SUN-PO154: Improvement in Frailty Status After Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease

Plas, Jelmer; Beek, Lies ter; Vaart, Huub van der; Jager‐Wittenaar, Harriët

doi:10.1016/s0261-5614(19)32787-6

Cited by 2 publications

(3 citation statements)

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“…Of four randomised trials, three tested the effectiveness of exercise-based interventions (a hospital-based pedal exercise intervention, 45 pulmonary rehabilitation with or without electrical muscle stimulation, 46 and home-based pulmonary rehabilitation 47 ); one trial tested whether the severity of respiratory disability affected outcomes of centre-or homebased pulmonary rehabilitation. 48 Of 12 cohort studies, most assessed the impact of pulmonary rehabilitation on frailty or frailty components, [49][50][51][52][53][54] three assessed the feasibility or outcomes of geriatric rehabilitation, [55][56][57] and three assessed how baseline characteristics (e.g. dyspnoea severity, exercise tolerance, frailty) affect pulmonary rehabilitation outcomes.…”

Section: Focus Of Included Studiesmentioning

confidence: 99%

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

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Background: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercisebased interventions might improve outcomes for people living with both COPD and frailty. Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour. Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent. Conclusion: Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.

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Section: Focus Of Included Studiesmentioning

confidence: 99%

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

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“…Although there is emerging evidence on multidisciplinary interventions including nutritional intervention targeting frailty in generalised older populations, a research gap exists regarding the application of such approaches to a chronic respiratory disease population. The very few studies to date have yielded limited evidence to inform practice [85,154,155,183,184]. This may be partly attributed to nutritional intervention studies typically targeting contributing or underlying nutrition diagnoses (e.g.…”

Section: Nutritional Management Of Frailty In Chronic Respiratory Dis...mentioning

confidence: 99%

“…malnutrition, sarcopenia) rather than the construct of frailty directly. This notwithstanding, data from multidisciplinary pulmonary rehabilitation programmes that include nutritional management have shown promise to improve frailty status [155,184]. Systematic reviews of studies that evaluate multidisciplinary interventions including nutritional management in frail older populations have shown similar effects [159,185].…”

Section: Nutritional Management Of Frailty In Chronic Respiratory Dis...mentioning

confidence: 99%

European Respiratory Society statement on frailty in adults with chronic lung disease

et al. 2023

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Frailty is a complex, multidimensional syndrome characterised by a loss of physiological reserves that increases a person's susceptibility to adverse health outcomes. Most knowledge regarding frailty originates from geriatric medicine, however, awareness of its importance as a treatable trait for people with chronic respiratory disease (including asthma, COPD and interstitial lung disease) is emerging. A clearer understanding of frailty and its impact in chronic respiratory disease is a pre-requisite to optimise clinical management in the future. This unmet need underpins the rationale for undertaking the present work.This European Respiratory Society Statement synthesises current evidence and clinical insights from international experts and people affected by chronic respiratory conditions regarding frailty in adults with chronic respiratory disease. The scope includes coverage of frailty within international respiratory guidelines, prevalence and risk factors, review of clinical management options (including comprehensive geriatric care, rehabilitation, nutrition, pharmacological and psychological therapies), and identification of evidence gaps to inform future priority areas of research. Frailty is under-represented in international respiratory guidelines, despite being common and related to increased hospitalisation and mortality. Validated screening instruments can detect frailty to prompt comprehensive assessment and personalised clinical management. Clinical trials targeting people with chronic respiratory disease and frailty are needed.

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SUN-PO154: Improvement in Frailty Status After Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease

Cited by 2 publications

References 0 publications

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

European Respiratory Society statement on frailty in adults with chronic lung disease

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