Background and objective: The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence‐based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts.Methods: The Guideline methodology adhered to the Appraisal of Guidelines for Research and Evaluation (AGREE) II criteria. Nine key questions were constructed in accordance with the PICO (Population, Intervention, Comparator, Outcome) format and reviewed by a COPD consumer group for appropriateness. Systematic reviews were undertaken for each question and recommendations made with the strength of each recommendation based on the GRADE (Gradings of Recommendations, Assessment, Development and Evaluation) criteria. The Guidelines were externally reviewed by a panel of experts.Results: The Guideline panel recommended that patients with mild‐to‐severe COPD should undergo PR to improve quality of life and exercise capacity and to reduce hospital admissions; that PR could be offered in hospital gyms, community centres or at home and could be provided irrespective of the availability of a structured education programme; that PR should be offered to patients with bronchiectasis, interstitial lung disease and pulmonary hypertension, with the latter in specialized centres. The Guideline panel was unable to make recommendations relating to PR programme length beyond 8 weeks, the optimal model for maintenance after PR, or the use of supplemental oxygen during exercise training. The strength of each recommendation and the quality of the evidence are presented in the summary.Conclusion: The Australian and New Zealand Pulmonary Rehabilitation Guidelines present an evaluation of the evidence for nine PICO questions, with recommendations to provide guidance for clinicians and policymakers.

Ication from wrist accelerometer data. Methods Three samples were used: 1) free living (n = 13, ages 20–60 yr); 2) laboratory based (n = 25, ages 30–65 yr); and 3) hospital inpatients (n = 10, ages 60–90 yr). All participants wore a GENEActiv on their wrist and activPAL on their thigh. The free-living sample wore an additional GENEActiv on the thigh and completed the Multimedia Activity Recall for Children and Adults. The laboratory-based sample wore the monitors while seated at a desk for 7 h, punctuated by 2 min of walking every 20 min. The free-living and inpatient samples wore the monitors for 24 h. Posture was classified from wrist-worn accelerometry using the Sedentary Sphere concept. Results Sitting time did not differ between the wrist GENEActiv and the activPAL in the free-living sample and was correlated in the three samples combined (rho = 0.9, P < 0.001), free-living and inpatient samples (r ≃ 0.8, P < 0.01). Mean intraindividual agreement was 85% ± 7%. In the laboratory-based and inpatient samples, sitting time was underestimated by the wrist GENEActiv by 30 min and 2 h relative to the activPAL, respectively (P < 0.05). Posture classification disagreed during reading while standing, cooking while standing, and brief periods during driving. Posture allocation validity was excellent when the GENEActiv was worn on the thigh, evidenced by the near-perfect agreement with the activPAL (96% ± 3%). Conclusions The Sedentary Sphere enables determination of the most likely posture from the wrist-worn GENEActiv. Visualizing behaviors on the sphere displays the pattern of wrist movement and positions within that behavior....

Physical activity (PA) has been shown to improve symptoms in people with chronic obstructive pulmonary disease (COPD). Despite the high health and financial costs, the uptake of management strategies, particularly participation in PA and pulmonary rehabilitation (PR), are low. The review objective here was to identify potential barriers and enablers, which people with COPD report being associated with their participation in PA programs, including PR. A systematic search was undertaken to identify studies (published Jan 2000 to Aug 2011) reporting any barriers and enablers experienced by people with COPD regarding participation in PA and PR. Methodological quality of the studies was appraised using McMaster critical appraisal tools. A narrative summary of findings was undertaken reporting on individual study characteristics, country of origin, participants, and potential barriers and enablers. Eleven studies (8 qualitative and 3 quantitative) met the inclusion criteria for this systematic review. Several methodological issues (small sampling, poor description of data collection and analysis, issues with generalizability of the research findings) were common among included studies. Barriers identified included changing health status, personal issues, lack of support, external factors, ongoing smoking, and program-specific barriers. Enablers identified included social support, professional support, personal drivers, personal benefit, control of condition, specific goals, and program-specific enablers. The findings from this review may assist health professionals, patients, care givers and the wider community to develop effective strategies to promote participation in PA and PR among people with COPD.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by a persistent blockage of airflow, prompting episodes of shortness of breath, commonly leading to hospitalization. Hospitalization may lead to a decline in physical activity following discharge. Physical activity has been shown to improve symptoms of COPD and reduce readmissions, and to decrease morbidity and mortality. This study aims to explore, from the perspectives of people with COPD, the barriers to and enablers of participation in physical activity following hospitalization for COPD. Methods: This study had a qualitative descriptive design and included semistructured interviews with 28 adult COPD patients who had been admitted to hospital with a primary diagnosis of exacerbation of COPD. Results: A plethora of barriers to but fewer enablers of participation in physical activity and pulmonary rehabilitation were identified for this cohort of people. The main barriers identified were health-related (comorbidities, COPD symptoms, and physical injury or illness) environment-related (weather, transport, and finance), and self-related. The main enabling factors reported were access to health professionals and equipment, social support, routine and extracurricular activities, personal goals and motivation, and the effect of physical activity and "feeling better". Conclusion: This research provides a snapshot of the barriers to and enablers of physical activity and pulmonary rehabilitation in people with COPD. It is evident that there are significant barriers which hinder the ability of people with COPD to undertake and continue participation in physical activity and pulmonary rehabilitation. While there are some enablers that may counter these barriers, it is clear that health professionals dealing with people suffering from COPD need to actively recognize and address barriers to physical activity and pulmonary rehabilitation. Hospital admission may create an opportunity for implementation of interventions promoting physical activity (such as referral to pulmonary rehabilitation), which may assist in reducing hospital readmission, as well as decreasing morbidity and mortality.

Background: Physical inactivity and sedentary behaviours have significant and independent effects on health. The use of wearable monitors to measure these constructs in people who are hospitalised with an acute illness is rapidly expanding, but has not been systematically described. Purpose: The purpose of this study was to review the use of accelerometer monitoring with inpatients who are acutely ill, including what activity and sedentary behaviours have been measured and how active or sedentary inpatients are. Data Sources: Databases used were MEDLINE, EMBASE, CINAHL, and Scopus. Study Selection: Quantitative studies of adults with an acute medical or surgical hospital admission, on whom an accelerometer was used to measure a physical activity or sedentary behaviour, were selected. Data Extraction and Data Synthesis: Procedures were completed independently by 2 reviewers, with differences resolved and cross-checked by a third reviewer. Forty-two studies were identified that recruited people who had medical diagnoses (n = 10), stroke (n = 5), critical illness (n = 3), acute exacerbations of lung disease (n = 7), cardiac conditions (n = 7) or who were postsurgery (n = 10). Physical activities or sedentary behaviours were reported in terms of time spent in a particular posture (lying/sitting, standing/stepping), active/inactive, or at a particular activity intensity. Physical activity was also reported as step count, number of episodes or postural transitions, and bouts. Inpatients were sedentary during 93% to 98.8% (range) of their hospital stay, and, in most studies completed <1000 steps/day despite up to 50 postural transitions/day. No study reported sedentary bouts. Many studies controlled for preadmission function as part of the recruitment strategy or analysis or both. Limitations: Heterogeneity in monitoring device (17 models), protocols, and variable definitions limited comparability between studies and clinical groups to descriptive synthesis without meta-analysis. Conclusions: Hospitalised patients were highly inactive, especially those with medical admissions, based on time and step parameters. Accelerometer monitoring of sedentary behaviour patterns was less reported and warrants further research.