Background: Severe and critically ill COVID-19 patients frequently need pulmonary rehabilitation (PR) after hospitalization. However, little is known about the effectiveness of PR in COVID-19 patients. Methods: We compared the performances in the six-min walk test (6MWT), chronic respiratory questionnaire (CRQ), and Functional Independence Measure (FIM) from inpatient PR between 51 COVID-19 patients and 51 other patients with common pneumonia. We used multivariate linear regression controlled for baseline values at entrance, age, sex, and cumulative illness rating scale. The odds ratios (ORs) of non-improvement/improvement in 6MWT (>30-m) and CRQ (>10-point) at discharge were compared between the two groups (Fisher’s exact test). Results: The two groups had similar improvements in 6MWT and CRQ, but the COVID-19 group achieved a 4-point higher FIM (p-value = 0.004). The OR of non-improvement/improvement in 6MWT was 0.30 (p-value = 0.13) between COVID-19 and controls; however, the odds of non-improvement in CRQ tended to be 3.02 times higher (p-value = 0.075) in COVID-19 patients. Severe and critical COVID-19 patients had similar rehabilitation outcomes. Conclusions: Inpatient PR can effectively improve physical functions and life quality in COVID-19 patients, irrespective of disease severity. Whether the relatively low gains in CRQ is an indicator of chronic disease development in COVID-19 patients needs further studies.

Background: Evidence from longitudinal studies on the impact of exacerbation symptoms on physical activity in chronic obstructive pulmonary disease (COPD) is lacking. The aim of this first exploratory study was to assess the association between exacerbation symptoms and physical activity, and to quantify the relative influence of specific symptoms. Methods: We recruited COPD patients at high risk for exacerbations from 2 pulmonary rehabilitation clinics and 1 acute care clinic in Switzerland. For 3 months after discharge, patients completed a daily symptom diary on a smartphone application, the EXAcerbations of Chronic pulmonary disease Tool (EXACT), and wore a pedometer to measure daily steps. We used mixed-effects models to determine the association of daily steps with exacerbation symptoms. Results: A total of 21 patients (Global Initiative for Chronic Obstructive Lung Disease grades 2–4) were enrolled for a mean of 94.4 days (standard deviation 4.2). The baseline median number of daily steps was 3,264.6 (interquartile range [IQR]: 1,851.3–4,784.1) and EXACT score was 37.0 (IQR: 30.9–41.4). A 12-point increase in EXACT score (indicating the start of an exacerbation) was statistically significantly associated with a decrease in daily steps of 653.3 (95% CI 969.7–336.9). Chest symptoms (tightness, discomfort and congestion) were more strongly associated with change in steps than breathlessness, and cough and sputum (z-value -4.5 vs -2.9 and -3.0). Conclusion: This is the first study to show that, in a small cohort of COPD patients, increases in exacerbation symptoms were associated with a statistically and clinically significant reduction in daily physical activity. These results underscore the importance for symptom control and exacerbation prevention in COPD patients.

Background: Physical exercise has become a cornerstone of management of chronic obstructive pulmonary disease (COPD) because it leads to clinically relevant improvements of exercise capacity and health-related quality of life (HRQL). Despite the scarcity of randomised trials directly comparing exercise protocols, current guidelines recommend high intensity continuous exercise for lower extremities as the probably most effective exercise modality. However, for patients admitted to inpatient respiratory rehabilitation programmes, it is often difficult to initiate such an exercise programme because they are severely limited by dyspnoea and leg fatigue and therefore unable to perform continuous exercise at higher intensities and for periods longer than 30 minutes. Interval exercise may be an attractive alternative for these COPD patients because it allows high intensity exercise with recovery periods. The aim of this study is to assess if interval exercise compared to high intensity continuous exercise is not of inferior effectiveness in terms of HRQL and exercise capacity improvements but associated with better exercise tolerance in patients with moderate to severe COPD at the beginning of a respiratory rehabilitation. Methods/Design: We will assign patients with moderately severe to severe COPD to either continuous exercise or interval exercise using a stratified randomisation. Patients will follow 12–15 exercise sessions during a comprehensive inpatient respiratory rehabilitation. Primary end point for effectiveness is HRQL as measured by the Chronic Respiratory Questionnaire (CRQ) two weeks after the end of rehabilitation and secondary endpoints include additional clinical outcomes such as functional exercise capacity, other HRQL measures, patients' experience of physical exercise as well as physiological measures of the effects of physical exercise such as cardiopulmonary exercise testing. Including expected drop-outs, we will need 52 patients per group to show differences corresponding to the minimal clinically important difference of the CRQ. Outcome assessors and investigators involved in data analysis will be blinded to group assignment until analyses have been carried out. Discussion: Clinicians and the scientific community need evidence on the benefits and tolerance of exercise protocols available in clinical practice. The proposed trial will provide important and needed data on interval and continuous exercise for decision making in clinical practice.

Background/Objectives: In cardiac rehabilitation, the 6-minute walk test (6-MWT) is a standard assessment of initial evaluation. It measures walking distance as a surrogate of submaximal physical performance. Thereby, a subjective rating of perceived exertion, assessed by the Borg Scale, plays an important role. It has been observed that patients with coronary heart disease often rate themselves lower than the person supervising the test. Since this discrepancy might lead to inadequate exercise prescription, this study aims to explore reasons for low self-rating. Methods: In a qualitative study, influencing factors for low self-rating were collected from patients using interviews and questionnaires and from a focus group of physiotherapists. The evaluation was based on the grounded theory. Results: Self-image after retirement emerged as the central factor, as it shaped patients’ behavior during the 6-MWT and their subsequent self-assessment. Additionally, five different categories of causal conditions were detected from ten patients and five therapists: fears, physical limitations, test instruction, testing conditions, and therapists’ expectations. Conclusions: Patients with coronary heart disease had poor self-perception of exercise intensity and limited understanding of the meaning of the Borg Scale and the 6-MWT. Physiotherapists should place greater emphasis on patients’ perceived exertion to be able to effectively tailor exercise prescription and, therefore, improve attainment of cardiac rehabilitation goals and long-term adherence.

Introduction Non-small cell lung cancer (NSCLC) survivors suffer from impaired physical and psychological functioning and reduced health-related quality of life (HRQoL) that persist after active treatment ends. Sustaining rehabilitation benefits, promoting a healthy lifestyle and facilitating self-management at home require a multifaceted aftercare programme. We aim to investigate the effect of a 12-week digital lifestyle intervention on HRQoL and lifestyle-related outcomes in NSCLC survivors after completion of inpatient rehabilitation. Methods and analysis QUAlity of life in LUng CAncer Survivors (QUALUCA) is a multicentre randomised controlled trial that follows a hybrid type 1 design. We randomly allocate participants in a 1:1 ratio to the intervention group (digital lifestyle intervention) or the control group (standard care) using block randomisation stratified by tumour stage and study site. Four accredited Swiss inpatient rehabilitation centres recruit participants. Key inclusion criteria are a diagnosis of NSCLC, an estimated life expectancy of ≥6 months and access to a smartphone or tablet. The 12-week intervention comprises physical activity, nutrition and breathing/relaxation, delivered through a mobile application (app). The primary outcome is the change in HRQoL from baseline (1 week after rehabilitation) to follow-up (3 months after baseline), assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Secondary outcomes include body mass index, self-reported physical activity, exercise capacity, risk of low protein intake, appetite, psychological distress, cancer-related fatigue, enablement and self-rated health. Explanatory outcomes in the intervention group include app usability, acceptability, appropriateness, and feasibility of the intervention, experiences and satisfaction with the intervention, and app usage data. We aim to enrol 88 participants. For the main statistical analysis, we will use analysis of covariance, adjusted for baseline measures, stratification variables, age and sex. Ethics and dissemination The Ethics Committees of the Canton of Zurich (lead), the Canton of Bern and Northwest and Central Switzerland approved the study (2023-00245). We will disseminate study results to researchers, health professionals, study participants and relevant organisations, and through publications in international peer-reviewed journals. Trial registration number NCT05819346.

Rehabilitation can improve health-related quality of life (HRQoL) in non-small cell lung cancer (NSCLC) survivors, but they lack structured aftercare to maintain these gains at home. This study aimed to assess the effectiveness of a co-created digital lifestyle intervention on HRQoL and health-related outcomes in NSCLC survivors following inpatient rehabilitation, alongside a comprehensive process evaluation. This multicenter randomized controlled trial allocated participants (1:1 ratio) to a 12-week self-managed digital lifestyle intervention delivered via a mobile application that targeted physical activity, nutrition, and breathing/relaxation (intervention group) or standard care (control group). The primary outcome was HRQoL and secondary outcomes included physical activity, exercise capacity, risk of low protein intake, appetite, cancer-related fatigue, psychological distress, and enablement. The process evaluation addressed implementation, mechanisms of impact, and contextual factors using app usage data, validated questionnaires, and qualitative interviews. We included twenty individuals (13 females, mean age 66.9 ± 6.0 years), 30% of the target sample size (n = 66). We found no statistically significant between-group difference for HRQoL at follow-up (adjusted mean difference: 2.89, 95% CI: -17.76 to 23.53, p = 0.77). However, the intervention group showed a statistically significant greater improvement in exercise capacity measured by repetitions in the 1-min sit-to-stand test (adjusted mean difference: -6.64, 95% CI: -12.96 to -0.33, p = 0.04). The process evaluation revealed high acceptability, feasibility, and usability of the intervention, and all participants reported positive perceived effects in at least one lifestyle domain (physical activity, nutrition, breathing/relaxation) that they attributed to the intervention. We identified key participant-level barriers to recruitment, including perceived burden, low digital literacy, and uncertainty about needs after discharge. Recruitment challenges limited statistical power, precluding firm conclusions regarding HRQoL and health-related secondary outcomes. Overall, the findings indicate that tailored digital lifestyle interventions may support survivors in the transition from rehabilitation to long-term self-management.