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Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial.
Messaggi-Sartor, M, Marco, E, Martínez-Téllez, E, Rodriguez-Fuster, A, Palomares, C, Chiarella, S, Muniesa, JM, Orozco-Levi, M, Barreiro, E, Güell, MR
European journal of physical and rehabilitation medicine. 2019;55(1):113-122
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Plain language summary
Lung cancer treatment initiates a deconditioning storm that further reduces the capacity to deliver and utilize oxygen and metabolic substrates during exercise, contributing to poor cardiorespiratory fitness. The main aim of this study was to assess the impact of aerobic exercise with inspiratory and expiratory muscle training on cardiovascular fitness and respiratory muscle dysfunction in non-small cell lung cancer patients. The study is a two-centre, prospective, single-blind, pilot randomized controlled trial. The eligible patients were randomly assigned to the exercise (n=16) or control groups (n=21). Study results showed strong improvement in respiratory muscle strength and exercise capacity following high-intensity inspiratory and expiratory muscle training. Authors conclude that structured and supervised exercise interventions should be recommended to patients with lung cancer.
Abstract
BACKGROUND Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer (NSCLC). The best design for exercise interventions in these patients has not been determined yet. AIM: To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery. DESIGN Prospective, single-blind, pilot randomized controlled trial. SETTING Outpatient cardiopulmonary rehabilitation unit of two university hospitals. POPULATION Thirty-seven patients with NSCLC after tumor resection. METHODS Patients were randomly assigned to exercise training or usual post-operative care. The training program consisted of aerobic exercises and high-intensity respiratory muscle training (24 supervised sessions, 3 per week, 8 weeks). Primary outcome was exercise capacity assessed with peak oxygen uptake (VO2peak) during cardiopulmonary exercise test. Secondary outcomes included changes in respiratory muscle strength, levels of serum insulin growth factor I (IGF-I) and IGF binding protein 3 (IGFBP-3), and quality of life assessed with the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire. RESULTS The 8-week training program was associated with significant improvement in VO2peak (2.13 mL/Kg/min [95%CI 0.06 to 4.20]), maximal inspiratory and expiratory pressures (18.96 cmH2O [95% CI 2.7 to 24.1] and 18.58 cmH2O [95% CI 4.0 to 33.1], respectively) and IGFBP-3 (0.61 µg/mL [%95 CI 0.1 to 1.12]). No significant differences were observed in the EORTC QLQ-C30. CONCLUSIONS An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity, respiratory muscle strength, and serum IGFBP-3 levels in NSCLC patients after lung resection. There was no impact on the other outcomes assessed. CLINICAL REHABILITATION IMPACT A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery.
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Comprehensive care of amyotrophic lateral sclerosis patients: a care model.
Güell, MR, Antón, A, Rojas-García, R, Puy, C, Pradas, J, ,
Archivos de bronconeumologia. 2013;(12):529-33
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working.