Exercise training for bronchiectasis

Lee, Annemarie L.; Gordon, Carla; Osadnik, Christian

doi:10.1002/14651858.cd013110.pub2

Cited by 15 publications

(21 citation statements)

References 93 publications

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“…We included clinical trials of pulmonary rehabilitation compared to usual care in patients with stable chronic airways disease, identified from published systematic reviews [ 1 , 4 , 8 ]. Systematic reviews were identified from Medline (Ovid) searches using keywords for diagnosis (COPD, asthma or bronchiectasis) and rehabilitation or exercise training, limited to “review articles” or “topic reviews (Cochrane)”.…”

Section: Methodsmentioning

confidence: 99%

“…Pulmonary rehabilitation is a highly effective intervention to enhance exercise capacity, improve symptoms and reduce hospitalisations in people with chronic airways disease [ 1 – 4 ]. Pulmonary rehabilitation is defined as the delivery of “patient tailored therapies … designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviours” [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Does pulmonary rehabilitation address treatable traits? A systematic review

et al. 2022

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BackgroundThere is growing interest in a “treatable traits” approach to pulmonary rehabilitation in chronic airways disease. The frequency with which pulmonary rehabilitation programmes address treatable traits is unknown.MethodsRandomised controlled trials of pulmonary rehabilitation compared to usual care in patients with stable chronic airways disease were included. The components of pulmonary rehabilitation delivered were extracted and mapped to treatable traits in pulmonary, extrapulmonary and behavioural/lifestyle domains. Meta-analysis was used to evaluate the impact of addressing >1 treatable trait on exercise capacity and health-related quality of life (HRQoL).Results116 trials were included (6893 participants). Almost all pulmonary rehabilitation programmes addressed deconditioning (97% of trials). The most commonly addressed extrapulmonary traits were nutritional status (obesity and cachexia, 18% each) and mood disturbance (anxiety and depression, 10% each). Behavioural/lifestyle traits most frequently addressed were nonadherence (46%), poor inhalation technique (24%) and poor family/social support (19%). Exercise capacity and HRQoL outcomes did not differ between studies that addressed deconditioning alone and those that targeted additional traits, but heterogeneity was high.ConclusionAside from deconditioning, treatable traits are infrequently addressed in existing trials of pulmonary rehabilitation. The potential of the treatable traits approach to improve pulmonary rehabilitation outcomes remains to be explored.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does pulmonary rehabilitation address treatable traits? A systematic review

et al. 2022

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“…Ein Cochrane Review von Lee [ 5 ] inkludierte 6 Studien mit 275 Patient:innen mit Bronchiektasenerkrankung, die in einem ambulanten Setting 6–8 Wochen einer PR unterzogen wurden. Hier kam es zu einer Verbesserung der Leistungsfähigkeit im Incremental-shuttle-walk-Test mit einem Unterschied von 87 m (95 %-Konfidenzintervall [KI] 43–132 m) und im 6‑min-Gehtest (6MWT) von 42 m (95 %-KI 22–62 m) in der PR-Gruppe vs. „usual care“.…”

Section: Evidenz Der Ambulanten Pneumologischen Rehabilitationunclassified

Ambulante pneumologische Rehabilitation

Zwick

2022

Pneumologe

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Hintergrund Ambulante pneumologische Rehabilitation (PR) spielt eine zentrale Rolle in der integrativen Versorgung von Patient:innen mit Lungenerkrankungen. Material und Methode In dieser Arbeit wird die rezente Evidenz zu ambulanter PR bei verschiedenen Erkrankungen, in verschiedenen Settings inklusive der Kosteneffektivität dargelegt. Diese basiert auf Literaturrecherche in den Datenbanken PubMed und MEDLINE, aktuellen Expertenmeinungen und klinischen Erfahrungen. Ergebnisse Frühe Rehabilitation nach Exazerbation führt bei COPD(chronisch obstruktive Lungenerkrankung)-Patient:innen zu einer Reduktion der Wiederaufnahme im Spital (Hazard Ratio 0,83) und zu einer Reduktion der Mortalität (Hazard Ratio 0,63) über den Zeitraum von 12 Monaten. Telerehabilitation ist eine vielversprechende Zukunftsperspektive in spezifischen Settings. Rezente Publikationen zu Bronchiektasenerkrankungen, interstitiellen Lungenerkrankungen und pulmonaler Hypertonie konnten die Machbarkeit und Sicherheit der ambulanten PR bestätigen, und die Kosteneffektivität konnte dargestellt werden. Auch zu Post‑/Long-COVID mehrt sich die Evidenz im stationären wie im ambulanten Reha-Setting. Schlussfolgerungen Es besteht zunehmend eine Gleichwertigkeit in Bezug auf die Evidenz der PR – unabhängig davon, ob sie im ambulanten oder stationären Setting erfolgt.

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“…Current clinical treatment guidelines recommend general exercise to improve aerobic fitness and HR-QoL [ 9 ]. However, the health impacts associated with therapeutic exercise in children with BE are not well understood [ 9 , 10 ]. A recent meta-analysis of the effects of exercise training on physical and psychosocial health in children with chronic respiratory disease identified no published studies investigating the impact of therapeutic exercise in this population [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Bronchiectasis - Exercise as Therapy (BREATH): rationale and study protocol for a multi-center randomized controlled trial

Jones

O’Grady

Goyal

et al. 2022

Trials

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Background Globally, bronchiectasis (BE) unrelated to cystic fibrosis (CF) is recognized as a major cause of respiratory morbidity, mortality, and healthcare utilization. Children with BE regularly experience exacerbations of their condition resulting in frequent hospitalizations and decreased health-related quality of life (HR-QoL). Guidelines for the treatment and management of BE call for regular exercise as a means of improving aerobic fitness and HR-QoL. Moreover, research in adults with BE has shown that exercise can reduce the frequency of exacerbations, a potent predictor of future lung function decline and respiratory morbidity. Yet, to date, the health benefits resulting from therapeutic exercise have not been investigated in children with BE. The BREATH, Bronchiectasis - Exercise as Therapy, trial will test the efficacy of a novel 8-week, play-based therapeutic exercise program to reduce the frequency of acute exacerbations over 12 months in children with BE (aged ≥ 4 and < 13 years). Secondary aims are to determine the cost-effectiveness of the intervention and assess the program’s impact on aerobic fitness, fundamental movement skill (FMS) proficiency, habitual physical activity, HR-QoL, and lung function. Methods This multi-center, observer-blinded, parallel-group (1:1 allocation), randomized controlled trial (RCT) will be conducted at three sites. One hundred and seventy-four children ≥ 4 and < 13 years of age with BE will be randomized to a developmentally appropriate, play-based therapeutic exercise program (eight, 60-min weekly sessions, supplemented by a home-based program) or usual care. After completing the baseline assessments, the number of exacerbations and secondary outcomes will be assessed immediately post-intervention, after 6 months of follow-up, and after 12 months of follow-up. Monthly, parental contact and medical review will document acute respiratory exacerbations and parameters for cost-effectiveness outcomes. Discussion The BREATH trial is the first fully powered RCT to test the effects of a therapeutic exercise on exacerbation frequency, fitness, movement competence, and HR-QoL in children with bronchiectasis. By implementing a developmentally appropriate, play-based exercise program tailored to the individual needs of children with bronchiectasis, the results have the potential for a major paradigm shift in the way in which therapeutic exercise is prescribed and implemented in children with chronic respiratory conditions. The exercise program can be readily translated. It does not require expensive equipment and can be delivered in a variety of settings, including the participant’s home. The program has strong potential for translation to other pediatric patient groups with similar needs for exercise therapy, including those with obesity, childhood cancers, and neurological conditions such as cerebral palsy. Trial registration Australian and New Zealand Clinical Trials Register (ANZCTR) ACTRN12619001008112

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Exercise training for bronchiectasis

Cited by 15 publications

References 93 publications

Does pulmonary rehabilitation address treatable traits? A systematic review

Does pulmonary rehabilitation address treatable traits? A systematic review

Ambulante pneumologische Rehabilitation

Bronchiectasis - Exercise as Therapy (BREATH): rationale and study protocol for a multi-center randomized controlled trial

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