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- Effect of Preoperative Home-Based Exercise Training on Quality of Life After Lung Cancer Surgery: A Multicenter Randomized Controlled TrialPublication . Machado, Pedro; Pimenta, Sara; Garcia, Ana Luís; Nogueira, Tiago; Silva, Sónia; Santos, Cláudia Lares dos; Martins, Maria Vitória; Canha, André; Oliveiros, Bárbara; Martins, Raul A.; Cruz, JoanaBackground. Preoperative exercise training is recommended for improvement of clinical outcomes after lung cancer (LC) surgery. However, its efectiveness in preventing postoperative decline in quality of life (QoL) remains unknown. This study investigated the efect of preoperative home-based exercise training (PHET) on QoL after LC surgery. Methods. Patients awaiting LC resection were randomized to PHET or a control group (CG). The PHET program combined aerobic and resistance exercise, with weekly telephone supervision. Primary outcome was QoL-assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQC30) at baseline, before surgery, and 1 month after surgery. The secondary outcomes were hospital length of stay and physical performance. The main analysis included a factorial repeated-measures analysis of variance. Additionally, the proportion of patients experiencing clinical deterioration from baseline to post-surgery was assessed. Results. The study included 41 patients (68.1±9.3 years; 68.3% male) in the intention-to-treat analysis (20 PHET patients, 21 CG patients). A signifcant group × time interaction was observed for global QoL (p =0.004). Betweengroup diferences in global QoL were statistically and clinically signifcant before surgery (mean diference [MD], 13.5 points; 95% confdence interval [CI], 2.4–24.6; p =0.019) and after surgery (MD, 12.4 points; 95% CI, 1.3–23.4; p=0.029), favoring PHET. Clinical deterioration of global QoL was reported by 71.4% of the CG patients compared with 30 % of the PHET patients (p =0.003). Between-group diferences in favor of PHET were found in pain and appetite loss as well as in physical, emotional and role functions after surgery (p <0.05). Compared with CG, PHET was superior in improving preoperative fve-times sit-to-stand and postoperative exercise capacity (p <0.05). No between-group diferences in other secondary outcomes were observed. Conclusion. The study showed that PHET can efectively prevent the decline in QoL after LC surgery.
- Role of digital health in pulmonary rehabilitation and beyond – shaping the futurePublication . Pimenta, Sara; Hansen, Henrik; Demeyer, Heleen; Slevin, Patrick; Cruz, JoanaPulmonary rehabilitation (PR) is a cost-effective intervention with well-known benefits on exercise capacity, symptoms and quality of life in patients with chronic respiratory diseases. Despite the compelling evidence of its benefits, PR implementation is still suboptimal, and maintenance of PR benefits is challenging. To overcome these pitfalls, there has been a growing interest to develop novel models for PR delivery. Digital health is a promising solution, as it has the potential to address some of the most reported barriers to PR uptake and adherence (such as accessibility issues), help maintain the positive results following a PR programme, and/or promote patients’ adherence to a more active lifestyle through physical activity (tele-)coaching. Despite the accelerated use of digital health to deliver PR during the COVID-19 pandemic, there are still several factors that contribute to the resistance in the adoption of digital health, such as the lack of evidence on its effectiveness, low acceptability by patients and healthcare professionals, concerns about implementation and maintenance costs, inequalities in access to the internet and technological devices, and data protection issues. Nevertheless, the trend towards reducing technology costs and the higher availability of digital devices, as well as the greater ease and simplicity of use of devices, enhance the opportunities for future development of digitally enabled PR interventions. This narrative review aimed to examine the current evidence on the role of digital health in the context of PR, including strengths and weaknesses, and to determine possible threats and opportunities, as well as areas for future work.
- What Motivates Patients with COPD to Be Physically Active? A Cross-Sectional StudyPublication . Pimenta, Sara; Silva, Cândida; Flora, Sofia; Hipólito, Nádia; Burtin, Chris; Oliveira, Ana; Morais, Nuno; Brites-Pereira, Marcelo; Carreira, Bruno P.; Januário, Filipa; Andrade, Lilia; Martins, Vitória; Rodrigues, Fátima; Brooks, Dina; Marques, Alda; Cruz, JoanaMotivation can be broadly defined as what moves people to act. Low motivation is a frequently reported factor for the reduced physical activity (PA) levels observed in patients with chronic obstructive pulmonary disease (COPD). This study assessed patients’ motives to be physically active, according to three pulmonary rehabilitation (PR) participation groups (Never PR, Previous PR and Current PR) and explored whether these motives were related to the PA levels and clinical characteristics. The motives to be physically active were assessed with the Exercise Motivation Inventory-2 (EMI-2, 14 motivational factors, five dimensions) and PA with accelerometry (PA groups: <5000 steps/day vs. ≥5000 steps/day). The clinical variables included symptoms, impact of the disease, exercise capacity and comorbidities. Ninety-two patients (67.4 ± 8.1 years, 82.6% male, forced expiratory volume in 1s (FEV1) 48.3 ± 18.9% predicted; 30.4% Never PR, 51% Previous PR and 18.5% Current PR) participated. The motivational dimensions related to health/fitness presented the highest scores (3.8 ± 1.1; 3.4 ± 1.3). The motives to be active were not significantly different between PA groups (p > 0.05) but having less symptoms and ≥two comorbidities were associated with higher scores in psychological/health and body-related motives, respectively (p < 0.05). The findings may encourage health professionals to actively explore with patients their motives to be physically active to individualise PA promotion.
- ASO Visual Abstract: Effect of Preoperative Home-Based Exercise Training on Quality of Life After Lung Cancer Surgery: A Multicenter Randomized Controlled TrialPublication . Machado, Pedro; Pimenta, Sara; Garcia, Ana Luís; Nogueira, Tiago; Silva, Sónia; Santos, Claúdia Lares dos; Martins, Maria Vitória; Canha, André; Oliveiros, Bárbara; Martins, Raul A.; Cruz, Joana