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Search Results: 1 - 10 of 191533 matches for " Darcy D Marciniuk "
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Fatigue in patients with COPD participating in a pulmonary rehabilitation program
Cindy J Wong, Donna Goodridge, Darcy D Marciniuk, et al
International Journal of Chronic Obstructive Pulmonary Disease , 2010, DOI: http://dx.doi.org/10.2147/COPD.S12321
Abstract: tigue in patients with COPD participating in a pulmonary rehabilitation program Short Report (8175) Total Article Views Authors: Cindy J Wong, Donna Goodridge, Darcy D Marciniuk, et al Published Date September 2010 Volume 2010:5 Pages 319 - 326 DOI: http://dx.doi.org/10.2147/COPD.S12321 Cindy J Wong1, Donna Goodridge1, Darcy D Marciniuk2, Donna Rennie1,3 1College of Nursing, 2College of Medicine, 3Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada Background: Fatigue is a distressing, complex, multidimensional sensation common in individuals with chronic obstructive pulmonary disease (COPD). While fatigue negatively impacts functional performance and quality of life, there has been little study of the fatigue that affects participants in pulmonary rehabilitation programs. The purpose of this study was to examine the emotional, behavioral, cognitive, and physical dimensions of fatigue and their relationships to dyspnea, mental health, sleep, and physiologic factors. Patients and methods: A convenience sample of 42 pulmonary rehabilitation participants with COPD completed self-report questionnaires which measured dimensions of fatigue using the Multidimensional Fatigue Inventory, anxiety and depression using the Hospital Anxiety and Depression Scale, and sleep quality using the Pittsburgh Sleep Quality Index. Data on other clinical variables were abstracted from pulmonary rehabilitation program health records. Results: Almost all (95.3%) participants experienced high levels of physical fatigue. High levels of fatigue were also reported for the dimensions of reduced activity (88.1%), reduced motivation (83.3%), mental fatigue (69.9%), and general fatigue (54.5%). Close to half (42.9%) of participants reported symptoms of anxiety, while almost one quarter (21.4%) reported depressive symptoms. Age was related to the fatigue dimensions of reduced activity (ρ = 0.43, P < 0.01) and reduced motivation (ρ = 0.31, P < 0.05). Anxiety was related to reduced motivation (ρ = -0.47, P < 0.01). Fatigue was not associated with symptoms of depression, sleep quality, gender, supplemental oxygen use, smoking status, or Medical Research Council dyspnea scores. Conclusions: Fatigue (particularly the physical and reduced motivation dimensions of fatigue) was experienced by almost all participants with COPD attending this pulmonary rehabilitation program. Fatigue affected greater proportions of participants than either anxiety or depression. The high prevalence of fatigue may impact on enrolment, participation, and attrition in pulmonary rehabilitation programs. Further investigation of the nature, correlates, and impact of fatigue in this population is required.
Fatigue in patients with COPD participating in a pulmonary rehabilitation program
Cindy J Wong,Donna Goodridge,Darcy D Marciniuk,et al
International Journal of COPD , 2010,
Abstract: Cindy J Wong1, Donna Goodridge1, Darcy D Marciniuk2, Donna Rennie1,31College of Nursing, 2College of Medicine, 3Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, CanadaBackground: Fatigue is a distressing, complex, multidimensional sensation common in individuals with chronic obstructive pulmonary disease (COPD). While fatigue negatively impacts functional performance and quality of life, there has been little study of the fatigue that affects participants in pulmonary rehabilitation programs. The purpose of this study was to examine the emotional, behavioral, cognitive, and physical dimensions of fatigue and their relationships to dyspnea, mental health, sleep, and physiologic factors.Patients and methods: A convenience sample of 42 pulmonary rehabilitation participants with COPD completed self-report questionnaires which measured dimensions of fatigue using the Multidimensional Fatigue Inventory, anxiety and depression using the Hospital Anxiety and Depression Scale, and sleep quality using the Pittsburgh Sleep Quality Index. Data on other clinical variables were abstracted from pulmonary rehabilitation program health records.Results: Almost all (95.3%) participants experienced high levels of physical fatigue. High levels of fatigue were also reported for the dimensions of reduced activity (88.1%), reduced motivation (83.3%), mental fatigue (69.9%), and general fatigue (54.5%). Close to half (42.9%) of participants reported symptoms of anxiety, while almost one quarter (21.4%) reported depressive symptoms. Age was related to the fatigue dimensions of reduced activity (ρ = 0.43, P < 0.01) and reduced motivation (ρ = 0.31, P < 0.05). Anxiety was related to reduced motivation (ρ = -0.47, P < 0.01). Fatigue was not associated with symptoms of depression, sleep quality, gender, supplemental oxygen use, smoking status, or Medical Research Council dyspnea scores.Conclusions: Fatigue (particularly the physical and reduced motivation dimensions of fatigue) was experienced by almost all participants with COPD attending this pulmonary rehabilitation program. Fatigue affected greater proportions of participants than either anxiety or depression. The high prevalence of fatigue may impact on enrolment, participation, and attrition in pulmonary rehabilitation programs. Further investigation of the nature, correlates, and impact of fatigue in this population is required.Keywords: COPD, fatigue, pulmonary rehabilitation, anxiety, depression, sleep quality
Cardiopulmonary Exercise Testing
Darcy D. Marciniuk,Bruce D. Johnson,J. Alberto Neder,Denis E. O'Donnell
Pulmonary Medicine , 2013, DOI: 10.1155/2013/686104
Abstract:
Assessing Exercise Limitation Using Cardiopulmonary Exercise Testing
Michael K. Stickland,Scott J. Butcher,Darcy D. Marciniuk,Mohit Bhutani
Pulmonary Medicine , 2012, DOI: 10.1155/2012/824091
Abstract: The cardiopulmonary exercise test (CPET) is an important physiological investigation that can aid clinicians in their evaluation of exercise intolerance and dyspnea. Maximal oxygen consumption ( ) is the gold-standard measure of aerobic fitness and is determined by the variables that define oxygen delivery in the Fick equation ( = cardiac output × arterial-venous O2 content difference). In healthy subjects, of the variables involved in oxygen delivery, it is the limitations of the cardiovascular system that are most responsible for limiting exercise, as ventilation and gas exchange are sufficient to maintain arterial O2 content up to peak exercise. Patients with lung disease can develop a pulmonary limitation to exercise which can contribute to exercise intolerance and dyspnea. In these patients, ventilation may be insufficient for metabolic demand, as demonstrated by an inadequate breathing reserve, expiratory flow limitation, dynamic hyperinflation, and/or retention of arterial CO2. Lung disease patients can also develop gas exchange impairments with exercise as demonstrated by an increased alveolar-to-arterial O2 pressure difference. CPET testing data, when combined with other clinical/investigation studies, can provide the clinician with an objective method to evaluate cardiopulmonary physiology and determination of exercise intolerance. 1. Introduction The cardiopulmonary exercise test (CPET) is an important physiological investigation that can aid clinicians in their diagnostic evaluation of exercise intolerance and dyspnea [1, 2]. Although cardiac and pulmonary etiologies are the most common causes for dyspnea and exercise intolerance [3, 4], neurological, metabolic, hematologic, endocrine, and psychiatric disorders can all contribute. The data gathered from a CPET can provide valuable information to differentiate between these causes [5], as progressive incremental exercise testing provides the most comprehensive and objective assessment of functional impairment and yields information about the metabolic, cardiovascular, and ventilatory responses to exercise. In addition to assisting in the diagnosis of dyspnea and exercise intolerance, CPETs can be used for a broad range of other applications such as determining disease severity, exercise prescription for rehabilitation, assessing the effectiveness of pharmacological agents, or in the assessment for lung transplant (see Table 1). Table 1: Indications for cardiopulmonary exercise testing. Algorithms exist to help identify CPET patterns of known clinical diagnosis [6], and typical clinical
Test-Retest Reliability and Physiological Responses Associated with the Steep Ramp Anaerobic Test in Patients with COPD
Robyn L. Chura,Darcy D. Marciniuk,Ron Clemens,Scotty J. Butcher
Pulmonary Medicine , 2012, DOI: 10.1155/2012/653831
Abstract: The Steep Ramp Anaerobic Test (SRAT) was developed as a clinical test of anaerobic leg muscle function for use in determining anaerobic power and in prescribing high-intensity interval exercise in patients with chronic heart failure and Chronic Obstructive Pulmonary Disease (COPD); however, neither the test-retest reliability nor the physiological qualities of this test have been reported. We therefore, assessed test-retest reliability of the SRAT and the physiological characteristics associated with the test in patients with COPD. 11 COPD patients (mean FEV1 43% predicted) performed a cardiopulmonary exercise test (CPET) on Day 1, and an SRAT and a 30-second Wingate anaerobic test (WAT) on each of Days 2 and 3. The SRAT showed a high degree of test-retest reliability ( ; %, and bias 4.5?W, error ?15.3–24.4?W). Power output on the SRAT was 157?W compared to 66?W on the CPET and 231?W on the WAT. Despite the differences in workload, patients exhibited similar metabolic and ventilatory responses between the three tests. Measures of ventilatory constraint correlated more strongly with the CPET than the WAT; however, physiological variables correlated more strongly with the WAT. The SRAT is a highly reliable test that better reflects physiological performance on a WAT power test despite a similar level of ventilatory constraint compared to CPET. 1. Introduction Individuals with Chronic Obstructive Pulmonary Disease (COPD) are often prescribed aerobic exercise to enhance function and reduce shortness of breath during activities of daily living. General guidelines for this exercise prescription suggest patients should exercise continuously at moderate intensities [1–3]. There is evidence, however, to suggest that exercise at higher intensities may be more beneficial for this population [4]. Traditionally, results from cardiopulmonary exercise testing (CPET) involving an incremental, graded exercise test (GXT) of 8–12 minutes in duration, have been used to prescribe exercise for individuals with COPD and are widely considered to be the gold standard for measurement of cardiopulmonary function and aerobic performance [5]. CPET, however, may underestimate the workload required for optimal physiological benefit from exercise training due to ventilatory limitations causing early test cessation and a blunted peak work rate [6, 7]. High-intensity interval exercise intensity may be prescribed for healthy individuals based on tests of anaerobic power and capacity, such as a 30-second Wingate Anaerobic Test (WAT), which is considered to be the gold standard measure of
Role of Leukotriene Receptor Antagonists in the Treatment of Exercise-Induced Bronchoconstriction: A Review
George S Philteos, Beth E Davis, Donald W Cockcroft, Darcy D Marciniuk
Allergy, Asthma & Clinical Immunology , 2005, DOI: 10.1186/1710-1492-1-2-60
Abstract: Asthma affects 14 to 15 million people in the United States and is responsible for more than 100 million days of restricted activity, more than 5,000 deaths, and 470,000 hospitalizations each year [1]. Previously characterized as a disease of airway smooth muscle, asthma is currently defined by the National Heart, Lung, and Blood Institute as "a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells." [2] Exercise-induced bronchoconstriction (EIB) occurs in approximately 80 to 90% of individuals with asthma and in approximately 11% of the general population without otherwise symptomatic asthma [3,4]. This article reviews the current literature and updates the reader on the safety, efficacy, and clinical applications of leukotriene modifiers in the treatment of EIB.Various biologic signals (including receptor activation, antigen-antibody interaction, and physical stimuli such as cold) activate cytosolic phospholipase A2 to liberate arachidonic acid from membrane phospholipids [5]. The liberated arachidonic acid is then metabolized to various active compounds, including the leukotrienes LTB4, LTC4, LTD4, and LTE4 (Figure 1).LTC4, LTD4, and LTE4, formerly known collectively as slow-reacting substance of anaphylaxis, are collectively called the cysteinyl leukotrienes. The dose of LTD4 required to produce clinical bronchoconstriction has been estimated to be 1,000- to 10,000-fold lower than that of histamine or methacholine, which indicates that these mediators are extremely potent [5]. The cysteinyl leukotrienes exert their biologic effects by binding to cysteinyl leukotriene receptors (specifically subtype 1, CysLT1) on airway smooth muscle and bronchial vasculature, and they contribute to the bronchospasm, increased bronchial hyperresponsiveness, mucus production and mucosal edema, enhanced smooth-muscle cell proliferation,
The Physiologic Effects of an Acute Bout of Supramaximal High-Intensity Interval Training Compared with a Continuous Exercise Bout in Patients with COPD
Scotty J. Butcher,Madison T. Yurach,Nichole M. Heynen,Brendan J. Pikaluk,Karla J. Horvey,Ron Clemens,Darcy D. Marciniuk
Journal of Respiratory Medicine , 2013, DOI: 10.1155/2013/879695
Abstract: This study compared physiological responses and work performed during a supramaximal high-intensity interval exercise training session (HIIT) and a constant work rate (CWR) exercise session. Fourteen patients with COPD (mean FEV1?? % predicted (±SD)) completed an incremental cardiopulmonary exercise test (CPET) and a steep ramp anaerobic test (SRAT) and then two exercise bouts to symptom limitation on separate days, in random order: (1) a CWR trial at 80% of CPET peak work rate (mean ?W) and (2) a HIIT trial using repeats of 30?s at 70% of SRAT peak work rate (mean ?W) followed by 90 s at 20% of CPET peak work rate. Subjects ceased exercise primarily due to dyspnea for both HIIT and CWR (64% vs. 57%, resp.). End-exercise , HR, dyspnea, and leg fatigue were similar between the two exercise protocols. Average work rate was lower in HIIT than CWR (32 vs. 63?W, ); however, subjects performed HIIT longer (542 vs. 202?s, ) and for greater total work (23.3 vs. 12.0?kJ, ). The supramaximal HIIT protocol was well tolerated and demonstrated similar maximal physiologic responses to constant work rate exercise, but with greater leg muscle work performed and greater peak exercise intensity. 1. Introduction Chronic obstructive pulmonary disease (COPD) is recognized as one of the fastest growing chronic diseases leading to mortality [1]. The chief symptom of COPD is dyspnea on exertion leading to exercise intolerance and deconditioning [2]. Exercise training is a vital component of rehabilitation for patients with COPD; however, limitations on ventilation during exercise often prevent patients from attaining maximal cardiovascular and/or muscular responses. These limitations lead to significant deconditioning [3] and can impair their ability to physiologically adapt to training. High-intensity interval training (HIIT) is a method of exercise training whereby short periods of high intensity work are interspersed with periods of lower intensity recovery or rest. In many clinical populations, HIIT has achieved greater physiological adaptations than traditional exercise rehabilitation utilizing continuous constant work rate (CWR) exercise [4–7]. Although HIIT has been proposed as a method of addressing the reduced training effects in patients with COPD [8, 9], studies reported to date demonstrate that the physiological adaptations with HIIT are no different than those with CWR training [9–11], although HIIT may be better tolerated by patients than CWR training [11]. These studies, however, have typically set work rate for the high-intensity work interval using peak power
Can inhaled fluticasone alone or in combination with salmeterol reduce systemic inflammation in chronic obstructive pulmonary disease? – study protocol for a randomized controlled trial [NCT00120978]
Don D Sin, SF Paul Man, Darcy D Marciniuk, Gordon Ford, Mark FitzGerald, Eric Wong, Ernest York, Rajesh R Mainra, Warren Ramesh, Lyle S Melenka, Eric Wilde, Robert L Cowie, Dave Williams, Roxanne Rousseau, the ABC (Advair, Biomarkers in COPD) Investigators
BMC Pulmonary Medicine , 2006, DOI: 10.1186/1471-2466-6-3
Abstract: After a 4-week run-in phase during which patients with stable chronic obstructive pulmonary disease will receive inhaled fluticasone (500 micrograms twice daily), followed by a 4-week withdrawal phase during which all inhaled corticosteroids and long acting β2-adrenoceptor agonists will be discontinued, patients will be randomized to receive fluticasone (500 micrograms twice daily), fluticasone/salmeterol combination (500/50 micrograms twice daily), or placebo for four weeks. The study will recruit 250 patients across 11 centers in western Canada. Patients must be 40 years of age or older with at least 10 pack-year smoking history and have chronic obstructive pulmonary disease defined as forced expiratory volume in one second to vital capacity ratio of 0.70 or less and forced expiratory volume in one second that is 80% of predicted or less. Patients will be excluded if they have any known chronic systemic infections, inflammatory conditions, history of previous solid organ transplantation, myocardial infarction, or cerebrovascular accident within the past 3 months prior to study enrolment. The primary end-point is serum C-reactive protein level. Secondary end-points include circulating inflammatory cytokines such as interleukin-6 and interleukin-8 as well as health-related quality of life and lung function.If inhaled corticosteroids by themselves or in combination with a long-acting β2-adrenoceptor agonist could repress systemic inflammation, they might greatly improve clinical prognosis by reducing various complications in chronic obstructive pulmonary disease.Chronic obstructive pulmonary disease (COPD) represents an increasing burden worldwide and is reported to be the sixth leading cause of death in 1990 [1] and the fourth in 2000 [2]. Discouragingly, by the year 2020, its mortality rate will rank third, only behind stroke and heart disease [1]. Although these figures are alarming, they are likely to be gross underestimates of the true health and economic burden
Bronchodilator Responsiveness and Reported Respiratory Symptoms in an Adult Population
Wan C. Tan, Jean Bourbeau, Paul Hernandez, Kenneth R. Chapman, Robert Cowie, J. Mark FitzGerald, Shawn Aaron, Darcy D. Marciniuk, Francois Maltais, A. Sonia Buist, Denis E. O’Donnell, Don D. Sin
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058932
Abstract: Background The relationship between patient-reported symptoms and objective measures of lung function is poorly understood. Aim To determine the association between responsiveness to bronchodilator and respiratory symptoms in random population samples. Methods 4669 people aged 40 years and older from 8 sites in Canada completed interviewer-administered respiratory questionnaires and performed spirometry before and after administration of 200 ug of inhaled salbutamol. The effect of anthropometric variables, smoking exposure and doctor-diagnosed asthma (DDA) on bronchodilator responsiveness in forced expiratory volume in 1 second (FEV1) and in forced vital capacity (FVC) were evaluated. Multiple logistic regression was used to test for association between quintiles of increasing changes in FEV1 and in FVC after bronchodilator and several respiratory symptoms. Results Determinants of bronchodilator change in FEV1 and FVC included age, DDA, smoking, respiratory drug use and female gender [p<0.005 to p<0.0001 ]. In subjects without doctor-diagnosed asthma or COPD, bronchodilator response in FEV1 was associated with wheezing [p for trend<0.0001], while bronchodilator response for FVC was associated with breathlessness. [p for trend <0.0001]. Conclusions Bronchodilator responsiveness in FEV1 or FVC are associated with different respiratory symptoms in the community. Both flow and volume bronchodilator responses are useful parameters which together can be predictive of both wheezing and breathlessness in the general population.
Intestinal mucosal atrophy and adaptation
Darcy Shaw,Kartik Gohil,Marc D Basson
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i44.6357
Abstract: Mucosal adaptation is an essential process in gut homeostasis. The intestinal mucosa adapts to a range of pathological conditions including starvation, short-gut syndrome, obesity, and bariatric surgery. Broadly, these adaptive functions can be grouped into proliferation and differentiation. These are influenced by diverse interactions with hormonal, immune, dietary, nervous, and mechanical stimuli. It seems likely that clinical outcomes can be improved by manipulating the physiology of adaptation. This review will summarize current understanding of the basic science surrounding adaptation, delineate the wide range of potential targets for therapeutic intervention, and discuss how these might be incorporated into an overall treatment plan. Deeper insight into the physiologic basis of adaptation will identify further targets for intervention to improve clinical outcomes.
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