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BackgroundCompared to age-matched healthy individuals, people with post-COVID syndrome exhibit profoundly reduced exercise tolerance, secondary to reduced aerobic capacity.AimsTo determine whether reduced aerobic capacity in previously hospitalised COVID-19 survivors is due to the diminished central cardiovascular output and/or due to the reduced capacity of the peripheral muscles to extract oxygen from the circulation during exercise.MethodsTwelve previously hospitalised COVID-19 survivors (mean age: 54±9 yrs) and seven age-matched healthy controls (58±11 yrs) underwent two exercise testing laboratory visits. First, an incremental cycling test to their maximum tolerable workload to determine peak work rate (PWR). On a subsequent visit, participants undertook a single bout of constant-load exercise (CLE) sustained at a load corresponding to 80% of each participant’s PWR. The CLE test was preceded by 3 minutes of unloaded pedalling to warm up. Cardiac output (CO), heart rate, stroke volume (assessed by impedance cardiography), oxygen uptake (VO2), and other respiratory parameters, including indices of ventilatory efficiency (VE/VO2 and VE/VCO2), were monitored throughout exercise. Arteriovenous oxygen content difference (a-vO2), which reflects how much oxygen is extracted from the blood by the muscles during exercise, was calculated by rearranging the Fick equation where VO2 = CO x (a-vO2).ResultsTwo-way ANOVA with repeated measures showed that compared to healthy individuals, COVID-19 survivors exhibited lower (p=0.035) VO2 during CLE (figure 1). Whilst CO was greater (p=0.001) in COVID-19 survivors compared to healthy controls, a-VO2 was lower (p=0.01) during exercise in COVID-19 survivors compared to healthy participants (figure 1). Ventilatory efficiency indices were not different between groups.Abstract S29 Figure 1Data points (mean ±SEM) are shown for unloading pedalling (UNL) and for each of the 4-min of exercise in people with post-COVID syndrome (closed circles) and healthy participants (open circles)[Image Omitted. See PDF.]ConclusionsWhilst central cardiovascular output and ventilatory efficiency were preserved in COVID-19 survivors during submaximal exercise, peripheral muscle oxygen extraction was diminished compared to healthy participants most likely reflecting compromised muscle vasculature and/or impaired muscle fibre oxidative capacity.

BackgroundWhile exercise-based rehabilitation has shown to improve short-term outcomes in post-COVID syndrome following an acute hospitalisation compared to usual care (UC) (Daynes et al; Eur Respir J 2025; 10.1183/13993003.02152–2024), its long-term effects remain unclear.AimTo determine the long-term effects of a face-to-face (F2F) exercise-based rehabilitation programme compared to UC over a period of 26±3 months post-intervention in previously hospitalised COVID-19 survivors.MethodsParticipants who took part in the PHOSP-Rehabilitation RCT (ISRCTN10980107/ISRCTN13293865) comparing an 8-week supervised rehabilitation programme (consisting of individualised prescribed exercise and education) to usual care at Newcastle Upon Tyne Hospitals NHS Trust, were invited for a follow-up assessment. The outcomes included change in performance on the Incremental Shuttle Walking Test (ISWT), health-related quality of life (EQ-5D-5L), anxiety and depression scores (GAD-7 and PHQ-9), Quadriceps muscle force (QMVC) and handgrip strength, dyspnoea (Dyspnea-12), fatigue (FACIT-Fatigue Scale), and the short physical performance battery (SPPB) test.ResultsA total of 23 participants have completed the follow-up visit to date: 12 in the face-to-face (F2F) group (mean age: 70 ± 6 years) and 11 in the usual care (UC) group (mean age: 68 ± 10 years). A two-way repeated measures ANOVA revealed a significant group-by-time interaction only for the ISWT (p=0.02) and the EQ-5D-5L Utility Index (UI) (p=0.05) (figure 1). Post hoc within group analysis (Bonferroni-adjusted) revealed a significant decrease (p=0.001) in the ISWT between baseline and follow up in the UC group (by 127.14 m; 95% CI: -196.09 to -58.19), whereas the decrease in the F2F group (by -58.33 m; CI: -132.8 to 16.14) was not significant (p=0.15). No significant within-group changes were found for EQ-5D-5L UI scores. Compared to baseline, clinically meaningful improvements were observed at follow-up in QMVC in the F2F group compared to the UC group (mean difference: 5.47 kg; 95% CI: 0.68 to 10.25), and in Dyspnea-12 scores (mean difference: 4.91; 95% CI: 0.45 to 9.21).Abstract S141 Figure 1Data points (mean±SEM) are shown at baseline, post-intervention discharge and follow up in the F2F group (closed circles) and the UC group (open circles) for the ISWT and the EQ-5D-5L UI[Image Omitted. See PDF.]ConclusionThe long-term outcomes of an exercise-based rehabilitation programme are superior to usual care in terms of exercise capacity, quality of life, leg strength and dyspnoea symptoms.

ObjectivesWe investigated the effect of inspiratory muscle training (IMT) on inspiratory muscle strength, functional capacity and respiratory muscle kinematics during exercise in older adults.Methods24 older adults (age: 68.3±2.5 years) were evenly randomised into an experimental (IMT) or control (SHAM-IMT) group. Both groups performed 30 breaths, twice daily, for 8 weeks, with the IMT group training at an intensity of ~50% maximal inspiratory pressure (PImax) and the SHAM-IMT group training at an intensity of <15% PImax. Measurements of PImax, breathing discomfort (Borg scale ratings) during a bout of IMT at 50% PImax, 6MWT, accelerometry-assessed physical activity levels, and balance (mini-BEST), were assessed pre- and post-intervention. Furthermore, respiratory muscle kinematics were assessed via optoelectronic plethysmography (OEP) during constant work rate cycling at the same absolute intensity (75% predicted peak work rate) before and after training. Participant views towards the intervention were explored via interviews.ResultsInspiratory muscle strength (reflected by an increased PImax) was significantly improved in the IMT group (by 20.0±11.9 cmH2O; p=0.001) but not in the SHAM-IMT group (by 2.24±9.3 cmH2O). Breathing discomfort ratings significantly decreased (from 3.5±0.9 to 1.7±0.8) following IMT but did not change (3.6±1.0 to 3.3±1.2) in SHAM-IMT. The 6MWD increased by 18.8±28.4 m (p=0.042) in the IMT group with no change (-0.4±29.0 m) in SHAM-IMT. Sedentary time was decreased following IMT (by 28.0±39.8 min; p=0.042), and the reactive component within the mini-BEST balance was improved (by 1.2±0.8; p<0.001) in the IMT group only. OEP measures showed a significantly greater contribution of the pulmonary and abdominal rib cage compartments to the total tidal volume (VT) expansion only in the IMT group. Older adults reported positive experiences with IMT, highlighting facilitators such as ease of use and sessions not being time-consuming.ConclusionsIMT significantly improved inspiratory muscle strength, IMT-induced breathing discomfort, and functional capacity in this population. Observations of respiratory muscle kinematics during exercise suggest greater expansion of the rib cage compartment following IMT, potentially due to a greater contribution of intercostal muscles and the diaphragm. Qualitative measures revealed that IMT is well-tolerated in healthy older adults.

IntroductionGround-based walking is a simple training modality which would suit pulmonary rehabilitation (PR) settings with limited access to specialist equipment. Patients with advanced COPD are, however, unable to walk uninterruptedly at a relatively fast walking pace to optimise training benefits.ObjectiveTo compare walking distance and circulatory responses between an intermittent (IntSWT) and an endurance shuttle walking (ESWT) protocol.MethodsIn this cross-sectional study we measured in 14 COPD patients (mean±SD FEV1: 45±21% predicted), walking distance, cardiac output (CO), heart rate (HR), arterial oxygen saturation (SpO2), and symptoms during (a) IntSWT, consisting of 1-min walking alternating with 1-min rest, and (b) ESWT, both sustained at 85% of peak VO2 predicted to the limit of tolerance (Tlim).ResultsMedian (IQR) distance and endurance time were greater (p=0.001) during IntSWT [735 (375–1107) m and 19.61 (19.0–28.8) min, respectively] compared to ESWT [190 (117–360) m and 3.23 (2.32–5.75) min, respectively]. At iso-distance (distance at Tlim during ESWT) IntSWT compared to ESWT was associated with lower CO (8.6±2.6 versus 10.3±3.7 L/min; p=0.013), HR (96±14 versus 103±13 beats/min; p=0.001), greater SpO2 (92±6 versus 90±7 %; p=0.002), and lower symptoms of dyspnoea (2.8±1.3 versus 4.9±1.4; p=0.001) and leg discomfort (2.3±1.7 versus 4.2±2.2; p=0.001). Furthermore, throughout the walking tests, IntSWT compared to ESWT was associated with lower symptoms of dyspnoea (p=0.001), and leg discomfort (p=0.03) (figure 1). However, at Tlim symptoms of dyspnoea and leg discomfort were not different between IntSWT and ESWT, suggesting that the major reasons for limiting walking endurance in both modalities were having reached comparable intensity of symptoms, which took longer during IntSWT compared to ESWT.Abstract S87 Figure 1A. Dysponea, and B. Leg discomfort at rest, warm up (WU), the first 4 minutes of walking and at Tlim for each walking protocol (Tlim ESWT and Tlim IntSWT). + denotes significant differences between ESWT and IntSWT. # denotes significant differences between ESWT and IntSWT at specific time points. Horizontal lines indicate peak values during the incremental shuttle walk test (SWT), Values are mean±SEMConclusionIntSWT may provide important clinical benefits in the PR settings because it is sustained with lower symptoms, thereby allowing greater work outputs compared to ESWT.

AimThis feasibility trial examined the acceptability of a community-based COVID-19 education and physical therapy programme for improving the symptomology of individuals with Long COVID-19.MethodsA sample of 22 individuals (age: 46±16, male: 12 & female: 10), 11±4 months since initial infection with Long COVID-19 symptoms (persisting for ≥12 weeks) participated in a 6-week physical therapy & community-based education programme. Participants were provided with guidance for the management of their health, lifestyle, symptomology and physical activity through weekly group-based in-person sessions and telephone consultations. Post-intervention qualitative data was also collected- from both completing and non-completing participants- to assess factors determining their programme compliance.ResultsHigh adherence to both the community-based sessions and telephone consultations was achieved. Physical therapy sessions were deemed safe, with only mild exertional symptoms observed for the 17/22 completers during the programme. Reasons for non-completion included ‘symptom exertion’ and ‘concerns for contracting COVID-19’. Repeated-measures T-test analyses demonstrated meaningful improvements in participants’ fatigue (Chalder Fatigue scale & FACIT-F) and respiratory (CAT) symptomology post-intervention [table 1]. Participants’ qualitative feedback praised the programme for enhancing their confidence and readiness for resuming activities of daily living, in addition to its feasible and enjoyable delivery style.Abstract P26 Table 1Means±St.Dev & p-values for symptoms of fatigue and respiratory symptoms Baseline Completion P CFS (Bimodel) 8±3 6±4 0.018* CFS (Likert) 23±7 19±7 0.007* FACIT-F 19±10 23±10 0.005* CAT 23±7 21±7 0.068 * Significant at α = .05; CFS: Chalder Fatigue Scale; CAT: COPD Assessment TestConclusionThe feasibility of delivering an accessible COVID-19 education and physical therapy programme within the community was high with good adherence rates and meaningful improvements in fatigue and respiratory symptoms. In terms of research importance, it plausible to suggest that thousands of people with long COVID-19 in the UK cannot be accommodated to hospital-based rehabilitation programmes, so community-based rehabilitation of this nature may provide a feasible alternative.

IntroductionInspiratory muscle training (IMT) has been shown to improve inspiratory muscle strength and exercise tolerance in healthy and diseased populations, however the acute physiological effects of short bouts of tapered flow resistive loading (TFRL) remain unclear. We investigated the acute responses of TFRL at low, moderate, and high IMT intensities and aimed to determine an optimal training load.MethodsTwelve healthy adults (26±3 years) performed 3 loaded trials (at 30, 50 and 70% maximal inspiratory pressure; PImax) applied in a balanced ordered sequence and lasting 3 minutes each. Thoracoabdominal volumes (captured by Optoelectronic Plethysmography), cardiac output (recorded by Cardio-impedance), gas exchange, and dyspnoea scores were assessed throughout.ResultsInspiratory loading induced significant increases in thoracoabdominal tidal volumes compared to QB (0.69±0.06 L): by 2.71±0.30 L at 30% PImax (p=0.003); 3.01±0.27 L at 50% PImax (p=0.002); and 3.02±0.27 L at 70% PImax (p=0.002). Increased end-inspiratory rib cage volume and decreased end-expiratory abdominal volume contributed to the expansion of thoracoabdominal tidal volumes. A significant difference in thoracoabdominal tidal volumes was observed between 30 and 50% PImax (p=0.033) and between 30 and 70% PImax (p=0.049). Cardiac output was significantly increased from rest (6.11±0.28 L/min) to 7.74±0.31 L/min at 30% PImax (p=0.004), 8.38±0.66 L/min at 50% PImax (p=0.003), and 8.36±0.57 L/min at 70% PImax (p=0.003). With increasing inspiratory intensity, BORG ratings for dyspnoea progressively increased from 2.36±0.20 at 30% PImax, to 3.45±0.21 at 50% PImax (p=0.003), and to 4.91±0.25 at 70% PImax (p=0.003). A significant difference in dyspnoea ratings was also observed between 50 and 70% PImax (p=0.002). End-tidal carbon dioxide pressure (PETCO2) progressively decreased from QB during 30% PImax (26.23±0.59 mmHg; p=0.005), 50% PImax (25.87±1.02 mmHg; p=0.005) and 70% PImax (24.30±0.82 mmHg; p=0.005). Significant differences in PETCO2 were found between 30% and 70% PImax (p=0.017) and 50% and 70% PImax (p=0.037).DiscussionThoracoabdominal tidal volumes and cardiac output responses were nearly identical between 50% and 70% PImax, however adverse physiological responses, such as hyperventilation (decreased PETCO2) and dyspnoea scores were significantly greater at 70% PImax. This study suggests that 50% PImax is the optimal intensity for IMT via TFRL in healthy subjects.

IntroductionThe effect of pharmacological and non-pharmacological interventions on physical activity (PA) outcomes across chronic respiratory diseases (CRDs) is not fully elucidated.Objectivesi) To evaluate the effects of all available interventions on PA outcomes in CRDs; ii) to explore which PA outcomes have been used as endpoints in clinical studies.MethodsTwo different databases were compiled with searches performed in July 2021 and June 2022, yielding a total of 89 studies.ResultsCompared to usual care (UC), PA behavioural modification interventions, applied alone or alongside exercise training, resulted in significant improvements in the mean (95% CI) steps/day: 1060 (667, 1454) (p<0.00001) (figure 1) and 679 (93, 1266) (p=0.02), respectively. Moreover, pharmacological interventions compared to placebo yielded a significant difference in steps/day: 602 (104, 1100) (p=0.01) (figure 1). In patients with CRDs exercise training alone compared to UC led to non-significant (p=0.11) improvements in steps/day (441 (-69, 951)). In patients with COPD, PA behavioural modification interventions compared to UC led to significant (p<0.0001) improvements in steps/day 913 (504, 1322), whilst bronchodilator therapy significantly improved steps/day by 396 (125, 668) (p=0.02).ConclusionsIn CRDs, only PA behavioural modification and pharmacological interventions lead to significant improvements in steps/day compared to the control. In COPD, bronchodilators led to significantly increased steps/day in patients with COPD (by 396 steps/day), compared to placebo, likely by reducing exertional breathlessness, improving lung function, and decreasing dynamic hyperinflation. PA behavioural modification interventions, however, lead to a 2-fold improvement in steps/day compared to bronchodilators, thereby promoting the assumption that there are significant (but limited improvements) in PA when lung function is ameliorated. For further improvements in PA, the behaviour of the patient towards PA should be modified. Clinical and methodological gaps were profound in the literature while large-scale clinical trials are needed to assess the minimal important difference of PA outcomes in response to different pharmacological or non-pharmacological interventions.Please refer to page A215 for declarations of interest related to this abstract.

BackgroundWe previously identified that 8/24 COPD patients did not improve dynamic hyperinflation (DH) (DH non-responders) with the application of portable non-invasive ventilation (pNIV; Inspiratory/Expiratory Positive Airway Pressure: 18/8 cmH2O) compared to the pursed lip breathing (PLB) technique during recovery from intermittent exercise (Chynkiamis et al 2020). In the present study we employed Optoelectronic Plethysmography during acute application of pNIV and PLB in recovery from exercise to examine potential differences in the pattern of thoracoabdominal volume regulation between DH responders and DH non-responders.Methods14 COPD patients (FEV1: 55±21%predicted) performed 2 intermittent cycling trials (consisting of 5 bouts for 2 minutes at 80% of peak work rate interspersed with 2 minutes of recovery) using PLB or pNIV during recovery on a balanced order sequence.ResultsPatients exhibited two different patterns of response to exercise-induced DH during pNIV compared to PLB application: those who recruited expiratory abdominal muscles, thereby compensating end-expiratory rib cage hyperinflation (DH responders: n=7) and those who did not recruit expiratory abdominal muscles to compensate rib cage hyperinflation (DH non-responders: n=7). In DH responders, pNIV application compared to PLB in the 1st minute of recovery decreased total end-expiratory thoracoabdominal volume by 364±114 ml (p=0.019), secondary to greater reduction in end-expiratory abdominal volume by 338±171 ml (p=0.047). In contrast, in DH non-responders, pNIV application compared to PLB increased end-expiratory thoracoabdominal volume by 379±76 ml (p=0.004), secondary to increased end-expiratory rib cage volume by 348±44 ml (p=0.001) with no change in end-expiratory abdominal volume (31±81 ml; p=0.720). Lung function measures were not different between responders and non-responders. However, DH responders had greater BMI (32.8±6.8) compared to DH non-responders (23.6±4.9) (p=0.019).ConclusionsReports that the respiratory muscles of patients with high BMI might have a mechanical advantage compared to patients with normal BMI (O’Donnell & Ciavaglia, 2014) may partly explain the difference between responders and non-responders. Moreover, pNIV used in the present study provided high extrinsic positive end-expiratory pressure (PEEPe), matching more effectively the higher intrinsic positive end-expiratory pressure, reported in patients with high BMI (O’Donnell & Ciavaglia, 2014). However, PEEPe was likely excessive for the DH non-responders, thereby worsening DH.

Abstract Purpose Walking is crucial for active and healthy ageing, but it changes with age and in the presence of diverse health conditions, such as non-communicable diseases. In the field of the chronic lung disease COPD (chronic obstructive pulmonary disease), extensive research has been done on physical activity limitation, but little is known about the patterns of walking during daily life (i.e., real-world). We aimed to assess the levels and distribution of real-world walking (walking activity and gait parameters) in people with COPD compared with healthy adults, and across disease severity; and to identify domains of walking in COPD, using a single wearable device. Methods In a cross-sectional study, 550 people with COPD (37% women, with a mean (SD) age of 68 (8) years, postbronchodilator FEV1 54 (21) %) and 19 age-matched healthy adults were recruited in ten cities across eight countries. Subjects were given a single wearable device to wear at their lower back for one week. Twenty-five walking activity and gait parameters (e.g., number of steps, number of walking bouts (WB)>30s, walking speed in WB > 30s, cadence in WB > 30s, walking speed and cadence variability) were derived from the device outputs. Results Most walking activity and gait parameters were reduced in people with COPD compared to healthy adults, and according to COPD severity. Differences remained statistically significant after adjusting for age, sex, height and comorbidities in multivariable analyses. Factor analysis identified six distinct walking domains: Amount of walking, Patterns of walking, Pace, Rhythm, Pace variability and Rhythm variability. Conclusion Real-world walking in people with COPD is a multi-dimensional behaviour that is impaired as the disease progresses. These results may be used to set priorities and improve patient centricity in clinical practice, research and public health initiatives. Support/Funding Source This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No. 820820. This JU receives support from the European Union’s Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA).

A detailed three-dimensional regional chemical transport model (Particulate Matter Comprehensive Air Quality Model with Extensions, PMCAMx) was applied over Europe, focusing on the formation and chemical transformation of organic matter. Three periods representative of different seasons were simulated, corresponding to intensive field campaigns. An extensive set of AMS measurements was used to evaluate the model and, using factor-analysis results, gain more insight into the sources and transformations of organic aerosol (OA). Overall, the agreement between predictions and measurements for OA concentration is encouraging, with the model reproducing two-thirds of the data (daily average mass concentrations) within a factor of 2. Oxygenated OA (OOA) is predicted to contribute 93% to total OA during May, 87% during winter and 96% during autumn, with the rest consisting of fresh primary OA (POA). Predicted OOA concentrations compare well with the observed OOA values for all periods, with an average fractional error of 0.53 and a bias equal to −0.07 (mean error = 0.9 μg m−3, mean bias = −0.2 μg m−3). The model systematically underpredicts fresh POA at most sites during late spring and autumn (mean bias up to −0.8 μg m−3). Based on results from a source apportionment algorithm running in parallel with PMCAMx, most of the POA originates from biomass burning (fires and residential wood combustion), and therefore biomass burning OA is most likely underestimated in the emission inventory. The sensitivity of POA predictions to the corresponding emissions' volatility distribution is discussed. The model performs well at all sites when the Positive Matrix Factorization (PMF)-estimated low-volatility OOA is compared against the OA with saturation concentrations of the OA surrogate species C* ≤ 0.1 μg m−3 and semivolatile OOA against the OA with C* > 0.1 μg m−3.