Compared with conventional hospitalization, Comprehensive Geriatric Hospital at Home allows functional rehabilitation in a more realistic environment. Methodologically robust measurement tools are needed to monitor the functional recovery and quality of care of older adults in the home setting. To this end, Patient-Reported Outcome Measures (PROMs) provide a valid and efficient means to assess physical activity in older adults. This systematic review aims to: (1) identify PROMs to monitor physical activity in older adults receiving home care and; (2) assess their psychometric properties. A systematic review was conducted in MEDLINE (PubMed), Scopus, and EMBASE databases, following PRISMA guidelines. The PROQOLID and BiblioPRO libraries were also checked. PROMs designed to assess physical activity levels were identified and screened against eligibility criteria and psychometric properties extracted. Psychometric properties were evaluated using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool, which scores range from 0 to 100, with higher scores indicating better psychometric properties. A total of 435 articles met inclusion criteria, of which 59 described 21 PROMs assessing physical activity. Seven PROMs assessing physical activity level met criteria: Community Health Model Activities Program for Seniors Physical Activity Questionnaire (CHAMPS), International Physical Activity Questionnaire (IPAQ), Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire (LAPAQ), Physical Activity Scale for the Elderly (PASE), Paffenbarger Physical Activity Questionnaire (PPAQ), Rapid Assessment of Physical Activity (RAPA), and Short Questionnaire to Assess Health Enhancing Physical Activity (SQUASH). Scores were highest for reproducibility and lowest for responsiveness and internal consistency. The CHAMPS achieved the best overall performance (71.21), followed by the PASE (58.17) and LAPAQ (50.16); scores of 50 or above are considered acceptable; whereas the PPAQ (21.51) and SQUASH (28.10) scores were the lowest. CHAMPS showed the lowest administration burden. CHAMPS, IPAQ, LAPAQ, PASE, and SQUASH were validated against accelerometry, yielding heterogeneous results that indicated low-to-moderate correlations. CHAMPS, PASE, and LAPAQ showed the most acceptable psychometric properties. Most PROMs had limited responsiveness and inconsistencies. Implementation should focus on robust PROMs, while research should enhance measurement quality, validate tools in home care settings, and standardize measurement methods.

Matías Otto-Yáñez,1 Rodrigo Torres-Castro,2 Jordi Vilaró3 1Health, Functionality, and Physical Activity Research Group (GISFAF), School of Kinesiology, Faculty of Health Sciences, Autonomous University of Chile, Santiago, Chile; 2Department of Physical Therapy, University of Chile, Santiago, Chile; 3Blanquerna School of Health Sciences, Global Research on Wellbeing, Ramon Llull University, Barcelona, SpainCorrespondence: Matías Otto-Yáñez, Email matias.otto@uautonoma.cl

Background: Amyotrophic lateral sclerosis (ALS) is a fatal heterogeneous neurodegenerative disease characterized by the degeneration of both upper and lower motor neurons and spinal cord. Measurement of respiratory muscle strength has been shown to be an important assessment in the decision-making process and can be assessed by maximum inspiratory (P Imax ) and expiratory pressures (P Emax ), sniff nasal inspiratory (SNIP) and expiratory (SNEP) pressures. Body position appears to have a significant effect on respiratory muscle strength. The aim of this study was to observe the difference in peak values of SNIP and SNEP of the respiratory muscles measured in 2 different positions (seated and supine with 45° elevation) in subjects with ALS and a group of matched healthy subjects. Methods: This is a case–control study of subjects with ALS and healthy subjects. Spirometry and surface electromyography (EMG) of the sternocleidomastoid, scalene, rectus abdominis, and external oblique muscles were assessed during P Imax and P Emax maneuvers in the seated position, and SNIP and SNEP in the seated and supine positions at 45° elevation (randomized). Results: SNEP values in the 45° elevation were lower than in the sitting position in ALS (70.3 ± 26.7 vs 57.3 ± 22.8 cm H 2 O, P = .041). SNIP and SNEP were lower in ALS in the 45° elevation compared with healthy subjects (69.1 ± 27.2 vs 95.5 ± 23.5 cm H 2 O; 57.3 ± 22.5 vs 92.7 ± 26.4 cm H 2 O, P = .041). In subjects with ALS, baseline electromyographic activity of the sternocleidomastoid muscle at rest was higher than in healthy subjects in both positions ( P = .041). No significant differences in electrical activity were found for other variables and measurements. Conclusions: In ALS, nasal pressure may be affected by reduced diaphragm and abdominal muscle effectiveness in the supine position. The sternocleidomastoid muscle showed increased electrical activity in the supine position with 45° elevation compared with controls, which may indicate muscle weakness.

BACKGROUND:Patients with COPD experience air flow limitation, reduced expiratory capacity, and dynamic hyperinflation (DH), which causes dyspnea and decreased exercise tolerance. Expiratory positive airway pressure (EPAP) is a potential intervention that can reduce DH and improve respiratory muscle efficiency, but its impact on exercise tolerance remains unclear. The aim was to evaluate the acute effects of EPAP during exercise on the respiratory pattern, chest wall volumes, thoracoabdominal asynchrony (TAA), and DH in individuals with COPD using optoelectronic plethysmography. METHODS:This is a cross-sectional, multi-center study in which the participants were divided in two moments EPAP versus SHAM doing exercise protocols on a cycle ergometer. The protocol consisted of two conditions (a) EPAP-2 min of calm breathing followed by cycling at 80% of maximum load with a 7.5 cm H2O EPAP mask until exhaustion; and (b) SHAM-the same procedure without EPAP. Effects of EPAP on chest wall volumes, breathing pattern, index of respiratory muscles shortening velocity, the TAA, and paradoxical movements were analyzed. Distribution of the data were tested using Shapiro-Wilk. The Wilcoxon test was used for between-group assessments, and two-way ANOVA or Friedman test was used to compare both groups and phases the protocol. A significance level of P < .05 was used. RESULTS:In COPD subjects exercising at 80% of maximum load, both EPAP and SHAM increased chest wall volumes, with EPAP showing greater recovery values and higher abdominal volume (0.74 ± 0.4 L vs 0.58 ± 0.2 L). EPAP maintained higher TI, TE, and Ttot at 50%Tlim (Time to Limitation) and Tlim but had lower minute ventilation (Tlim 29.6 ± 11.7 vs 34.7 ± 13.1 L/min, P < .001) and reduced exercise tolerance (P = .001) with greater dyspnea (P = .001). It also increased end-inspiratory chest wall volume at 50% Tlim and recovery (P < .001), sustained rib cage expansion, and reduced diaphragm shortening velocity during exercise. Phase angle differences indicated more TAA with EPAP at Tlim (P = .002), although paradoxical movements increased similarly in both groups during exercise. CONCLUSIONS:The use of EPAP during exercise in subjects with COPD tended to increase dyspnea, increase TAA, and reduce exercise tolerance without significant improvement in DH.

INTRODUCTION:Pulmonary hypertension (PH) is characterized by exertional dyspnea and reduced exercise capacity. This study aims to synthesize current evidence to guide more effective exercise-based interventions. METHODS:This overview included systematic reviews (SRs) of randomized controlled trials in adults with PH that performed an exercise intervention as exercise training (ET), inspiratory muscle training (IMT) or combined training (CT). The main outcome was exercise capacity measured (e.g. six-minute walk test (6MWT) or cardiopulmonary exercise test (CPET). The searches were conducted in seven databases. Two independent reviewers conducted the analysis, with a third resolving disagreements. Methodological quality and certainty of evidence were assessed using AMSTAR-2 and GRADE, along with overlap analysis. RESULTS:A total of 14 SRs were included, categorized into ET, IMT, and CT. All three interventions demonstrated improvements in functional capacity, with increases in 6MWT distance of >48.5 m (ET), 39.1 m (IMT), and 49.5 m (CT). VO2peak improved in ET and CT groups by >2.07 and >3.0 mL/kg/min, respectively. Only one study performed IMT, with gains. Overall, methodological quality was rated as critically low, with significant overlap across studies. CONCLUSION:These findings suggest a clinically significant benefit of exercise-based interventions, with a slight superiority of CT.Protocol registration: http://www.crd.york.ac.uk/prospero identifier is CRD42025643615.

BACKGROUND:Mechanical insufflation-exsufflation (MI-E) consists of increasing expiratory air flow, thereby promoting an increase in cough peak flow (CPF) and secretion clearance. Respiratory impairment, characterized by reduced lung volumes and ineffective cough, is the major cause of morbidity and mortality in patients with amyotrophic lateral sclerosis (ALS). This study aimed to assess the acute effects of MI-E on CPF and chest wall compartmental and operational volumes in patients with ALS. METHODS:Ten ALS subjects (6 males) were studied by optoelectronic plethysmography (OEP) to assess the immediate effects of MI-E on CPF, chest wall volume variations and their distribution in the chest wall compartments, breathing pattern, and shortening velocity of the respiratory muscles before, during, and after the application of MI-E. RESULTS:No differences were observed in the CPF analysis between time points (pre, MI-E, post). A significant increase in CPF (P = .01) was obtained immediately after the application of MI-E in subjects with spinal-onset ALS (n = 7). No significant differences in total and compartmental lung volumes and chest wall operational volumes were observed between pre MI-E (quiet breathing), during MI-E (after coughs 1, 2, and 3), and post MI-E time points. CONCLUSIONS:The application of the MI-E technique may increase CPF in individuals with spinal ALS. However, no significant changes in total thoracic volumes, total and compartmental chest wall volumes, or changes in breathing patterns in the participants in our sample after the application of the technique were observed.

BackgroundProgressive respiratory muscle weakness in neuromuscular diseases (NMD) impairs cough effectiveness and increases respiratory morbidity. We compared peak cough flow (PCF) and vital capacity (VC) across airway clearance/cough augmentation techniques in adolescents and young adults using home noninvasive ventilation (NIV).MethodsIn this cross-sectional physiological study, adolescents and young adults with NMD receiving home NIV were evaluated at home. PCF and VC were measured at baseline and immediately after manual assisted cough (MAC), NIV at usual settings, NIV at inspiratory positive airway pressure of 30 cmH2O, air stacking (AS), glossopharyngeal breathing (GPB), and mechanical insufflation-exsufflation (MI-E). Techniques were tested alone and in combination with MAC; the sequence was randomized within participants.ResultsTwenty-four participants (70.8% male; age 17.5 ± 2.4 years) were included. Baseline PCF was 211.2 ± 89.4 L/min. Compared with baseline, PCF increased with MAC, AS, NIV at usual settings, NIV at 30 cmH2O, and MI-E (all p < 0.05), whereas GPB showed no significant change. When combined with MAC, all techniques further increased PCF (e.g., AS + MAC, 306.7 ± 98.4; NIV-30 + MAC, 297.1 ± 94.0 L/min; all p < 0.001), with no between-technique differences. VC increased after AS, MI-E, and NIV (all p < 0.005), but not after GPB.ConclusionsIn adolescents and young adults with NMD using home NIV, AS, NIV, and MI-E improved cough effectiveness and lung volume, and adding MAC produced additional PCF gains.

INTRODUCTION:Chronic respiratory diseases are a major global health burden, and oxygen therapy remains a cornerstone treatment for chronic hypoxemia. However, the effectiveness of long-term oxygen therapy (LTOT) depends not only on indication but also on the interaction between device performance, patient physiology, and real-world use. Variability in delivery systems, inadequate titration, and poor adherence often lead to mismatches between prescribed and delivered oxygen doses. AREAS COVERED:This review synthesizes current evidence on LTOT as a drug-delivery system, focusing on device characteristics, delivery performance, and patient-device matching across rest, exertion, and sleep. It examines stationary and portable systems, as well as home high-flow nasal cannula (HFNC). Key challenges such as pulse-dose variability, device limitations, adherence, and safety are addressed. Evidence from clinical trials, physiological studies, registries, and guidelines is integrated to show how delivery systems and patient factors influence effectiveness. EXPERT OPINION:LTOT should be reframed as a precision drug delivery system rather than a simple flow-based prescription. Device-specific titration, confirmation of adequate oxygenation with the prescribed device under the intended conditions of use, and individualized matching are essential. Future strategies should prioritize objective monitoring, advanced technologies, and scalable education to reduce the gap between prescription and real-world effectiveness.

OBJECTIVES:(i) To develop sex-specific reference equations to predict distance walked (6MWD) in the 6-minute walk test (6MWT), in healthy subjects aged 45-85 years, from different geographic areas of Spain; and (ii) to compare developed equations with previously published in a large sample of COPD patients. METHODS:First, a cross-sectional multicentre sample of randomly selected healthy subjects from 17 Spanish hospitals and universities performed two 6MWT. Linear regression and fractional polynomial modelling were used to develop the equations. Second, the developed equations were applied to 715 COPD patients from Spanish primary care centres and hospitals, and the % predicted 6MWD obtained was compared with previously published equations using Dunnett's multiple comparisons test. RESULTS:568 healthy subjects were included (51% females, mean (SD) age 62 (11) years), walked a 6MWD of 615 (113) and 557 (93)m in males and females, respectively. The developed equations included age, weight and height, and explained 43% and 51% of the 6MWD variance for males and females, respectively. In the COPD sample (n=715, 14% females, 68 (9) years, FEV1 61 (18) % predicted, 6MWD 464 (97)m), only 1 out of 9 previously published equations for males, and 6 out of 9 for females predicted 6MWD values similar to those of the newly developed Spanish reference equations. CONCLUSIONS:The newly developed reference equations provide a more valid prediction of 6MWD in Spanish adults with COPD compared to previously published equations. We suggest their use in future research and clinical practice for the Spanish adult population.

ObjectiveTo determine whether daily air stacking (AS) over 12 weeks improves cough effectiveness and pulmonary volumes in individuals with spinal cord injury (SCI).MethodsThis retrospective study analyzed the records of individuals with SCI who received AS training at the Los Coihues Clinic in Chile. Participants performed AS exercises five days per week for 12 weeks. Pulmonary function was assessed at baseline and after the intervention, including peak cough flow (PCF) in four conditions (spontaneous, with AS, with manually assisted cough [MAC], and combined AS + MAC), vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Paired t-tests were used to compare pre and post-intervention values, with significance at p < 0.05.ResultsTwenty individuals (19 men; mean age 38.8 ± 13.1 years) with cervical (85%) and thoracic (15%) SCI were included. Significant improvements were observed after 12 weeks in VC (2.41 ± 0.91 vs. 3.01 ± 1.06 L; p = 0.004), MIC (3.80 ± 0.96 vs. 4.48 ± 0.96 L; p = 0.006), MIP (71.2 ± 26.2 vs. 88.9 ± 26.5 cmH2O; p < 0.001), and PCF in all conditions: spontaneous (p < 0.001), with AS (p = 0.03), with MAC (p = 0.02), and with combined AS + MAC (p = 0.02). No significant change was found in MEP.ConclusionsTwelve weeks of daily AS training significantly improved cough effectiveness and pulmonary function in individuals with SCI. These sustained improvements may enhance airway clearance and respiratory health in this population.

Objective: To investigate the relationship between respiratory function, functionality, and mortality in amyotrophic lateral sclerosis (ALS) patients and to determine which respiratory parameters show the strongest correlation with functionality and mortality. Methods: The study was conducted in Rio Grande do Norte, Northeast Brazil, between January 2018 and December 2023. This was a retrospective cohort, following individuals with ALS who were evaluated at the University Laboratory. Results: A total of 74 ALS patients were included in the analysis, with a mean age of 55.7 ± 13.5 years. Most were male (66.2%) and predominantly presented with spinal-onset ALS (51.3%). Respiratory variables (except peak expiratory flow (PEF)) showed a weak but significant inverse correlation with mortality (FVC% predicted (rpb = −0.260; p < 0.001), SNIP (rpb = −0.235; p = 0.001), MEP (rpb = −0.207; p = 0.007), MIP (rpb = −0.198; p = 0.009), and PEF% predicted (rpb = −0.156; p = 0.013)). When analyzing their correlation with ALSFRS-R, all variables showed a significant positive correlation (ranging from weak to moderate) with functionality. A reduction of one unit in the respiratory variables PEF% of predicted, maximal inspiratory pressure (MIP), and sniff nasal inspiratory pressure (SNIP) increased the risk of death by an average of 300% (OR = 2.99; 95% CI: 2.05–4.35), 2% (OR = 1.02; 95% CI: 1.01–1.03), and 1% (OR = 1.01; 95% CI: 1.00–1.02), respectively. Conclusions: Our findings suggest that direct measurements of respiratory function and muscle strength, particularly PEF and SNIP, may serve as more useful markers to guide early interventions such as non-invasive ventilation, thereby improving quality of life and potentially prolonging survival.

Introduction:There has been inconclusive findings regarding the effectiveness of inspiratory muscle training (IMT) in chronic respiratory diseases (CRDs). Our objective was to determine the effectiveness of IMT on exercise tolerance, maximum respiratory pressure, lung function, symptoms and quality of life in different CRDs. Methods:We conducted an overview of systematic reviews (SRs) in adults with CRDs who underwent IMT. We reviewed five databases in March 2025. We chose the most comprehensive SRs to report on the analysed outcomes. Results:Twenty-three SRs were included. In chronic obstructive pulmonary disease (COPD), IMT increased the six-minute walk distance (6MWD) by 35.7 m (95% CI 25.7, 45.7), maximum inspiratory pressure (MIP) by 10.9 cmH2O (95% CI 8.0, 13.9). In asthma, IMT increased the forced expiratory volume in the first second (FEV1) by 3.3%pred (95% CI 1.4, 5.1), forced vital capacity (FVC) by 4.1%pred (95% CI 1.0, 7.3), MIP by 21.9 cmH2O (95% CI 15.0, 28.8), and dyspnoea was reduced (standard mean difference -0.8, 95% CI -1.3,-0.2). In obstructive sleep apnoea (OSA), IMT increased MIP by 29.6 cmH2O (95% CI 6.0, 53.1). In pulmonary hypertension (PH), IMT increased 6MWD by 39.0 m (95% CI 20.7, 57.4), MIP in 21.2 cmH2O (95% CI 11.3, 31.1), maximum expiratory pressure by 14.4 cmH2O (95% CI 6.9, 21.9), and dyspnoea was reduced by 0.5 (95% CI 0.1, 0.9) in modified Medical Research Council scale. In lung resection (LR), IMT increased MIP by 8.1 cmH2O (95% CI 1.3, 14.9). In bronchiectasis, IMT increased MIP by 6.1 cmH2O (95% CI 1.4, 10.8). Overall, the most consistent effect of IMT across different CRDs was an increase in MIP. Conclusion:IMT improved several clinically relevant outcomes, including MIP, exercise capacity, and dyspnoea in different CRDs. However, the limited evidence for certain outcomes and populations highlights the need for further high-quality studies.

The five-repetition STS test (5-STS) is a field test utilized for evaluating physical function, primarily assessing the risk of falls, and is also included as a component in other assessments, such as the Short Physical Performance Battery (SPPB). This test proves to be easily implementable and of significant clinical utility; however, no reference values are currently available for the Chilean population. AIM:To establish reference values for the 5-STS in the adult Chilean population. METHODS:A multicenter cross-sectional study encompassed data acquisition from five distinct sites across Chile. Healthy adults aged between 18 and 80 were enrolled as participants. Anthropometric measures, physical activity levels, smoking history, Borg scale assessments, and the time to complete five repetitions were registered. Reference values were subsequently established based on sex and specific age categories. RESULTS:463 subjects were included in the study, comprising 269 women. The median (and LIN) of time of 5 repetitions in women was: 18-29 years: 7.4 (10.6), 30-39 years: 7.7 (11.4), 40-49 years: 8.5 (13.1), 50-59 years: 9.2 (14.0), 60-69 years: 9.7 (15.3) and 70-80 years: 11.3 (17.7). While in men it was: 18-29 years: 7.8 (10.3), 30-39 years: 6.5 (11.4), 40-49 years: 8.1 (11.5), 50-59 years: 9.8 (15.1), 60-69 years: 11 (15.8), 70-80 years: 13 (18.5). The predictive equations are as follows: Men: 5-STS= 4.698 + (age(y) * 0.096); Women: 5-STS= -3.185 + (age(y) *0.074) + (height(cm) *0.055). CONCLUSION:This study successfully established reference values for the adult Chilean population, providing essential data for the accurate assessment of the physical capacity of the people when using the 5-STS.

Background:Physical activity is crucial in slowing COPD progression and reducing mortality, yet the influence of the neighbourhood's sociodemographic and socioeconomic environment on it remains unexplored. Our aim is to assess the relationship between these neighbourhood characteristics and physical activity in people with COPD. Methods:We analysed cross-sectional data from 407 COPD participants from primary care and hospitals of five Catalan municipalities. We obtained neighbourhood percentages of sociodemographic (older adults and non-EU15 immigrants) and socioeconomic (illiteracy, unemployment and households in poor-conditioned buildings) characteristics from the Spanish Urban Vulnerability Atlas. Over 1 week, we tracked steps per day, time spent in physical activity of any intensity, moderate-to-vigorous physical activity (MVPA) and sedentary time using an activity monitor. Results:After adjusting for age, sex, marital status, social class, road traffic noise levels and PM2.5 in multivariable linear regression models, each 10% increase in the neighbourhood percentage of older adults was associated with 922 (95% CI: 84-1759) more steps per day and 11 (1 to 20) more minutes per day in MVPA. Each 10% increase in the neighbourhood percentage of non-EU15 immigrants was associated with fewer steps per day (-332; 95% CI: -647 to -16), fewer minutes per day in physical activity of any intensity (-5; 95% CI: -11 to 0) and fewer minutes per day in MVPA (-5; 95% CI: -7 to 0). No associations were found between neighbourhood socioeconomic characteristics and physical activity. Conclusion:A neighbourhood's percentages of older adults and non-EU15 immigrants are associated with physical activity of COPD patients.

Lower limb strength is a key factor in physical education and sports. This study examined the reliability and feasibility of the one-leg sit-to-stand test (OLSTST) as a functional assessment tool. The OLSTST uses only one leg to perform five sit-to-stand repetitions from a standard chair. Ninety-six healthy participants completed one testing session assessing dominant (preferred for tasks like kicking a ball) and non-dominant legs, with three trials per leg. Reliability was evaluated using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). The OLSTST showed good test-retest reliability (ICC >0.83). SEM (0.30-0.46 s) reflected low measurement error, and MDC (0.84-1.28 s) indicated that small changes in performance can be confidently interpreted as real. A learning effect was observed, supporting a two-trial protocol. Feasibility was high (82.76%). The OLSTST is a practical, reliable tool for assessing unilateral lower limb strength in applied settings.

Introduction The one-minute sit to stand test (1min-STST) is a field test used to assess functional capacity. It is easily implementable and of significant clinical utility; however, no reference values are currently available for the Chilean population. The objective of this study was to establish reference values for the 1min-STST in a healthy Chilean population. Methods A multicenter cross-sectional study involving data collection from six locations in Chile was conducted. Healthy adults between 18 and 80 years of age were recruited. The anthropometric variables, levels of physical activity, smoking status, Borg scale ratings, and number of repetitions during the 1min-STST were recorded. Reference values were determined according to sex and age range. Results Four hundred ninety-nine healthy subjects (57.5% women, n = 287; median height, 1.63 (0.14) m; weight, 72.8 (20) kg; average BMI, 27.3 ± 4.1 kg/m 2 ) were included in the study. The median (and the lower limit of normality (LLN) values) for the 1min-STST in men ranged from 18–29 years, with 38 (LLN 27) repetitions and 23 (LLN 15) repetitions for 70–80 years. For women aged 18–29 years, 38 (LLN 28) repetitions were performed, and for women aged 70–80 years, 24 (LLN 17) repetitions were performed. Conclusions This study established reference values for the healthy adult Chilean population.