Abstract
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 VO2max), 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 (standardised 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), VO2max (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.
Key words: Severe Acute Respiratory Syndrome, Rehabilitation, Exercise Training, Randomised Controlled Trials, Physiotherapy
References
- ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories American Thoracic Society Statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine. 2002;166:111–117. doi: 10.1164/ajrccm.166.1.at1102. [DOI] [PubMed] [Google Scholar]
- Berry M.J., Rejeski W.J., Adair N.E., Zaccaro D. Exercise rehabilitation and chronic obstructive pulmonary disease stage. American Journal of Respiratory and Critical Care Medicine. 1999;160:1248–1253. doi: 10.1164/ajrccm.160.4.9901014. [DOI] [PubMed] [Google Scholar]
- Berry M.J., Rejeski W.J., Adair N.E., Ettinger W.H., Jr, Zaccaro D.J., Sevick M.A. A randomized, controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease. Journal of Cardiopulmonary Rehabilitation. 2003;23:60–68. doi: 10.1097/00008483-200301000-00011. [DOI] [PubMed] [Google Scholar]
- Bohannon R.W. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Archives of Physical Medicine and Rehabilitation. 1997;78:26–32. doi: 10.1016/s0003-9993(97)90005-8. [DOI] [PubMed] [Google Scholar]
- Coordinating Committee for Physiotherapy, Hospital Authority (2003): Normative data of 6-minute walk test. Hong Kong Special Administrative Region, Hospital Authority.
- Decramer M., de Bock V., Dom R. Functional and histologic picture of steroid-induced myopathy in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1996;153:1958–1964. doi: 10.1164/ajrccm.153.6.8665061. [DOI] [PubMed] [Google Scholar]
- Donnelly C.A., Ghani A.C., Leung G.M., Hedley A.J., Fraser C., Riley S., Abu-Raddad L.J., Ho L.M., Thach T.Q., Chau P., Chan K.P., Lam T.H., Tse L.Y., Tsang T., Liu S.H., Kong J.H., Lau E.M., Ferguson N.M., Anderson R.M. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003;361:1761–1766. doi: 10.1016/S0140-6736(03)13410-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Donner C.F., Howard P. Pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) with recommendations for its use. Report of the European Respiratory Society Rehabilitation and Chronic Care Scientific Group. European Respiratory Journal. 1992;5:266–275. [PubMed] [Google Scholar]
- Gauchard G.C., Tessier A., Jeandel C., Perrin P.P. Improved muscle strength and power in elderly exercising regularly. International Journal of Sports Medicine. 2003;24:71–74. doi: 10.1055/s-2003-37203. [DOI] [PubMed] [Google Scholar]
- Graves J.E., Pollock M.L., Bryant C.X. 3rd ed. William and Wilkins; Baltimore: 1998. Assessment of Muscular Strength and Endurance. ACSM Resource Manual Guidelines for Exercise Testing and Prescription. 363–367. [Google Scholar]
- Herridge M.S., Cheung A.M., Tansey C.M., Matte-Martyn A., Diaz-Granados N., Al-Saidi F., Cooper A.B., Guest C.B., Mazer C.D., Mehta S., Stewart T.E., Barr A., Cook D., Slutsky A.S. One-year outcomes in survivors of the acute respiratory distress syndrome. New England Journal of Medicine. 2003;348:683–693. doi: 10.1056/NEJMoa022450. [DOI] [PubMed] [Google Scholar]
- Heyward V.H. 4th ed. Human Kinetics; Champaign: 2002. Advanced Fitness Assessment and Exercise Prescription. 113–134. [Google Scholar]
- Jensen C.V. A computer program for randomization of patients with near-even distribution of important parameters. Computers and Biomedical Research. 1991;24:429–434. doi: 10.1016/0010-4809(91)90018-r. [DOI] [PubMed] [Google Scholar]
- Lam C.L., Gandek B., Ren X.S., Chan M.S. Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 health survey. Journal of Clinical Epidemiology. 1998;51:1139–1147. doi: 10.1016/s0895-4356(98)00105-x. [DOI] [PubMed] [Google Scholar]
- Lam C.L., Lauder I.J., Lam T.P., Gandek B. Population based norming of the Chinese (HK) version of the SF-36 health survey. The Hong Kong Practitioner. 1999;21:460–470. [Google Scholar]
- Lau M.C., Lee W.C., Wong N.C., Ng Y.F., Jones Y.M., Hui S.C. The impact of severe acute respiratory syndrome on the physical profile and quality of life. Archives of Physical Medicine and Rehabilitation. 2005;86:1134–1140. doi: 10.1016/j.apmr.2004.09.025. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lee N., Hui D., Wu A., Chan P., Cameron P., Joynt G.M., Ahuja A., Yung M.Y., Leung C.B., To K.F., Lui S.F., Szeto C.C., Chung S., Sung J.J. A major outbreak of severe acute respiratory syndrome in Hong Kong. New England Journal of Medicine. 2003;348:1986–1994. doi: 10.1056/NEJMoa030685. [DOI] [PubMed] [Google Scholar]
- Nakago K., Senda M., Touno M., Takahara Y., Inoue H. Influence of exercise on muscle fibers in rats with steroid myopathy. Acta Medicine Okayama. 1999;53:265–270. doi: 10.18926/AMO/31621. [DOI] [PubMed] [Google Scholar]
- Neff T.A., Stocker R., Frey H.R., Stein S., Russi E.W. Long-term assessment of lung function in survivors of severe ARDS. Chest. 2003;123:845–853. doi: 10.1378/chest.123.3.845. [DOI] [PubMed] [Google Scholar]
- Peolsson A., Hedlund R., Oberg B. Intra- and inter-tester reliability and reference values for hand strength. Journal of Rehabilitation Medicine. 2001;33:36–41. doi: 10.1080/165019701300006524. [DOI] [PubMed] [Google Scholar]
- Rothenhausler H.B., Ehrentraut S., Stoll C., Schelling G., Kapfhammer H.P. The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: Results of an exploratory study. General Hospital Psychiatry. 2001;23:90–96. doi: 10.1016/s0163-8343(01)00123-2. [DOI] [PubMed] [Google Scholar]
- Schelling G., Stoll C., Vogelmeier C., Hummel T., Behr J., Kapfhammer H.P., Rothenhausler H.B., Haller M., Durst K., Krauseneck T., Briegel J. Pulmonary function and health-related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome. Intensive Care Medicine. 2000;26:1304–1311. doi: 10.1007/s001340051342. [DOI] [PubMed] [Google Scholar]
- Sciurba F., Criner G.J., Lee S.M., Mohsenifar Z., Shade D., Slivka W., Wise R.A. Six-minute walk distance in chronic obstructive pulmonary disease: Reproducibility and effect of walking course layout and length. American Journal of Respiratory Critical Care Medicine. 2003;167:1522–1527. doi: 10.1164/rccm.200203-166OC. [DOI] [PubMed] [Google Scholar]
- Sykes K. ASSIST Creative Resources Ltd; Liverpool: 1998. The Chester Step Test: ASSIST Physiological Measurement Resources Manual Version 3. [Google Scholar]
- Tsang K.W., Ho P.L., Ooi G.C., Yee W.K., Wang T., Chan-Yeung M., Lam W.K., Seto W.H., Yam L.Y., Cheung T.M., Wong P.C., Lam B., Ip M.S., Chan J., Yuen K.Y., Lai K.N. A cluster of cases of severe acute respiratory syndrome in Hong Kong. New England Journal of Medicine. 2003;348:1977–1985. doi: 10.1056/NEJMoa030666. [DOI] [PubMed] [Google Scholar]
- Walther M., Werner A., Stahlschmidt T., Woelfel R., Gohlke F. The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: Results of a prospective, randomized study. Journal of Shoulder and Elbow Surgery. 2004;13:417–423. doi: 10.1016/j.jse.2004.02.002. [DOI] [PubMed] [Google Scholar]
- Ware J.E., Snow K.K., Kosinski M., Gandek B. Quality Metric Incorporated; Lincoln: 2000. SF-36 Health Survey Manual and Interpretation Guide. [Google Scholar]
- Wong K.T., Antonio G.E., Hui D.S., Lee N., Yuen E.H., Wu A., Leung C.B., Rainer T.H., Cameron P., Chung S.S., Sung J.J., Ahuja A.T. Severe acute respiratory syndrome: Radiographic appearances and pattern of progression in 138 patients. Radiology. 2003;228:401–406. doi: 10.1148/radiol.2282030593. [DOI] [PubMed] [Google Scholar]
- Yoshikawa M., Yoneda T., Takenaka H., Fukuoka A., Okamoto Y., Narita N., Nezu K. Distribution of muscle mass and maximal exercise performance in patients with COPD. Chest. 2001;119:93–98. doi: 10.1378/chest.119.1.93. [DOI] [PubMed] [Google Scholar]