Browsing by Author "Šablinskis, Matīss"

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    Individualized home-based exercise program for idiopathic pulmonary arterial hypertension patients : A preliminary study
    (2019) Butane, Lina; Šmite, Daina; Šablinskis, Matīss; Skride, Andris; Rīga Stradiņš University
    Background: Exercise-based rehabilitation has been proved as a benefi cial additional non-pharmacological treatment in patients with stable pulmonary arterial hypertension (PAH). Majority of studies include hospital-based supervised programs. To improve patient accessibility to this important intervention and long-term efect the research on home-based programs is warranted. The purpose of our study was to evaluate the adherence, safety, training efects of 12-week individualized home-based exercise program in patients with idiopathic PAH. Methods: This was a prospective pilot uncontrolled interventional study. Six patients with iPAH confi rmed by right-heart catheterization from the Latvian PAH registry were selected. A 12-week exercise program adaptable for each patient's functional state and home environment was created. The program included muscle strength training, respiratory, aerobic exercise and neuro-muscular relaxation techniques, self-control monitoring, weekly phone control and on-site re-assessment by physiotherapist were parts of the program to ensure both individualized adjustments and proper execution, and to maximize clinical safety. The primary outcome measures for training efects were exercise capacity, breathing pattern and quality of life, for adherence days of performance, for safety any event of "alarm sign" indicators during exercising, incomplete recovery, worsening of PH symptoms. Results: The results showed a rather high degree of adherence to the prescribed exercise regimen (in average 92.5%). No adverse events were observed during the course of the program. The results proved the importance of ensuring optimal self-control skills both for objective measures and subjective symptoms. The 6-minute walking test (6MWT) results show that the developed program signifi cantly improves exercise capacity (mean improvement 39 ± 17.5 m). In four participants (66.7%) the minimum clinically important diference (MCID) for 6MWT distance in PAH patients was observed (25-33 m). Signifi cant improvement in chest excursions confi rm changes in breathing pattern suggesting better engagement of diaphragm during breathing after the program. Results did not show signifi cant improvements in either SF-36 survey domain. However, half of the participants reached MCID (11%) after the program at the physical health subscales. Conclusion: The results of this preliminary study prove that the created individualized home-based exercise program is safe, easily followed and allows progression in exercise intensity and improves physical functional state in clinically stable iPAH patients. This study hypothesis supports the need for RCT to continue research and approve the results.
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    Individually tailored 12-week home-based exercise program improves both physical capacity and sleep quality in patients with pulmonary arterial hypertension
    (2021) Butāne, Līna; Šablinskis, Matīss; Skride, Andris; Šmite, Daina; Rīga Stradiņš University
    Background: Most patients with optimal PAH-targeted medical therapy suffer from clinical symptoms, reduced exercise tolerance and have a poor quality of life. The 2019 European Respiratory Society task force statement on physical exercise and rehabilitation in patients with severe, chronic PH suggests that individually adjusted and monitored exercise programs are likely to be safe for PH patients, who are clinically stable on medical therapy. Currently, the development of PAH-specific rehabilitation interventions is still in the research stage. We present the preliminary results of a more extensive study with the aim to show the effectiveness of a 12-week individualized, home-based exercise program in promoting physical capacity, quality of sleep and reducing signs of emotional distress in patients with PAH. Methods: This was a prospective randomized controlled interventional study. 16 PAH patients were included in the analysis. Training group underwent a complex training program, consisting of 12-week individually tailored home-based exercise training, education, self-control measures and tele-rehabilitation components. The program included muscle strength training, respiratory, aerobic exercise and relaxation techniques. Results: A statistically significant mean increase in 6MWT distance was observed for the training group (Δ = 51.7 ± 45.1 m). In six participants (66.7%) from the training group and two patients (28.6%) from the control group, the minimal clinically significant difference for 6MWT distance was observed (25–33 m). IPsubmax test results changed significantly in training group (Δ = 9.8 ± 4.7 cm H20). PSQI values sleep quality improved from poor to good in four (44.5%) patients from training group. HADS sub-scales scores values confirmed clinically important reduction of anxiety symptoms in both groups. Depression symptoms did not show clinically important changes. No adverse events were observed. Conclusion: The studied 12-week individually tailored home-based exercise program is effective in stable PAH patients by improving physical functional capacity, as well as sleep quality. Further studies are required to solidify the methodology of exercise programmes in the field of PAH. These are the preliminary results of ongoing study.
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    Individually tailored home-based physiotherapy program makes sustainable improvement in exercise capacity and daily physical activity in patients with pulmonary arterial hypertension
    (2022-11) Butāne, Līna; Spilva-Ekerte, Liene; Šablinskis, Matīss; Skride, Andris; Šmite, Daina; Rehabilitācijas fakultāte; Department of Internal Diseases
    BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare, chronic, progressive, and life-threatening cardiopulmonary disease. This study investigated the impact of an individually tailored 12 weeks home-based physiotherapy program in PAH patients, with the aim to evaluate change in exercise capacity and daily physical activity level. METHODS: This was an analysis of secondary outcomes from a prospective, randomized, controlled intervention study. Twenty-one participants were recruited from the Latvian PH registry based on inclusion criteria and randomized in a training group (TG) and control group (CG). Both groups continued a medical target therapy, but for TG, the individually tailored home-based physiotherapy program was added including physical exercises, relaxation, self-control, education, and supervision with telehealth elements. Outcomes included a 6-min walk test (6MWT) (m) and daily physical activity based on accelerometry results assessed at baseline, after 12 weeks, and at follow-up 6 months after commencement of intervention. RESULTS: 6MWT distance significantly (p < 0.05) and clinically (>33 m) increased within TG after 12 weeks (51.8 m, 95% CI = 25.7-77.9 m, Cohen's d = 1.7) and at follow-up (75.5 m, 95% CI = 46.1-104.8 m, Cohen's d = 2.1). A significant difference in 6MWT results between the groups at 12 weeks and follow-up was approved. In TG, low-intensity activities significantly (p < 0.05) increased both after 12 weeks (Cohen's d = 1.6) and at follow-up (Cohen's d = 1.2), moderate-intensity activities significantly (p < 0.05) increased at follow-up (Cohen's d = 1.3), and no significant improvements were present in CG. CONCLUSION: The individually tailored 12 weeks home-based physiotherapy program comprising comprehensive physical exercise training, relaxation, self-control skills training, and education, added to stable medical target therapy and supervised by physiotherapist through telehealth elements, is effective in improving exercise capacity and increasing daily time in low or moderate physical activities 6 months after commencement of the intervention in patients with PAH.