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  • 1. Arne, Mats
    et al.
    Emtner, Margareta
    Lisspers, Karin
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stallberg, Bjorn
    Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden2016Inngår i: EUROPEAN CLINICAL RESPIRATORY JOURNAL, ISSN 2001-8525, Vol. 3, artikkel-id 31601Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Pulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden. Methods: A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support. Results: A total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PRwas not available toCOPD patients - neither in primary care nor at hospitals. Conclusion: Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

  • 2.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Thilen, U.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Exercise self-efficacy (ESE) in adults with congential heart disease2017Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, nr Suppl. 1, artikkel-id ehx501.P618Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Many adults with congenital heart disease (CHD) have reduced aerobic exercise capacity and impaired muscle function. However, it is largely unknown which factors have influence on the confidence to perform exercise training, i.e. Exercise Self-Efficacy (ESE).

    Aims: To identify factors related to low ESE, and thus identify potential targets for rehabilitation and thereby enhance the potential for being physically active.

    Methods: Seventy-nine adults with CHD; simple lesions n=38 (women n=16), complex lesions n=41 (women n=17) (mean age 36.7±14.6 years) and 42 age and sex matched controls were recruited. All participants completed questionnaires on ESE, quality of life (EQ-5D), and physical activity (international physical activity questionnaire, IPAQ), and performed muscle endurance tests.

    Results: ESE was categorised into low (<26 points, n=24) and high (≥26 points, n=55). Patients with low ESE were older (45.2±15.4 vs. 32.6±12.5 years, p=0.002), more often had prescribed medication (67% vs. 44%, p=0.06), higher New York Heart Association functional class (NYHA) (≥ III) (25% vs. 7%, p=0.03) and performed fewer shoulder flexions (30.9±16.1 vs. 45.9±23.9, p=0.01) compared with those with high ESE. In the high ESE group, ESE did not differ from controls (33.8±3.9 vs. 33.4±6.1, p=0.74). In linear multivariate analysis age (B;-0.18, 95% CI -0.28- -0.08), smoking (B;-3.73, 95% CI -7.17- -0.28), EQ-5Dindex <1 (B;-3.33, 95% CI -6.08- -0.57) and number of shoulder flexions (B; 0.09, 95% CI 0.03–0.16) were independently associated with ESE.

    Conclusion: Many adults with CHD have low ESE. Rehabilitation targeting quality of life, smoking cessation and muscle training may improve ESE, and thus enhance the potential for being physically active in this population.

  • 3.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Thilén, Ulf
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Exercise self-efficacy in adults with congenital heart disease2018Inngår i: International Journal of Cardiology: Heart and vasculature, E-ISSN 2352-9067, Vol. 18, s. 7-11Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Physical activity improves health, exercise tolerance and quality of life in adults with congenital heart disease (CHD), and exercise training is in most patients a high-benefit low risk intervention. However, factors that influence the confidence to perform exercise training, i.e. exercise self-efficacy (ESE), in CHD patients are virtually unknown. We aimed to identify factors related to low ESE in adults with CHD, and potential strategies for being physically active.

    Methods: Seventy-nine adults with CHD; 38 with simple lesions (16 women) and 41 with complex lesions (17 women) with mean age 36.7 ± 14.6 years and 42 matched controls were recruited. All participants completed questionnaires on ESE and quality of life, carried an activity monitor (Actiheart) during four consecutive days and performed muscle endurance tests.

    Results: ESE in patients was categorised into low, based on the lowest quartile within controls, (≤ 29 points, n = 34) and high (> 29 points, n = 45). Patients with low ESE were older (42.9 ± 15.1 vs. 32.0 ± 12.4 years, p = 0.001), had more complex lesions (65% vs. 42%, p = 0.05) more often had New York Heart Association functional class III (24% vs. 4%, p = 0.01) and performed fewer shoulder flexions (32.5 ± 15.5 vs. 47.7 ± 25.0, p = 0.001) compared with those with high ESE. In a logistic multivariate model age (OR; 1.06, 95% CI 1.02-1.10), and number of shoulder flexions (OR; 0.96, 95% CI 0.93-0.99) were associated with ESE.

    Conclusion: In this study we show that many adults with CHD have low ESE. Age is an important predictor of low ESE and should, therefore, be considered in counselling patients with CHD. In addition, muscle endurance training may improve ESE, and thus enhance the potential for being physically active in this population.

  • 4.
    Camilla, Sandberg
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Pomeroy, Jeremy
    Thilén, Ulf
    Gradmark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Habitual Physical Activity in Adults with Congenital Heart Disease Compared with Age- and Sex- Matched Controls2016Inngår i: Canadian Journal of Cardiology, ISSN 0828-282X, E-ISSN 1916-7075, Vol. 32, nr 4, s. 547-553Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Most adult patients with congenital heart disease (CHD) have reduced aerobic exercise capacity. Their habitual physical activity (PA) level is, however, less well studied. In this study habitual PA level in a cohort of adults with CHD compared to healthy age and gender matched controls was investigated.

    Methods: Eighty adults with CHD, classed as either “complex” (n=40) or “simple” (n=40), and 42 healthy controls were studied with a combined uniaxial accelerometer and heart rate monitor worn during 4 consecutive days. We analysed 1) the time spent during ≥ moderate/vigorous PA, 2) accelerometer counts/day and 3) to what extent the World Health Organization recommendations on PA were reached.

    Results: Patients with simple lesions had higher total accelerometer counts/day compared to both patients with complex lesions and controls (simple lesions; median (IQR) 107.7(63.4) vs. complex lesions; 72.8(53.5) and controls; 78.3(49.6), p≤0.001 and p=0.002). Furthermore, no differences in time spent during ≥ moderate-to-vigorous PA was found between patients and controls. In addition 46% of the patients with simple lesions, 55% of the patients with complex lesions and 44% of the controls did not reach the W.H.O.-recommended level of daily PA, but no significant differences between groups were found. There were no differences in achieving recommended PA level between patients in NYHA I vs. NYHA II+III.

    Conclusions: Patients with CHD follow the same PA-level pattern as the general population. Broad strategies promoting an active lifestyle are needed across the population and especially for patients with complex CHD and impaired NYHA class.

  • 5. Emtner, M.
    et al.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Effects of exercise training in patients with chronic obstructive pulmonary disease: a narrative review for FYSS (Swedish Physical Activity Exercise Prescription Book)2016Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, nr 6, s. 368-371Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    The aims of this review were to determine the level of evidence for exercise training in the management of patients with chronic obstructive pulmonary disease (COPD) and provide evidence-based recommendations on exercise training. This review was performed in PubMed and Cochrane Library. Included studies investigated patients with COPD who had been randomised to exercise training or no training. Six systematic reviews were included. The methodological quality was scored using a grading system (GRADE). The analysis showed that aerobic and resistance training in patients in a stable state of COPD results in improved health-related quality of life and decreased dyspnoea, anxiety and depression (moderately strong scientific evidence, grade +++), and increased physical capacity and decreased dyspnoea in daily activities (limited scientific evidence, grade ++). In patients with an acute exacerbation, aerobic and resistance training, performed directly after the exacerbation, results in improved health-related quality of life (moderately strong scientific evidence, grade +++), improved exercise capacity and decreased mortality and hospitalisation (limited scientific evidence, grade ++). Thus, patients with COPD should be recommended to take part in exercise training.

  • 6. Emtner, Margareta
    et al.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sjukgymnastik vid KOL2014Inngår i: KOL: kroniskt obstruktiv lungsjukdo / [ed] Kjell Larsson, Lund: Studentlitteratur AB, 2014, 3, s. 569-587Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 7. Holland, Anne E
    et al.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Spruit, Martijn A
    How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD2013Inngår i: European Respiratory Review, ISSN 0905-9180, E-ISSN 1600-0617, Vol. 22, nr 130, s. 577-586Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD) and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD.

  • 8.
    Janaudis-Ferreira, Tania
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Henriksson-Larsn, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lundgren, Rune
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Differences in training effects following training with and without supplemental oxygen in patients with COPD2009Inngår i: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 11, s. 186-192Artikkel i tidsskrift (Fagfellevurdert)
  • 9.
    Janaudis-Ferreira, Tania
    et al.
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Sjukgymnastik.
    Henriksson-Larsén, Karin
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lundgren, Rune
    Wadell, Karin
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Sjukgymnastik.
    Mechanisms of improved physcical performance after training with and without oxygen in patients with chronic obstructive pulmonare disease2007Konferansepaper (Annet vitenskapelig)
  • 10.
    Janaudis-Ferreira, Tania
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.
    Hill, Kylie
    Goldstein, Roger S
    Robles-Ribeiro, Priscila
    Beauchamp, Marla K
    Dolmage, Thomas E
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Brooks, Dina
    Resistance arm training in patients with chronic obstructive pulmonary disease: a randomized controlled trial2011Inngår i: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 139, nr 1, s. 151-158Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The study aimed to evaluate the effect of upper extremity resistance training for patients with COPD on dyspnea during activity of daily living (ADL), arm function, arm exercise capacity, muscle strength and health related quality of life (HRQL)

    METHODS: Patients were randomly assigned to an intervention or control group. The intervention group underwent arm resistance training. The control group performed a sham. Both groups exercised 3 times a week for 6 weeks. Dyspnea during ADL and HRQL were measured using the chronic respiratory disease questionnaire (CRDQ). Arm function and exercise capacity were measured using the 6-minute pegboard and ring test (6PBRT) and the unsupported upper limb exercise test (UULEX), respectively. Muscle strength for the biceps, triceps, anterior and middle deltoids was obtained using an isometric dynamometer.

    RESULTS: Thirty-six patients with COPD (66 +/- 9 yrs) participated in the study. Compared with the control group, the magnitude of change in the intervention group was greater for the 6PBRT (p = 0.03), UULEX (p = 0.01) and elbow flexion force (p = 0.01); elbow extension force (p = 0.02), shoulder flexion force (p = 0.029) and shoulder abduction force (p = 0.01). There was no between-group difference in dyspnea during ADL, HRQL or symptoms during the 6PBRT or UULEX (all p values greater than 0.08).

    CONCLUSIONS: Resistance based arm training improved arm function, arm exercise capacity and muscle strength in patients with COPD. No improvement in dyspnea during ADL, HRQL or symptoms was demonstrated.

  • 11. Janaudis-Ferreira, Tania
    et al.
    Hill, Kylie
    Goldstein, Roger S
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Brooks, Dina
    Relationship and responsiveness of three upper-limb tests in patients with chronic obstructive pulmonary disease2013Inngår i: Physiotherapy Canada, ISSN 0300-0508, E-ISSN 1708-8313, Vol. 65, nr 1, s. 40-43Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To determine (1) the relationship among three common upper-limb tests for patients with chronic obstructive pulmonary disease (COPD): unsupported upper limb exercise test (UULEX), 6-minute pegboard and ring test (6PBRT), and a muscle-strength test using a hand-held dynamometer; and (2) the responsiveness of these three tests to changes after pulmonary rehabilitation that included a resistance arm-training programme.

    Methods: The study was a secondary analysis of a randomized controlled trial (RCT). The UULEX and the 6PBRT were used to measure peak arm exercise capacity and arm function, respectively. A handheld dynamometer was used to measure elbow and shoulder flexion force. We analyzed baseline data for all participants in the ACT, as well as baseline and post-PR data for those who completed 6-week follow-up testing.

    Results: 36 patients with COPD (mean forced expiratory volume in 1 second [FEV1] = 35% [SD 15%] predicted; age 66 [9] y) participated, of whom 13 completed an arm-training programme. The correlations among the test results ranged from 0.41 to 0.81 (p < 0.0001). Standardized response means were 1.0 for muscle force of elbow flexion, 1.2 for shoulder flexion, and 1.8 for the 6PBRT and UULEX.

    Conclusions: Although the three tests (UULEX, 6PBRT, and muscle-strength test using a hand-held dynamometer) are intended to measure different constructs, they were moderately to highly correlated with one another. The 6PBRT, UULEX, and muscle-strength test were demonstrated to be responsive to the resistance arm-training programme.

  • 12.
    Janaudis-Ferreira, Tania
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Hill, Kylie
    Goldstein, Roger
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Brooks, Dina
    Arm exercise training in patients with cronic obstructíve pulmonary disease: a systematic review2009Inngår i: Journal of cardiopulmonary rehabilitation and prevention, ISSN 1932-7501, Vol. 29, s. 277-283Artikkel i tidsskrift (Fagfellevurdert)
  • 13.
    Janaudis-Ferreira, Tania
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Comparison of the 6-minute walk distance test performed on a non-motorised treadmill and in a corridor in healthy elderly subjects2010Inngår i: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 96, nr 3, s. 234-239Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To compare the 6-minute walk distance (6MWD) test performed on a non-motorised treadmill (6MWD-T) with the 6MWD test performed in a corridor (6MWD-C) in healthy elderly subjects.

    PARTICIPANTS: Sixteen healthy elderly individuals.

    DESIGN: Participants performed three 6MWD-T tests and three 6MWD-C tests on two different days.

    OUTCOME MEASURES: Distance walked was recorded in metres. Perceived exertion and leg fatigue were rated on the modified Borg scale before and after each test.

    RESULTS: Using the Bland and Altman limits of agreement analysis method, the mean difference between the two methods was 153.3m (limits of agreement: 28 to 278). The mean difference between days 1 and 2 for the 6MWD-C test was -7.2m (limits of agreement: -45.4 to 30.8), and the mean difference between days 1 and 2 for the 6MWD-T test was -1.6m (limits of agreement: -64.0 to 60.7). The mean difference between the first and second repetitions of the 6MWD-C test was -5m (limits of agreement: -41 to 31), and the mean difference between the first and second repetitions of the 6MWD-T test was -17m (limits of agreement: -85 to 51).

    CONCLUSIONS: The 6MWD-C and 6MWD-T tests are not interchangeable. However, the results showed good test-retest reliability between days and between test repetitions for both tests. Therefore, the 6MWD-T test may offer an alternative option to the 6MWD-C test when a 30-m corridor is not available. These findings may have implications for execution of the 6MWT-T test within cardiac and pulmonary rehabilitation.

  • 14.
    Janaudis-Ferreira, Tania
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Thigh muscle strength and endurance in patients with COPD compared with healthy controls.2006Inngår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 100, nr 8, s. 1451-1457Artikkel i tidsskrift (Fagfellevurdert)
  • 15.
    Karin, Wadell
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Fysisk träning vid obstruktiv lungsjukdom (KOL)2004Inngår i: Incitament, ISSN 1103-503X, nr 6, s. 439-442Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Kronisk obstruktiv lungsjukdom (KOL) är ett samlingsnamn i vilket kronisk bronkit, kronisk bronkiolit och emfysem ingår. Ansträngningsutlöst andfåddhet är ett av de vanligaste symtomen. Fysisk träning har visat sig vara effektivt för att minska symtom och förbättra patienternas livskvalitet.

  • 16.
    Larsson, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Thilen, Ulf
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Adults with congenital heart disease overestimate their physical activity level2019Inngår i: IJC Heart & Vasculature, ISSN 2352-9067, Vol. 22, s. 13-17Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Physical activity reduces the risk of acquired cardiovascular disease, which is of great importance in patients with congenital heart disease (CHD). There are diverging data whether physical activity level (PAL) differs between patients with CHD and controls. Furthermore, it is unknown if PAL can be reliably assessed in patients with CHD using self-reported instruments.

    Methods: Seventy-five patients with CHD (mean age 37.5 ± 15.5 years, women n = 29 [38.7%]) and 42 age and sex matched controls completed the International Physical Activity Questionnaire (IPAQ) and carried the activity monitor Actiheart over 4 days. Time spent at ≥3 METS ≥21.4 min/day, i.e. reaching the WHO recommendation for PAL to promote health, was used as the outcome measure. Data on PAL obtained from IPAQ were compared with Actiheart.

    Results: The proportion of individuals reaching target PAL according to IPAQ was similar in patients with CHD and controls (70.7%vs.76.2%, p = 0.52) as well as between patients with simple and complex lesions. There was an overall difference between IPAQ and Actiheart in detecting recommended PAL (72.6%vs.51.3%, p b 0.001). In a subgroup analysis, this difference was also detected in patients but was borderline for controls. The negative predictive value for IPAQ in detecting insufficient PAL was higher in patients than in controls (73%vs.40%).

    Conclusions: The proportion of persons reaching sufficient PAL to promote health was similar in patients and controls. The self-reported instrument overestimated PAL in relation to objective measurements. However, with a high negative predictive value, IPAQ is a potentially useful tool for detecting patients with insufficient PAL.

  • 17. Laveneziana, Pierantonio
    et al.
    Webb, Katherine A
    Ora, Josuel
    Wadell, Karin
    Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
    O'Donnell, Denis E
    Evolution of dyspnea during exercise in COPD: impact of critical volume constraints2011Inngår i: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 184, nr 12, s. 1367-1373Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rationale: Patients with COPD primarily describe their exertional dyspnea using descriptors alluding to increased effort or work of breathing and unsatisfied inspiration or inspiratory difficulty. Objective: The purpose of this study was to examine the impact of changes in dynamic respiratory mechanics during incremental (INCR) and high-intensity constant work-rate (CWR) cycle exercise on the evolution of dyspnea intensity and its major qualitative dimensions in patients with moderate-to-severe COPD. Methods: Sixteen COPD subjects performed symptom-limited INCR and CWR cycle exercise tests. Measurements included: dyspnea intensity and qualitative descriptors, breathing pattern, operating lung volumes and esophageal pressure (Pes). Measurements and Main Results: During both exercise tests, there was an inflection in the relation between tidal volume (VT) and ventilation. This inflection occurred significantly earlier in time during CWR versus INCR exercise but at a similar ventilation, VT and tidal Pes swing. Beyond this inflection, there was no further change in VT despite a continued increase in ventilation and tidal Pes. During both tests, "work/effort" was the dominant dyspnea descriptor selected up to the inflection point, whereas after this point dyspnea intensity and the selection frequency of "unsatisfied inspiration" rose sharply. CONCLUSIONS: Regardless of the exercise test protocol, the inflection (or plateau) in the VT response marked the point where dyspnea intensity rose abruptly and there was a transition in the dominant qualitative descriptor choice from "work/effort" to "unsatisfied inspiration". Intensity and quality of dyspnea evolve separately and are strongly influenced by mechanical constraints on VT expansion during exercise in COPD.

  • 18. Laveneziana, Pierantonio
    et al.
    Webb, Katherine A
    Wadell, Karin
    Respiratory Investigation Unit, Department of Medicine, Queen’s University ; Kingston General Hospital, Kingston, ON, Canada.
    Neder, J Alberto
    O'Donnell, Denis E
    Does expiratory muscle activity influence dynamic hyperinflation and exertional dyspnea in COPD?2014Inngår i: Respiratory Physiology & Neurobiology, ISSN 1569-9048, E-ISSN 1878-1519, Vol. 199, s. 24-33Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Increased expiratory muscle activity is common during exercise in patients with COPD but its role in modulating operating lung volumes and dyspnea during incremental cycle ergometry is currently unknown. We compared gastric (Pga) and esophageal (Pes) pressures, operating lung volumes and qualitative descriptors of dyspnea during exercise in 12 COPD patients and 12 age- and sex-matched healthy controls. Pes- and Pga-derived measures of expiratory muscle activity were significantly (p<0.05) greater in COPD than in health during exercise. End-expiratory lung volume (EELV) increased by 0.8L, independent of increased expiratory muscle activity in COPD. Dynamic function of the diaphragm was not different in health and COPD throughout exercise. In both groups, dyspnea descriptors alluding to increased work and inspiratory difficulty predominated whereas expiratory difficulty was rarely reported, even at the limits of tolerance. In conclusion, increased expiratory muscle activity did not mitigate the rise in EELV, the relatively early respiratory mechanical constraints or the attendant perceived inspiratory difficulty during exercise in COPD.

  • 19.
    Lundell, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Rehn, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Nyberg, Andre
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea2015Inngår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, nr 1, s. 11-26Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Only a minority of patients with chronic obstructive pulmonary disease (COPD) have access to pulmonary rehabilitation (PR). Home-based solutions such as telehealthcare, have been used in efforts to make PR more available. The aim of this systematic review was to investigate the effects of telehealthcare on physical activity level, physical capacity and dyspnea in patients with COPD, and to describe the interventions used. 

    Methods: Randomized controlled trials were identified through database searches, reference lists and included authors. Articles were reviewed based on eligibility criteria by three authors. Risk of bias was assessed by two authors. Standardized mean differences (SMD) or mean differences (MD) with 95% CI were calculated. Forest plots were used to present data visually.

    Results: Nine studies (982 patients) were included. For physical activity level, there was a significant effect favoring telehealthcare (MD, 64.7 min; 95% CI, 54.4-74.9). No difference between groups was found for physical capacity (MD, -1.3 m; 95% CI, -8.1-5.5) and dyspnea (SMD, 0.088; 95% CI, -0.056-0.233). Telehealthcare was promoted through phone calls, websites or mobile phones, often combined with education and/or exercise training. Comparators were ordinary care, exercise training and/or education. 

    Conclusions: The use of telehealthcare may lead to improvements in physical activity level, although the results should be interpreted with caution given the heterogeneity in studies. This is an important area of research and further studies of the effect of telehealthcare for patients with COPD would be beneficial.

  • 20.
    Lundell, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Tistad, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. School of Education, Health and Social Studies, Dalarna University, Sweden.
    Rehn, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective2017Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, artikkel-id 467Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is a public health problem. Interprofessional collaboration and health promotion interventions such as exercise training, education, and behaviour change are cost effective, have a good effect on health status, and are recommended in COPD treatment guidelines. There is a gap between the guidelines and the healthcare available to people with COPD. The aim of this study was to increase the understanding of what shapes the provision of primary care services to people with COPD and what healthcare is offered to them from the perspective of healthcare professionals and managers.

    Methods: The study was conducted in primary care in a Swedish county council during January to June 2015. A qualitatively driven mixed methods design was applied. Qualitative and quantitative findings were merged into a joint analysis. Interviews for the qualitative component were performed with healthcare professionals (n = 14) from two primary care centres and analysed with qualitative content analysis. Two questionnaires were used for the quantitative component; one was answered by senior managers or COPD nurses at primary care centres (n = 26) in the county council and the other was answered by healthcare professionals (n = 18) at two primary care centres. The questionnaire data were analysed with descriptive statistics.

    Results: The analysis gave rise to the overarching theme building COPD care on shaky ground. This represents professionals driven to build a supportive COPD care on 'shaky' organisational ground in a fragmented and non-compliant healthcare organisation. The shaky ground is further represented by uninformed patients with a complex disease, which is surrounded with shame. The professionals are autonomous and pragmatic, used to taking responsibility for their work, and with limited involvement of the management. They wish to provide high quality COPD care with interprofessional collaboration, but they lack competence and are hindered by inadequate routines and lack of resources.

    Conclusions: There is a gap between COPD treatment guidelines and the healthcare that is provided in primary care. To facilitate implementation of the guidelines several actions are needed, such as further training for professionals, additional resources, and improved organisational structure for interprofessional collaboration and patient education.

  • 21.
    Lundell, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Tistad, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. School of Education, Health and Social Studies, Dalarna University.
    Enhancing confidence or coping with stigma in an ambiguous interaction with primary care: a qualitative study of people with COPDManuskript (preprint) (Annet vitenskapelig)
  • 22.
    Lundell, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Tistad, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Interacting with primary care - experiences of patients with COPD. A qualitative study2018Inngår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Pulmonary rehabilitation aims to support self-management strategies and behaviour change in patients with COPD, which requires an interaction between the patients and healthcare professionals.

    Aim: The aim was to explore how patients with COPD interact with primary care, and how they experience this interaction.

    Methods: The study was conducted in primary care in northern Sweden. Interviews were performed with patients with COPD (n=13) with varied disease severity, symptoms, sex and age, from four primary care centres. The interviews were analysed with grounded theory.

    Results: The analysis ended up in a process of becoming a more active patient with COPD, moving back and forth between different stages of interaction with primary care. The category building self-esteem with empowering support comprises factors that facilitated this process, such as having a positive spirit, experiences of availability, continuity and regular contacts in primary care, along with a good support where the patients felt respected.

    The simultaneous and conflicting category struggling with the stigma and threat of COPD captures factors inhibiting the process such as the patients’ fear of dyspnea and death, along with feelings of shame and guilt, the low status of COPD and disempowering support from primary care.

    Conclusions: The interaction with primary care could be seen as an ongoing, flexible empowering process for patients with COPD, affected by both inhibiting and facilitating factors. These results could help primary care to empower patients with COPD and facilitate their social process of becoming more active and in control of their disease by using the facilitating factors and decreasing the inhibiting factors.

  • 23.
    Nordvall Strömberg, Petronella
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Enhanced information regarding exercise training as treatment is needed. An interview study in patients with chronic obstructive pulmonary disease2015Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, nr 16, s. 1424-1430Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The purpose of this study is to describe thoughts and attitudes of patients with chronic obstructive pulmonary disease (COPD) when talking about exercise training as treatment.

    METHODS: Semi-structured interviews were performed and analyzed with the grounded theory method. Four men and six women were interviewed (ages 66-84 years), with moderate to severe COPD, and no experience of organized exercise training as treatment for COPD.

    RESULTS: The analysis resulted in one core category, unknown territory, and three categories, good for those who can, but not for me; fear of future; and mastering. Exercise training as treatment was perceived by the participants as something unknown. It was also described as important for others but not for them. Their perceptions were that they could not perform exercise training, and did not have the knowledge of what or how to perform exercise that was good for them.

    CONCLUSIONS: Patients with COPD, with no previous experience of exercise training as treatment for their disease, describe exercise training as something unknown and unimportant for them. The results provide important knowledge for healthcare professionals regarding how to educate patients with COPD about the content and benefits of exercise training as treatment. Implications for Rehabilitation Exercise training is effective for patients with chronic obstructive pulmonary disease (COPD) with regard to dyspnea, physical capacity, health-related quality of life, and health care use. Patients with COPD perceive a lack of information regarding exercise training as treatment. The information and the presentation of exercise training as treatment might be of importance to get better adherence to this treatment.

  • 24.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Hedlund, Mattias
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Kolberg, Albin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Alm, Lisa
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    The accuracy of using elastic resistance bands to evaluate muscular strength2014Inngår i: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, European Journal of Physiotherapy, Vol. 16, nr 2, s. 104-112Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Elastic resistance as a tool for evaluation of muscular strength has rarely been addressed even though it is commonly used in exercise and rehabilitation regimens involving the shoulder muscles. The aim was therefore to investigate the relationship and potential difference between development of force during maximal isokinetic (maximum peak force, maximum mean force and peak mean force) and elastic (one-repetition maximum (1 RM)) concentric shoulder fl exion in healthy older adults. A total of 30 voluntary adults over the age of 50 (15 women, 15 men) were included. Intraclass correlation coefficient absolute agreement was 0.85, 0.43 and 0.48 for the isokinetic values respectively, when all subjects were analysed together. No difference was found between the isokinetic maximum peak force value and the elastic 1 RM for all participants (0.15 kg, p 0.791), for men (0.80 kg, p 0.121) or women ( 0.49 kg, p 0.135). Variations at an individual level, i.e. 95% limits of agreement, were 3.3 kg for all participants, 2.8 kg for women and 3.2 kg for men. These results imply that elastic resistance could be used to evaluate shoulder fl exion strength in both older men and women. However, thevariation on an individual level and the lower agreement among women is important to consider.

  • 25.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Aronsson, Nils
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Näslund, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Validity of using elastic bands to measure knee extension strength in older adults2016Inngår i: Journal of Novel Physiotherapy and Physical Rehabilitation, ISSN 2455-5487, Vol. 3, nr 1, s. 16-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and objectives: Maximal strength assessment of knee extensors in older adults using elastic resistance bands have rarely been addressed even though resistance training using elastic bands have shown large effects on muscle strength in this group of people. We therefore aim to determine the validity of maximal knee extension strength assessment using elastic resistance bands in older women and men.

    Methods: Twenty-four participants (12 women and 12 men; 61.8 ± 6.0 years; 173.5 ± 10.2 cm; 71.9 ± 15.7 kg) were included. To assess maximal knee extension strength, participants performed one-repetition maximum testing of concentric knee extension using elastic resistance bands as well as a maximal concentric knee extension isokinetic test at 60°/s using a stationary isokinetic dynamometer. Concurrent validity of the two measurement techniques were assed using intraclass correlation coefficient (ICC2.1), Pearson correlations (R), concordance correlations (Rc) and by determining variations on an individual level using 95% limits of agreement (LoA) with isokinetic dynamometry measurement as the reference standard.

    Results: Validity analysis showed good to excellent agreement and relationships but wide 95% LoA between elastic one-repetition maximum and isokinetic peak torque for all participants (ICC = 0.88; R = 0.90; Rc = 0.85, LoA = 10.5 kg), for women (ICC = 0.67; R = 0.77; Rc = .62, LoA = 7.7 kg) and for men (ICC = 0.80; R = 0.85; Rc = 0.78, LoA = 13.1 kg), respectively.

    Conclusion: One-repetition maximum testing using elastic resistance bands provides valid measurements of maximal knee extension strength in older women and men but with wide variations on an individual level.

  • 26.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Rickenlund, Anette
    Institutionen för klinisk fysiologi, Karolinska universitetssjukhuset, Stockholm; Institutionen för molekylär medicin och kirurgi, Karolinska Institutet, Stockholm.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Low-load/high-repetition elastic band resistance training in patients with COPD: a randomized, controlled, multicenter trial2015Inngår i: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 9, nr 3, s. 278-288Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: High-repetitive resistance training is recommended to increase peripheral muscular endurance in healthy adults, however the effects of resistance training with this design on exercise capacity and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD) is unknown.

    Objective: Investigate if low load / high repetition elastic band resistance training (RT) could improve functional capacity, muscular function, endurance cycle capacity or HRQOL in patients with COPD.

    Methods: A prospective, randomized controlled multicentre trial was constructed with concealed allocation, blinded outcome assessment, and intention-to-treat analysis. A total of 44 patients with moderate to very severe COPD (FEV1 44.6% predicted) were included. Patients were randomized to either the experimental group receiving eight weeks of RT (3 sessions/week) in combination with patient education (four occasions) or the control group receiving the patient education alone.

    Results: At post-tests, the between-group differences were in favor of the experimental group on the 6 minute walk test (mean difference (95% confidence interval)): 34 meters (14 to 54) and the 6 minute pegboard and ring test (20 rings (3 to 37). No difference between groups was found on the chronic respiratory disease questionnaire (0.1 (-0.2 to 0.4). On secondary outcomes, results were in favor of the experimental group regarding upper extremity endurance capacity, muscular function and depression but no difference was seen between groups on endurance cycle capacity and HRQOL.

    Conclusion: RT can increase functional capacity and muscular function but not cycle endurance capacity and HRQOL in patients with moderate to severe COPD.

  • 27.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    A Cohort Study to Evaluate the Feasibility of Low Load/High Repetition Elastic Band Resistance Training for People with Chronic Obstructive Pulmonary Disease2014Inngår i: Journal of Novel Physiotherapies, ISSN 2165-7025, Vol. 4, artikkel-id 190Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Resistance training is an important component of pulmonary rehabilitation in people with Chronic Obstructive Pulmonary Disease (COPD). A vast majority or resistance training studies in COPD have focused on increasing muscular strength with use of weight machines and has been found to be a feasible approach in COPD. However, regarding feasibility of resistance training equipment other than weight machines, such as elastic resistance equipment, information is scarce. In addition, little is known regarding other trainable muscle characteristics, such as peripheral muscular endurance in COPD. We therefore aim to evaluate the feasibility of a low load/high repetition elastic band Resistance Training (RT) regimen in people with moderate to severe COPD. We also aim to evaluate if the RT regimen is feasible for the physiotherapists, conducting the intervention.

    Methods: Twenty-two participants with moderate to severe COPD (mean forced expiratory volume in one second, FEV1 58.7% predicted) and five physiotherapists participated in the study. Measurements of attendance, assessment and progression of exercise intensity, adverse events, participant and compliance (participant and physiotherapist) were collected for assessment of feasibility.

    Results: The mean (95% confidence interval) attendance rate was 94% (91-97) and mean exercise intensity was 79% (74-83) of the predicted maximum intensity. Furthermore, the median (interquartile range) compliance was 96% (94-96) and 100% (94-100) for the people with COPD and the physiotherapists respectively. Exercise intensity increased on all exercises and any recorded adverse events were considered minor and temporary.

    Conclusions: Low load/high repetition elastic band resistance training appears to be feasible for both people with COPD and the physiotherapists performing the intervention. These results indicate that elastic bands could be a feasible alternative to weight machines in resistance training for people with COPD.

  • 28.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Assessing the effect of high-repetitive single limb exercises (HRSLE) on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD): study protocol for randomized controlled trial2012Inngår i: TRIALS, ISSN 1745-6215, Vol. 13, s. 114-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Single-limb knee extension exercises have been found to be effective at improving lower extremity exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Since the positive local physiological effects of exercise training only occur in the engaged muscle(s), should upper extremity muscles also be included to determine the effect of single limb exercises in COPD patients. Methods/design: Trial design: a prospective, assessor-blind, block randomized controlled, parallel-group multicenter trial. Participants: stage II-IV COPD patients, > 40 years of age, ex-smokers, with stable medical treatment will be included starting May 2011. Recruitment at three locations in Sweden. Interventions: 1) high-repetitive single limb exercise (HRSLE) training with elastic bands, 60 minutes, three times/week for 8 weeks combined with four sessions of 60 minutes patient education, or 2) the same patient education alone. Outcomes: Primary: determine the effects of HRSLE on local muscle endurance capacity (measured as meters walked during 6-minute walk test and rings moved on 6-minute ring and pegboard test) and quality of life (measured as change on the Swedish version of the Chronic Respiratory Disease Questionnaire). Secondary: effects on maximal strength, muscular endurance, dyspnea, self-efficacy, anxiety and depression. The relationship between changes in health-related variables and changes in exercise capacity, sex-related differences in training effects, feasibility of the program, strategies to determine adequate starting resistance and provide accurate resistance for each involved movement and the relationship between muscle fatigue and dyspnea in the different exercise tests will also be analyzed. Randomization: performed by a person independent of the recruitment process and using a computer random number generator. Stratification by center and gender with a 1: 1 allocation to the intervention or control using random block sizes. Blinding: all outcome assessors will be blinded to group assignment. Discussion: The results of this project will contribute to increase the body of knowledge regarding COPD and HRSLE.

  • 29.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Tistad, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    An internet based tool to promote self-management in patients with COPD in primary care: a controlled pragmatic pilot trial with short- and long-term follow-upInngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Artikkel i tidsskrift (Fagfellevurdert)
  • 30.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Tistad, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. School of Education Health and Social studies, Dalarna University, Falun, Sweden.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up2019Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, nr 1, s. 69-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Evaluate the feasibility of the COPD Web and its study design and study procedures and to increase the understanding of the potential effect of the tool in order to provide guidance for a future large scale trial.

    Design: Parallel-group controlled pragmatic pilot trial.

    Subjects: There was a total of 83 patients with COPD (mean age 70 +/- 8 years with a forced expiratory volume in first second percent predicted of 60 +/- 17%). The intervention group (n = 43) was introduced to and had access to the COPD Web in addition to usual care, while the control group (n = 40) received usual care alone.

    Main outcome measures: The feasibility of the COPD Web (i.e., if and how the COPD Web was used) was automatically collected through the website, while outcomes on health, conceptual knowledge, and physical activity (PA) were collected through questionnaires at baseline, 3 months and 12 months.

    Results: At 3 months, 77% of the intervention group was considered users, and the majority of time spent on the site was related to PA and exercises and was spent during the first month (>80%). In addition, the intervention group reported increased PA (odds ratio [OR] = 4.4, P < .001), increased conceptual knowledge in five domains (OR = 2.6-4.2, all P < .05), and altered disease management strategies (e.g., increased PA) (OR >= 2.7 P < .05) in comparison to the control group. The latter was also different between groups at 12 months (OR = 3.7, P = .044). Knowledge of PA was correlated with level of PA (rho = .425-.512, P < .05) as well as to the use of PA as a strategy to manage their disease (chi(2) = 11.2-32.9, P < .05).

    Conclusion: Giving patients with COPD access to the COPD Web in addition to their ordinary primary care might be an effective shorter term (3 month) strategy to promote self-management. However, these results needs to be confirmed in a definitive large-scale trial.

  • 31.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Törnberg, Anna
    Department of Neurobiology, Care Sciences and Society, Karolinska Instiitutet, Stockholm, Sweden.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Correlation between limb muscle endurance, strength and functional capacity in people with chronic obstructive pulmonary disease2016Inngår i: Physiotherapy Canada, ISSN 0300-0508, E-ISSN 1708-8313, Vol. 68, nr 1, s. 46-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To examine the correlation between limb muscle function (endurance and strength) and functional capacity in upper limbs (ULs) and lower limbs (LLs) of people with chronic obstructive pulmonary disease (COPD). Method: This article describes a secondary analysis of data from a randomized controlled trial. A stationary dynamometer was used to measure isokinetic muscle strength and endurance; the 6-minute walk test, the 6-minute pegboard and ring test, and the unsupported UL exercise test were used to measure functional capacity. Results: Participants were 44 adults with COPD. Muscle strength and endurance in ULs and LLs demonstrated a moderate to strong correlation with functional capacity. When controlling for muscle strength, muscle endurance was moderately correlated with functional capacity in ULs and LLs, but when controlling for muscle endurance, there was no positive and significant correlation between muscle strength and functional capacity for the ULs or LLs. Conclusions: Functional capacity seems to be more closely related to limb muscle endurance than to limb muscle strength in people with COPD.

  • 32.
    Nyberg, André
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Evidence for single-limb exercises on exercise capacity, quality of life, and dyspnea in patients with chronic obstructive pulmonary disease or chronic heart failure2013Inngår i: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 18, nr 3, s. 157-172Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Although single-limb exercise (SLE) has been used for patients with chronic obstructive pulmonary disease (COPD) and for patients with chronic heart failure (CHF), the evidence for SLE has not been evaluated systematically and remains unclear.

    Objectives: Determine the evidence for the effect of SLE compared to any comparator on outcome measurements for exercise capacity, quality of life (QoL) or dyspnea in patients with COPD or CHF.

    Methods: PubMed, PEDro, and CENTRAL databases were searched from inception until 31 May 2011. Searches started 1 April 2011. English language randomized controlled trials (RCTs) were included. Extraction of data was performed by two review authors. Data and evidence for SLE were summarized in accordance with grading of recommendations assessment, development and evaluation (GRADE) guidelines. Authors of included studies were contacted for missing data.

    Results: Six RCTs (two COPD and four CHF) were included. Low to very low-quality evidence indicates that SLE significantly improved exercise capacity, but not dyspnea, in patients with COPD, and significantly improved exercise capacity outcomes compared to a control in patients with CHF. However, when SLE was compared to non-SLE regimes in patients with CHF, positive effects were found irrespective of training regime regarding exercise capacity and QoL.

    Conclusions: SLE appears to be effective in both conditions especially regarding exercise capacity, and might be included in exercise programs in patients with COPD or CHF. However, the evidence is low to very low according to GRADE and more clinical studies of high quality are required.

  • 33.
    Nyberg, André
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Tistad, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Internet-based support for self-management strategies for people with COPD-protocol for a controlled pragmatic pilot trial of effectiveness and a process evaluation in primary healthcare2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 7, artikkel-id e016851Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: The use of adequate self-management strategies for people with chronic obstructive pulmonary disease (COPD) reduces healthcare use, improves health-related quality of life (HRQoL) and recovery after acute exacerbations. However, not many people with COPD receive support that promotes the use of such strategies and therefore new methods to facilitate and promote the use of self-management strategies are highly warranted. This pilot trial aims to evaluate the feasibility of the study design and study procedures considering effectiveness of the novel intervention, the COPD-web.

    Methods and analysis: The overall design is a pragmatic controlled pilot trial with preassessments and postassessments and a parallel process evaluation. Patients with the diagnosis of COPD will be eligible for the study. The intervention group will be recruited when visiting one of the six participating primary care units in Sweden. The control group will be identified from the unit's computerised registers. The intervention, the COPD-web, is an interactive web page with two sections; one directed at people with COPD and one at healthcare professionals. The sections aim to support patients' self-management skills—and to facilitate the provision of support for self-management strategies, respectively. Effectiveness with regard to patients' symptoms, HRQoL, knowledge of and readiness for COPD-related self-management, health literacy, self-efficacy for physical activity and time spent in physical activity and time being sedentary, and further, healthcare professionals' knowledge of and readiness to support COPD-related self-management strategies will be assessed using questionnaires at 3 and 12 months. The process evaluation will include observations and interviews.

    Ethics and dissemination: Ethical approval has been obtained. Findings will be presented at conferences, submitted for publication in peer-reviewed publications and presented to the involved healthcare professionals, patients and to patient organisations.

    Trial registration number: ClinicalTrials.gov: NCT02696187

  • 34. Ora, Josuel
    et al.
    Laveneziana, Pierantonio
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Preston, Megan
    Webb, Katherine A
    O'Donnell, Denis E
    Effect of obesity on respiratory mechanics during rest and exercise in COPD2011Inngår i: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 111, nr 1, s. 10-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The presence of obesity in COPD appears not to be a disadvantage with respect to dyspnea and weight-supported cycle exercise performance. We hypothesized that one explanation for this might be that the volume-reducing effects of obesity convey mechanical and respiratory muscle function advantages. Twelve obese chronic obstructive pulmonary disease (COPD) (OB) [forced expiratory volume in 1 s (FEV(1)) = 60%predicted; body mass index (BMI) = 32 ± 1 kg/m(2); mean ± SD] and 12 age-matched, normal-weight COPD (NW) (FEV(1) = 59%predicted; BMI = 23 ± 2 kg/m(2)) subjects were compared at rest and during symptom-limited constant-work-rate exercise at 75% of their maximum. Measurements included pulmonary function tests, operating lung volumes, esophageal pressure, and gastric pressure. OB vs. NW had a reduced total lung capacity (109 vs. 124%predicted; P < 0.05) and resting end-expiratory lung volume (130 vs. 158%predicted; P < 0.05). At rest, there was no difference in respiratory muscle strength but OB had greater (P < 0.05) static recoil and intra-abdominal pressures than NW. Peak ventilation, oxygen consumption, and exercise endurance times were similar in OB and NW. Pulmonary resistance fell (P < 0.05) at the onset of exercise in OB but not in NW. Resting inspiratory capacity, dyspnea/ventilation plots, and the ratio of respiratory muscle effort to tidal volume displacement were similar, as was the dynamic performance of the respiratory muscles including the diaphragm. In conclusion, the lack of increase in dyspnea and exercise intolerance in OB vs. NW could not be attributed to improvement in respiratory muscle function. Potential contributory factors included alterations in the elastic properties of the lungs, raised intra-abdominal pressures, reduced lung hyperinflation, and preserved inspiratory capacity.

  • 35.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Engström, Karl Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dellborg, Mikael
    Thilén, Ulf
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Heart Centre, Umeå.
    The level of physical exercise is associated with self-reported health status (EQ-5D) in adults with congenital heart disease2015Inngår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, nr 2, s. 240-248Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The prognosis in adults with congenital aortic valve disease is usually favourable; nevertheless, a number of medical and social factors might hamper long-term prognosis and quality of life. With a focus on physical exercise level, data from the Swedish National Registry on Congenital Heart Disease (SWEDCON) were analysed and variables associated with health-related quality of life in adults with congenital aortic valve disease were identified.

    METHODS: In this registry study, SWEDCON was searched for adult patients with isolated congenital aortic valve disease and valid EuroQol-5Dimensions health questionnaire (EQ-5D) data.

    RESULTS: This study identified 315 patients. The majority (n = 202, 64%) reported best possible health status (EQ-5Dindex = 1) whereas 113 (35%) reported some impairment (EQ-5Dindex < 1) with mean EQ-5Dindex 0.73 ± 0.17. In a multivariate logistic regression model, self-reported physical exercise > 3 h/week was independently associated with best possible health status (EQ-5Dindex = 1; p = 0.013). Moreover presence of cardiovascular symptoms (p < 0.001), active smoking (p = 0.002), history of valve surgery (p = 0.017), low educational level (p = 0.022), and higher systolic blood pressure (p = 0.029) were independently associated with impaired health status (EQ-5Dindex < 1).

    CONCLUSIONS: Physical exercise >3 h/week was, as a single variable, associated with best possible health status in adults with congenital aortic valve disease. In contrast, a number of medical and social factors are associated with worse self-reported health status. Among these, symptoms, smoking, and educational level are potential targets for modification and intervention. There is a need for studies investigating the effect of increased level of physical exercise in patients with congenital aortic valve disease.

  • 36.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hedström, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Dellborg, M.
    Magnusson, A.
    Zetterstöm, A. -K
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Increased endurance capacity in adults with complex congenital heart disease after home-based interval exercise training on ergometer cycle2015Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, s. 458-458Artikkel i tidsskrift (Annet vitenskapelig)
  • 37.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Hedström, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Dellborg, Mikael
    Ahnfelt, Anders
    Zetterström, Anna-Klara
    Öhrn, Amanda
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Home‐based interval training increases endurance capacity in adults with complex congenital heart disease2018Inngår i: Congenital Heart Disease, ISSN 1747-079X, E-ISSN 1747-0803, Vol. 13, nr 2, s. 254-262Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The beneficial effects of exercise training in acquired heart failure and coronary artery disease are well known and have been implemented in current treatment guidelines. Knowledge on appropriate exercise training regimes for adults with congenital heart disease is limited, thus further studies are needed. The aim of this study was to examine the effect of home‐based interval exercise training on maximal endurance capacity and peak exercise capacity.

    Design: Randomized controlled trial.

    Methods: Twenty‐six adults with complex congenital heart disease were recruited from specialized units for adult congenital heart disease. Patients were randomized to either an intervention group—12 weeks of home‐based interval exercise training on a cycle ergometer (n = 16), or a control group (n = 10). The latter was instructed to maintain their habitual physical activities. An incremental cardiopulmonary exercise test and a constant work rate cardiopulmonary exercise test at 75% of peak workload were performed preintervention and postintervention.

    Results: Twenty‐three patients completed the protocol and were followed (intervention n = 13, control n = 10). Postintervention exercise time at constant work rate cardiopulmonary exercise test increased in the intervention group compared to controls (median[range] 12[–4 to 52]min vs 0[–4 to 5]min, P = .001). At incremental cardiopulmonary exercise test, peak VO2 increased 15% within the intervention group (P = .019) compared to 2% within the control group (P = .8). However, in comparison between the groups no difference was found (285[–200 to 535] ml/min vs 17[–380 to 306] ml/min, P = .10). In addition, peak workload at incremental cardiopulmonary exercise test increased in the intervention group compared to controls (20[–10 to 70]W vs 0[–20 to 15]W, P = .003).

    Conclusion: Home‐based interval exercise training increased endurance capacity and peak exercise capacity in adults with complex congenital heart disease. Aerobic endurance might be more relevant than peak oxygen uptake with regard to daily activities, and therefore a more clinically relevant measure to evaluate.

  • 38.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Rinnström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Dellborg, Mikael
    Thilén, Ulf
    Sörensson, Peder
    Nielsen, Niels-Erik
    Christersson, Christina
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Height, weight and body mass index in adults with congenital heart disease2015Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 187, s. 219-226Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: High BMI is a risk factor for cardiovascular disease and, in contrast, low BMI is associated with worse prognosis in heart failure. The knowledge on BMI and the distribution in different BMI-classes in adults with congenital heart disease (CHD) are limited. Methods and results: Data on 2424 adult patients was extracted from the Swedish Registry on Congenital Heart Disease and compared to a reference population (n = 4605). The prevalence of overweight/obesity (BMI >= 25) was lower in men with variants of the Fontan procedure, pulmonary atresia (PA)/double outlet right ventricle (DORV) and aortic valve disease (AVD) (Fontan 22.0% and PA/DORV 15.1% vs. 43.0%, p = 0.048 and p < 0.001) (AVD 37.5% vs. 49.3%, p < 0.001). Overt obesity (BMI >= 30) was only more common in women with AVD (12.8% vs. 9.0%, p = 0.005). Underweight (BMI < 18.5) was generally more common in men with CHD (complex lesions 4.9% vs. 0.9%, p < 0.001 and simple lesions 3.2% vs. 0.6%, <0.001). Men with complex lesions were shorter than controls in contrast to females that in general did not differ from controls. Conclusion: Higher prevalence of underweight in men with CHD combined with a lower prevalence of over-weight/obesity in men with some complex lesions indicates that men with CHD in general has lower BMI compared to controls. In women, only limited differences between those with CHD and the controls were found. The complexity of the CHD had larger impact on height in men. The cause of these gender differences as well as possible significance for prognosis is unknown.

  • 39.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Thilen, U.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Engström, Karl-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Complex adult congenital heart disease is associated with impaired skeletal muscle function2013Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, nr Supplement: 1, s. 383-383Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Complex congenital heart disease is often associatedwith impaired physical functioning, usually measured as peak oxygen uptake in an exercise test. Skeletal muscle function is, however, less studied in these patients.

    Methods: Unilateral isotonic shoulder flexion was tested in 79 adultpatients (mean age 36.6±14.8 years, 31 females) with congenital heartdisease, classed as either "complex" (n=41, 51.9%) or "simple" (n=38, 48.1%). The patients were sitting comfortably in a chair with their back touching the wall and holding a weight (2 kg for women and 3 kg for men) in the hand of the tested side. The patients were asked to elevate the arm, from 0 to 90 degrees flexion, as many times as possible. The pace of 20 contractions per minute was held using a metronome.

    Results: Patients with complex lesions performed less shoulder flexions compared with patients with simple lesions (29.2±10.0 vs. 54.6±25.8, p<0.001). In univariate analysis including a number of demographic and clinical variables, only complexity of cardiac lesion (p<0.001) and on-going cardiac medications (p=0.012) were associated with shouldermuscle function, of which complexity (p<0.001) remained significant in multivariate analysis.

    Conclusion: There is a marked difference in shoulder muscle functionbetween patients with complex and simple congenital heart disease. Such differences might affect ability to perform daily activities and contribute to impaired overall physical functioning. Rehabilitation targeting muscle function may be indicated in patients with complexcongenital heart disease.

  • 40.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Thilen, U.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Gradmark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Adults with congenital heart disease have lower habitual physical activity level compared to healthy age and gender matched controls2014Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, nr Supplement 1, Meeting abstract P1352, s. 237-237Artikkel i tidsskrift (Annet vitenskapelig)
  • 41.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Thilen, U.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Adults with complex congenital heart disease have impaired skeletal muscle function and lower confidence in performing exercise training compared to healthy age and gender matched controls2014Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, nr Supplement 1, Meeting abstract P3279, s. 579-579Artikkel i tidsskrift (Annet vitenskapelig)
  • 42.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Thilén, Ulf
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Adults with complex congenital heart disease have impaired skeletal muscle function and reduced confidence in performing exercise training2015Inngår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, nr 12, s. 1523-1530Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Adults with congenital heart disease (ACHD) usually have reduced aerobic exercise capacity compared with controls. However, their skeletal muscle function is less studied. Material and methods In this cross-sectional study, unilateral isotonic shoulder flexion, unilateral isotonic heel-lift, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were tested in 85 patients with ACHD (35 women, mean age 36.814.8 years), classed as either complex' (n=43) or simple' (n=42), and 42 age and gender matched controls (16 women, mean age 36.914.9). Maximum number of shoulder flexions and heel-lifts were measured. MIP/MEP was tested using a handheld respiratory pressure meter. Exercise self-efficacy, measuring confidence in performing exercise training, was evaluated. Results Adults with complex lesions performed fewer shoulder flexions compared with controls and patients with simple lesions (28.2 +/- 11.1 vs. 63.6 +/- 40.4, p<0.001 and 28.2 +/- 11.1 vs. 54.9 +/- 24.9, p<0.001), as well as fewer heel-lifts compared with controls and patients with simple lesions (17.6 +/- 7.7 vs. 26.3 +/- 12.8, p<0.001 and 17.6 +/- 7.7 vs. 23.2 +/- 7.0, p=0.024), lower MIP than controls (80.7 +/- 26.7 vs. 111.1 +/- 29.9cm H2O, p<0.001) and lower MEP compared with controls (110.8 +/- 39.9 vs. 141.8 +/- 39.5, p<0.001). Their exercise self-efficacy was lower than controls (28.0 +/- 8.3 vs. 33.4 +/- 6.1, p=0.002). In a linear regression model complex heart lesions were independently associated with impaired limb muscle function. Conclusion Adults with complex congenital heart disease have impaired skeletal muscle function compared with patients with simple lesions and healthy controls. They also had lower confidence in performing exercise training. Thus, this population might have a potential for rehabilitation focusing on improving muscle function and confidence in performing exercise training.

  • 43.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Gradmark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Thilen, U.
    Engström, Karl-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Physical activity level in adults with congenital heart disease: effects of gender and complexity of heart lesion2013Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, nr Supplement: 1, s. 382-383Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Many adults with congenital heart disease have reduced exercise capacity but only little is known about habitual physical activityin this group. The aim of this study was to investigate habitual physicalactivity level in a cohort of adults with congenital heart disease.

    Methods: Seventy-five adult patients (29 females) aged 37.2±15.1 yearswith congenital heart disease classed as either simple or complex were studied with a combined accelerometer and heart rate monitor (Actiheart). The patients carried the Actiheart during 5 consecutive days, and where encouraged to proceed with their usual daily activities. Data was analysed with the Actiheart Software version 2.2. A mean ofPhysical Activity Level (PAL) (PAL=Total Energy Expenditure/Resting Energy Expenditure) over 4 days was calculated. PAL < 1.45 was categorised as low, 1.45-1.6 as moderate and >1.6 as high.

    Results: Forty-three patients (57,3%) had low PAL, 18 (24%) moderate PAL and 14 (16,7%) high PAL. PAL was lower in women compared to men (1.32±0.10 vs. 1.52±0.18, p < 0.001). PAL was higher in patients withsimple compared with complex congenital heart disease (1.50±0.21 vs. 1.39±0.14, p = 0.019). Among men, active smoking (p=0.015) and lower age (p=0.04) were independently associated with higher PAL, whereas no such associations were observed among women.

    Conclusion: The majority of the observed patients had low PAL and women had lower PAL compared to men. PAL was related to complexity ofheart lesion. Efforts to increase habitual physical activity may beindicated in this population, especially in women and patients withcomplex congenital heart disease.

  • 44.
    Sehlin, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Brändström, Helge
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Winsö, Ola
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Haney, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Simulated flying altitude and performance of continuous positive airway pressure devices2014Inngår i: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 85, nr 11, s. 1092-1099Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Continuous positive airway pressure (CPAP) is used in air ambulances to treat patients with impaired oxygenation. Differences in mechanical principles between CPAP devices may affect their performance at different ambient air pressures as will occur in an air ambulance during flight. METHODS: Two different CPAP systems, a threshold resistor device and a flow resistor device, at settings 5 and 10 cm H2O were examined. Static pressure, static airflow and pressure during simulated breathing were measured at ground level and at three different altitudes (2400 m (8 kft), 3000 m (10 kft) and 10700 m (35 kft)). RESULTS: When altitude increased, the performance of the two CPAP systems differed during both static and simulated breathing pressure measurements. With the threshold resistor CPAP, measured pressure levels were close to the preset CPAP level. Static pressure decreased 0.71 ± 0.35 cm H2O, at CPAP 10 cm H2O, comparing ground level and 35 kft. With the flow resistor CPAP, as the altitude increased CPAP produced pressure levels increased. At 35 kft, the increase was 5.13 ± 0.33 cm H2O at CPAP 10 cm H2O. DISCUSSION: The velocity of airflow through the flow resistor CPAP device is strongly influenced by reduced ambient air pressure leading to a higher delivered CPAP effect than the preset CPAP level. Threshold resistor CPAP devices seem to have robust performance regardless of altitude. Thus, the threshold resistor CPAP device is probably more appropriate for CPAP treatment in an air ambulance cabin, where ambient pressure will vary during patient transport.

  • 45.
    Sehlin, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Winsö, Ola
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Immediate effects of positive expiratory pressure and continuous positive airway pressure breathing on changes in inspiratory capacity as an indirect measure of induced changes in functional residual capacity in healthy individualsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Introduction: Positive expiratory pressure (PEP) and continuous positive airway pressure (CPAP) are used to enhance breathing parameters such as functional residual capacity (FRC) in patients. Studies comparing effects of PEP and CPAP on FRC are sparse. One reason for this may be that sophisticated equipment, not suitable in the clinical setting, is required. Total lung capacity consists of inspiratory capacity (IC) and FRC and a change in IC should therefore result in a corresponding change in FRC. We aimed to investigate if PEP and CPAP induced changes in IC could be used as an indirect measure of changes in FRC and also to evaluate immediate effects of PEP and CPAP devices, with different kinds of resistors, on IC. 

    Methods: 20 healthy volunteers breathed with two PEP devices, a PEP-mask (flow resistor) and a PEP-bottle (threshold resistor) and two CPAP devices, a flow resistor device and a threshold resistor device, in a randomized order. The measurement sequence consisted of 30 breaths with an IC measurement performed before and immediately after the 30th breath, while the participants were still connected to the respective breathing device. Perceived exertion of the respective 30 breaths was measured with Borg CR10 scale.

    Results: Three of the four breathing devices, the PEP-mask and the two CPAP devices, significantly decreased IC (p < 0.001). Median perceived exertion was quite low for all four breathing devices but the difference in perceived exertion within the different breathing devices was large.

    Conclusion: When measured in direct continuation of PEP and CPAP breathing, changes in IC could be used as an indirect measure of changes in FRC. All investigated breathing devices except the PEP-bottle decreased IC, i.e. increased FRC.

  • 46.
    Sehlin, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Winsö, Ola
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Inspiratory Capacity as an Indirect Measure of Immediate Effects of Positive Expiratory Pressure and CPAP Breathing on Functional Residual Capacity in Healthy Subjects2015Inngår i: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 60, nr 10, s. 1486-1494Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Positive expiratory pressure (PEP) and CPAP are used to enhance breathing parameters such as functional residual capacity (FRC) in patients. Studies comparing effects of PEP and CPAP on FRC are few and variable. One reason for this may be that sophisticated equipment, not suitable in the clinical setting, is required. Because total lung capacity (TLC) consists of inspiratory capacity (IC) and FRC, a change in IC should result in a corresponding change in FRC given constant TLC. We aimed to evaluate the effects of different PEP and CPAP devices on IC as an indirect measure of induced changes in FRC from these devices in healthy subjects. METHODS: Twenty healthy subjects breathed with 2 PEP devices, a PEP mask (flow resistor) and a PEP bottle (threshold resistor), and 2 CPAP devices, a flow resistor and a threshold resistor, in a randomized order. The measurement sequence consisted of 30 breaths with an IC measurement performed before and immediately after the 30th breath while the subjects were still connected to the breathing device. Perceived exertion of the 30 breaths was measured with the Borg category ratio 10 scale. RESULTS: Three of the 4 breathing devices, the PEP mask and the 2 CPAP devices, significantly decreased IC (P <.001). Median perceived exertion was quite low for all 4 breathing devices, but the difference in perceived exertion among the different breathing devices was large. CONCLUSIONS: Provided that TLC is constant, we found that measurements of changes in IC could be used as an indirect measure of changes in FRC in healthy subjects. All investigated breathing devices except the PEP bottle decreased IC, as an indirect measure of increased FRC.

  • 47.
    Stenlund, Tobias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Nyberg, Andre
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundell, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Web-based support for self-management strategies versus usual care for people with COPD in primary healthcare: a protocol for a randomised, 12-month, parallel-group pragmatic trial2019Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 10, artikkel-id e030788Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: The use of adequate self-management strategies for people with chronic obstructive pulmonary disease (COPD) may increase the level of physical activity (PA), improve health-related quality of life (HRQoL) and reduce healthcare use. Whether web-based support in addition to prompts (email and SMS) could be used to promote self-management strategies to facilitate behaviour change in people with COPD is not clear. This clinical trial aims to generate evidence on the effect of a web-based solution, the COPD Web, in a cohort of people with COPD in a primary healthcare context.

    METHODS AND ANALYSIS: The overall design is a pragmatic randomised controlled trial with preassessments and postassessments (3 and 12 months) and an implementation and user experience evaluation. People with a diagnosis of COPD, treated in primary healthcare will be eligible for the study. A total of 144 participants will be enrolled by healthcare professionals at included primary healthcare units and, after fulfilled baseline assessments, randomised to either control or intervention group. All participants will receive usual care, a pedometer and a leaflet about the importance of PA. Participants in the intervention will, in addition, get access to the COPD Web, an interactive self-managed website that aims to support people with COPD in self-management strategies. They will also continuously get support from prompts with a focus on behaviour change.The effect on participants' PA, dyspnoea, COPD-related symptoms, HRQoL and health economics will be assessed using accelerometer and questionnaires. To identify enablers and barriers for the use of web-based support to change behaviour, semistructured interviews will be conducted in a subgroup of participants at the 3 months follow-up.

    ETHICS AND DISSEMINATION: Ethical approval has been received from the Regional Ethical Review Board in Umeå, Sweden. Dnr 2018-274-31. Findings will be presented at conferences, submitted for publication in peer-reviewed journals and presented to the involved healthcare professionals, participants and patient organisations.

    TRIAL REGISTRATION NUMBER: NCT03746873.

  • 48.
    Tistad, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. School of Education, Health and Social Studies, Dalarna University, Falun.
    Lundell, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Nyberg, Andre
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Usefulness and relevance of an eHealth Tool in supporting the self-management of chronic obstructive pulmonary disease: explorative qualitative study of a cocreative process2018Inngår i: JMIR Human Factors, E-ISSN 2292-9495, Vol. 5, nr 4, artikkel-id e10801Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives.

    Objective: The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers.

    Methods: Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis.

    Results: The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge.

    Conclusions: The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases.

  • 49.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Rehabilitering vid lungsjukdom2015Inngår i: Lungmedicin / [ed] Thomas Sandström, Anders Eklund, Lund: Studentlitteratur AB, 2015, 2, s. 485-489Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 50.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Water-based exercise is more effective than land-based exercise for people with COPD and physical comorbidities2014Inngår i: Journal of Physiotherapy, ISSN 1836-9553, E-ISSN 1836-9561, Vol. 60, nr 1, s. 57-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Question: In patients with chronic obstructive pulmonary disease (COPD) who have physical comorbidities, is water-based exercise more effective than land-based exercise for improving exercise capacity and health-related quality of life (HRQoL)? Design: Randomised controlled trial with concealed allocation and blinding of outcome assessors. Setting: The outpatient department or hydrotherapy pool of a hospital in Sydney, Australia. Participants: Adults with stable COPD were included if they had at least one physical comorbid condition that was likely to compromise their capacity to participate in land-based exercise (eg, musculoskeletal conditions, peripheral vascular disease, neurological conditions or body mass index ≥32 kg/m2). Exclusion criteria were unstable cardiac disease or a contraindication to water-based exercise, such as open wounds or incontinence. Randomisation allocated 18 participants to the water-based exercise (WBE) group, 20 to the land-based exercise (LBE) group and 15 to the control group. Interventions: Both WBE and LBE required participants to attend three 60-minute sessions each week, for 8 weeks. The WBE group and LBE group were matched as closely as possible in terms of intensity and the muscle groups exercised. Intensity was titrated to achieve moderate dyspnoea. Those in the control group continued with usual medical care. Outcome measures: The primary outcome was exercise capacity measured using the endurance shuttle walk test (ESWT) at 8 weeks. Results: A total of 45 participants completed the study. On completion of the training period, compared with the control group, greater gains were seen in the distance walked during the ESWT in the WBE group (309 m, 95% CI, 96 to 522 m) but not in the LBE group (81 m, 95% CI, −136 m to 297 m). The gains seen in the WBE group were also greater than those seen on the LBE group (228 m, 95% CI, 19 to 438 m). Similar results were demonstrated for the distance achieved during the incremental shuttle walk test and the fatigue domain of the Chronic Respiratory Disease Questionnaire (ie, a domain of HRQoL). Conclusion: In people with COPD and physical comorbidities, WBE appears to confer greater gains in exercise capacity and fatigue, when compared with LBE

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