Objective Pulmonary rehabilitation is recommended for people with chronic respiratory disease, yet attendance barriers persist. There is increasing interest in models that may overcome some of these barriers, including minimal equipment exercise training. The capacity of a purely minimal equipment circuit to elicit an acute physiological response sufficient to confer health benefits has not been evaluated. This study assessed whether a minimal equipment circuit session enabled participants to achieve a training intensity of ≥60% V ˙ O 2 peak. Methods People with chronic respiratory disease referred to pulmonary rehabilitation completed a cardiopulmonary exercise test to determine peak oxygen consumption ( V ˙ O 2 peak), followed by a 60-minute minimal equipment exercise circuit training session. The session included 3 circuits each comprising 7 exercise stations including upper- and lower-limb training. Physiological signs and symptoms were monitored throughout. The primary outcome was the percentage of session spent at or above the desired training intensity (≥60% V ˙ O 2 peak). Results Eighteen participants completed the study (mean (SD) age 67 (11) years). Participants spent a mean 72% (21) of the session at ≥60% V ˙ O 2 peak, with a median [IQR] of 40[32-47] minutes above this threshold. Fifteen participants (83%) achieved the target intensity for ≥30 minutes. Participants reported positive immediate ratings of confidence, comfort, and enjoyment (5-point Likert scale median 5, IQR 4-5) at the conclusion of the minimal equipment session. Conclusion A minimal equipment exercise training session can provide an exercise intensity of ≥60% V ˙ O 2 peak for >70% of the exercise session in people with chronic respiratory disease. This approach requires further investigation as to whether it may support pulmonary rehabilitation delivery in diverse settings.
BackgroundMindfulness-Based Stress Reduction (MBSR) has demonstrated benefits in chronic conditions such as cancer, chronic pain, cardiovascular disease, and type 2 diabetes. However, evidence in chronic obstructive pulmonary disease (COPD) remains limited, particularly regarding the feasibility of implementing a full standardized program within pulmonary rehabilitation.MethodsThis prospective pilot study evaluated the feasibility of delivering a standardized 8-weeks MBSR program to people with COPD enrolled in pulmonary rehabilitation. Feasibility outcomes included recruitment, program completion, attendance at group sessions, home practice, and reasons for withdrawal. Adherence was conceptualized as behavioral engagement, assessed through predefined measures (session attendance and weekly self-reported home practice), and interpreted post hoc using thresholds commonly applied in previous MBSR feasibility studies (attendance ≥6/8 sessions; home practice ≥3 days/week). Reasons for discontinuation were collected by phone or email follow-up. Descriptive statistics were used.ResultsEighteen people with COPD (56% women, mean age 68 (±7.4) years; mean FEV1 48 (±16%) predicted) were enrolled. 14 participants (78%) completed the program, and 86% attended at least eight of nine sessions. Participants reported an average of 4.4 (±2.3) days of home practice per week, indicating regular engagement despite inter-individual variability. Reasons for withdrawal included musculoskeletal pain (n = 2) and limited availability (n = 2).ConclusionsThe standardized, in-person 8-weeks MBSR program was feasible in people with COPD undergoing pulmonary rehabilitation, as reflected by their regular attendance at hospital sessions and reported engagement in home practice. This structured context likely supported adherence and program fidelity, but its generalizability to individuals with reduced mobility or clinical instability remains uncertain. Future research should evaluate the feasibility of extending this approach to broader COPD populations and its potential psychological and clinical benefits.
The option of tracheostomy and prolonged invasive mechanical ventilation (IMV) for chronic respiratory failure in myotonic dystrophy type 1 (DM1) poses challenges in decision-making. The Myotonic Dystrophy Foundation consensus recommendations on respiratory management do not directly address the implications of this intervention given the progressive physical and cognitive manifestations of DM1. Here, we consider IMV in DM1 using the ethical principles of beneficence, non-maleficence, autonomy and justice. We call for further research on post-tracheostomy morbidity, mortality, and quality of life (QOL) to help guide decision-making. Our ethical analysis has yielded programmatic changes we hope will improve patient outcomes.
