Participants were aware of the potential for stigma related to COPD. Emerging themes included the prevalence of blame related to smoking, both from others, including health care providers, and from themselves. Although many decreases in social activities appear to be pragmatic adaptations to functional limitations, these decisions may also be attempts to avoid potentially stigmatizing situations.

Background Little is known about frailty in people with chronic obstructive pulmonary disease (COPD). The purposes of this study were to describe frailty, to identify, which demographic and clinical characteristics contributed to frailty, and to examine the relationship between frailty and health-related outcomes in people with COPD. Methods This was a secondary cross-sectional study, using data from the National Health and Nutrition Evaluation Survey. The frailty index and outcome measures were derived primarily from survey responses. Results The prevalence of frailty was 57.8%. Multivariate logistic regression showed that individuals with COPD who had self-reported shortness of breath and comorbid diabetes were more likely to be frail than those who did not. Frail people tended to have a greater number of disabilities. Conclusions The findings support the importance of frailty in the COPD population. Further study is needed to understand frailty in people with COPD, using objective measures for criteria of frailty.

In patients with chronic obstructive pulmonary disease (COPD) the intensity of aerobic training is limited by dyspnea. Improving strength of the inspiratory muscles could enhance aerobic exercise training by reducing exercise-related dyspnea. We examined effects of home-based inspiratory muscle training (IMT) and cycle ergometry training (CET) in 53 patients with moderate to severe COPD (FEV(1)% pred, 50 +/- 17 [mean +/- SD]). Patients were randomly assigned to 4 mo of training in one of four groups: IMT, CET, CET + IMT, or health education (ED). Patients were encouraged to train to the limits of their dyspnea. Inspiratory muscle strength and endurance increased in IMT and CET + IMT groups compared with CET and ED groups (p < 0. 01). Peak oxygen uptake increased and heart rate, minute ventilation, dyspnea, and leg fatigue decreased at submaximal work rates in the CET and CET + IMT groups compared with the IMT and ED groups (p < 0. 01). There were no differences between the CET and CET + IMT groups. Home-based CET produced a physiological training effect and reduced exercise-related symptoms while IMT increased respiratory muscle strength and endurance. The combination of CET and IMT did not produce additional benefits in exercise performance and exercise-related symptoms. This is the first study to demonstrate a physiological training effect with home-based exercise training.