INTRODUCTION

1. A randomized controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome Lau HM; Ng GY; Jones AY; Lee EW; Siu EH; Hui DS. A randomized controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome. Australian Journal of Physiotherapy. 2005; 51: 213-219. METHODS AND MATERIALS ABSTRACT INTRODUCTION Clinical Significant Article #1 • Morris PE; Goad A; Thompson C; et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008; 36: 1-8. • 330 patients admitted to the MICU with acute respiratory failure • Half the patients received physical therapy within 48 hrs of admission to the MICU • Patients receiving exercise were out of bed earlier and had a shorter LOS in the MICU • Patients also had a higher compliance rate to physical therapy after discharge from the MICU • Early exercise decreased the LOS and days spent in bed for acute respiratory failure patients • A global outbreak of SARS in March 2003 • Following discharge many patients still experienced troubles with ADL’s, and complained of hand tremors and dyspnea on exertion • Previous study done by authors showed patients have decreased 6-min walk test distance and below average performance in curl-up and push-up tests • Key component in rehab program to restore patients physical fitness and independence is exercise training • Physical fitness – the ability to perform occupational, recreational and daily activities without undue fatigue • Dependent on functional status of the respiratory, cardiovascular and musculoskeletal systems • Health related QOL is also important to investigate • Purpose – to investigate the effects of a 6 week physical rehab program on the post-discharge SARS patients in improving their physical fitness and health related QOL • Patients: • After the exclusion criteria, 133 patients were found to be eligible for this study • Baseline measurements were taken at least 2 weeks after discharge from hospital • Patients were randomly assigned to the control or experiment groups using a computer generated minimization • Control group received a standardized educational session from the physiotherapist • Exercise group received the same session as well as a six week supervised exercise training program, with 4-5 sessions per week for 1-1.5 hours • During sessions patients performed 30-45 mins of aerobic exercise and 3 sets of 10-15 repetitions for each large muscle group of upper and lower limbs • Outcome Measures: • Cardiorespiratory fitness – assessed by the 6-minute walk test and the Chester Step test • Musculoskeletal fitness – assessed by a digital handheld dynamometer (ant. Deltoid and Gluteus Maximus) and a hydraulic grip dynamometer (distal muscle strength), One minute curl-up and push-up tests were used to evaluate endurance of abdominal and upper limb • Health-related QOL – assessed using the SF-36, consists of 36 questions divided into eight subscales/health concepts • Physical therapists focus on improving the QOL in patients who have respiratory diseases • When treating SARS patients the focus should be on regaining their cardiovascular and musculoskeletal fitness • Patients recovering from SARS will improve their fitness levels faster when enrolled in a six week exercise program with supervision • They will improve in cardiovascular and musculoskeletal fitness, but not in health related QOL The aim of this study was to evaluate the effectiveness of an exercise training program on cardiorespiratory and musculoskeletal performance and health-related quality of life of patients who were recovering from severe acute respiratory syndrome (SARS). A 6-week supervised exercise training program was carried out in the physiotherapy department of a university teaching hospital. One hundred and thirty-three patients referred from a SARS Review Clinic solely for physiotherapy were included. Cardiorespiratory fitness (6-minute walk test, Chester Step Test for predicting VO[2max]), musculoskeletal performance (isometric deltoid and gluteal muscles strength, handgrip strength, 1-minute curl-up and push-up tests) and health-related quality of life (SF-36) were measured and evaluated. Patients were assigned randomly to either a control group (standardized educational session about exercise rehabilitation) or an exercise group. After 6 weeks, significantly greater improvement was shown in the exercise group in the 6-minute walk test (77.4 m vs 20.7 m, p < 0.001), VO[2max] (3.6 ml/kg/min vs 1 ml/kg/min, p = 0.04), and musculoskeletal performance (handgrip strength, curl-up and push-up tests, p < 0.05). Effects on health-related quality of life were not statistically significant. It was concluded that the exercise training program was effective in improving both the cardiorespiratory and musculoskeletal fitness in patients recovering from SARS. However, health-related quality of life was not affected by physical training. Article #2 • Burtin C; Clerckx B; Robbeets C; et al. Early exercise in critically ill patients enhances short-term function recovery. Crit Care Med. 2009; 37: 1-7. • 90 critically ill patients were included as soon as their cardio respiratory condition allowed bedside cycling • Both groups received respiratory therapy and P/AROM of upper and lower limbs, the treatment group also performed 20 mins/day of exercise using a bedside ergometer • At hospital discharge, 6-min walk test, isometric quad force and feeling of well being were significantly higher in the exercise group • Early exercise in critically ill patients enhances recovery of functional exercise capacity RESULTS DISCUSSION CONCLUSIONS We have shown that a 6-week intensive physical training program, supervised by a group of physiotherapists, was effective in improving both the cardiorespiratory and musculoskeletal performance in patients recovering from SARS. Nevertheless, physical training during the intervention period had no impact on health-related QOL. Further controlled study is needed to evaluate the long-term effects of the current training program among SARS survivors. • This study has showed that a 6 week exercise training program for SARS survivors could lead to a greater improvement in both cardiovascular and musculoskeletal performances • A possible explanation for the differences in groups might be that supervision and reinforcement given by the physiotherapists during the training sessions facilitated the progression of the patients in the exercise group • Both the groups performed better then patients with COPD in the 6-minute walk test which showed that recovery of SARS patients was better then that of COPD patients • Both groups also had a higher VO2 max when compared to patients with COPD and ARDS, showing that aerobic capacity of SARS patients was more responsive to exercise then COPD and ARDS patients • The exercise group had similar results in the 6-minute walk test and VO2 max when compared to healthy individuals showing that post-SARS patients could recover their cardiovascular fitness and exercise tolerance with a 6 week training program • Muscular performance of the exercise group was significantly improved in both the proximal and distal muscle groups, males had increased strength when compared to the females • Their was no significant change in the SF-36 when comparing groups, however certain domains seemed to be affected by difference factors • 100% of the patients that started the study finished it, with an 85% attendance rate • Significant difference were found in 6-min walk distance, VO2 Max, handgrip strength, and the curl-up and push-up tests between groups • There was no significant difference found in the isometric strength and any domain of the SF-36 between group • Age, patients who had resumed work, and patients who had a longer post-SARS duration had significant difference in the health-related QOL, physical functioning and left handgrip strength, respectively. Summary • In patients with SARS and other respiratory diseases implementation of early exercise is beneficial in recovery of the cardiovascular and musculoskeletal systems • Patients who received exercise recovered faster and spent less time in the hospital then those who did not receive exercise treatment • They also recovered back to the cardiovascular levels of a healthy person faster than those who did not receive exercise CONTACT Jackie Muenchow, SPT Bellarmine University Physical Therapy, Louisville KY