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By Editorial Team | on February 23, 2023

The Towns spring co-ed recreational programs have consistently proven to be one of the most popular programs the Town offers each year, as they provide a terrific outlet for our residents to exercise and stay in shape, said Town Councilwoman Laura Maier. The Towns Parks Department has done an amazing job offering residents the opportunity to take advantage of these classes and stay physically active, creating an optimal environment for fitness and forging new friendships!

This April, residents can participate in a variety of fitness classes that will be held at the Hicksville Athletic Center:

Online registration begins Monday, March 6 at 5 p.m. at http://www.oysterbaytown.com/portal. You must upload proof of residency (tax or utility bill) and a valid identification card such as a drivers license.

In-person registration will be available at the Hicksville Athletic Center, located at 167 S. Broadway in Hicksville, on Tuesday, March 7, from 5 p.m. to 9 p.m. The schedule is subject to change. If a session is cancelled, make-up day(s) will be attempted. Class fees are $60 for residents and $70 for non-residents (checks or money orders only). Proof of residency/age required when registering, with TOB residents given first preference. Participants must bring their own mat to yoga and Pilates. For more information, call(516) 797-7945 or email tobparks@oysterbay-ny.gov.

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Town offers fitness classes for spring - The Mid Island Times

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Swimming is one of the activities that people of all ages enjoy. Apart from being a popular sport in many countries, it is also a great way to bond with families and friends during summer. Swimming is not only enjoyable, but it can help you to stay fit and healthy!

Since it is a low-impact activity, many older adults and young children prefer this type of exercise to promote both physical and mental health.

Competitive swimming is for people who want to take this sport to a competitive level. During the Olympics, swimming remains one of the marquee events, with many people watching the games and rooting for their favourite swimmer.

Competitive swimming requires numerous hours of training over prolonged periods. Olympians start very young and spend most of their time training for specific swimming events. As elite athletes, Olympian swimmers show the power and benefits of this sport. These swimmers demonstrate how swimming is a vigorous workout while introducing fans to the thrill of competitive sports.

During competitive swimming, the main strokes used are:

All people of all ages can enjoy swimming as a recreation. This type of swimming provides people with a low-impact workout. Further, it is also an excellent way to feel good and relax with friends and family.

Similar to competitive swimming, there are also four common swimming styles:

Swimming is an essential full-body exercise workout as you swim against the resistance of the water.

Any type of exercise is better than no exercise at all. One of the most common forms of exercise is walking, which is feasible for many people as it is a low-impact activity and can be done anytime indoors or outdoors. Running is another common exercise since it is an extension of walking. Next to these two exercises is swimming. Considered an all-body workout, swimming also dramatically improves cardiovascular fitness.

In a study published in the International Journal of Aquatic Research and Education [1], investigators examined the association between swimming, running, and walking on all-cause mortality of 40 547 men aged 20 to 90. All the participants completed a health examination from 1971 to 2003 for 32 years. The investigators observed 543,330 person-years and recorded 3 386 deaths. After adjusting for body-mass index, age, alcohol intake, smoking, and family history of cardiovascular disease, the researchers found out that the swimmers had the lowest all-cause mortality risk compared with walkers, runners or those with a sedentary lifestyle.

Results showed that swimmers had 53% lower all-cause mortality risk than sedentary people. When compared with walkers or runners, swimmers had a 50% and 49% lower risk of all-cause mortality, respectively. The investigators, who are faculty members of the Exercise Science Department of the University of South Carolina, Columbia, concluded that swimmers had lower mortality rates than sedentary people, runners and walkers. After the longitudinal study, all participants were followed-up for an additional 13 years. At the end of the follow-up period, only 2% of the swimmers died compared with 8% of runners. Meanwhile, 9% of the walkers and 11% of non-exercisers died during the follow-up period.

Swimming is a crucial all-over workout since it works both the lungs and the heart. This workout trains the body to use oxygen more efficiently. As a result, the breathing and resting heart rates reduce following years of a swimming workout. For instance, the resting heart rate for non-athletes is 60-70 beats per minute. In contrast, swimmers have a resting heart rate of 40-60 beats per minute, demonstrating oxygen efficiency. Non-athletes have a normal breathing rate of 12-20 breaths per minute. However, the fitter you are, the lower your breathing rate. For competitive swimmers, the breath rate may be as low as eight breaths/per minute.

Since swimming uses both arms and legs and other muscle groups, it improves flexibility and muscle strength.

Regular swimming can improve physical strength and composition in middle-aged women and reduce blood lipid levels. A study [2] published in the Journal of Exercise Rehabilitation recruited a total of 24 middle-aged women who were assigned to the swimming group and a control group. The average age in the swimming group was 45.5 years, and 47.2 in the control group. There were no significant differences in each groups height, weight and BMI.

Women in the swimming group performed exercises for 60 minutes thrice a week for a total of 180 minutes. The exercise sessions lasted for 12 weeks. The control group did not engage in any exercise during the duration of the study.

Results indicated significant differences in physical composition between the swimming and control groups at the end of the study. There were also substantial differences in physical strength, cardiovascular endurance and flexibility between groups. There were significant differences in total cholesterol between the groups.

Although the study had a relatively small sample size, the findings are significant since it adds to evidence of the effectiveness of swimming in reducing body fats, increasing a persons physical strength and reducing the risk of cardiovascular disorders.

Results are also essential when promoting longevity among middle-aged women. This study showed that swimming is an excellent exercise in improving strength and flexibility, reducing body fats and reducing the risk of cardiovascular disease in older women. Since swimming minimizes the stress in joints, it would help middle-aged women with pain in their knee joints engage in exercise that does not negatively impact their joints.

People with osteoarthritis and associated joint pain would find it difficult to perform exercises such as walking and running. However, the good news is they can exercise through swimming. Swimming is known to be an ideal form of exercise for patients with joint pain and arthritis.

Osteoarthritis is the most common form of arthritis and a significant cause of pain and physical disability. The knee is recognized as the most commonly affected joint. Risk factors associated with knee osteoarthritis include increased age and body-mass index, female gender, prior ACL tears, prior history of trauma, and meniscal damage or surgery [3].

A randomized trial [4] published in the Journal of Rheumatology enrolled a total of 48 middle-aged and older adults who did not engage in any exercise. All participants were diagnosed with osteoarthritis. The participants were randomly assigned to a cycling exercise training and swimming group. Exercise training was performed three times a week, 45 minutes per day, at 60-70% heart rate reserve for three months or 12 weeks.

Results of the study showed significant reductions in stiffness and pain in the joints and physical limitation in both groups. Further, all also reported significantly increased quality of life. Both groups also increased their functional capacity and distance covered during the six-minute walk. There were no significant differences in the magnitude of improvements between cycling and swimming training.

It should be noted that the most frequently prescribed exercise for those with osteoarthritis is cycling training. However, joint pain and stiffness due to osteoarthritis can be reduced while functional capacity and muscle strength improve with swimming exercise programs. Since swimming is a low-impact activity, it is ideal for middle-aged to older adults with osteoarthritis.

Meanwhile, a retrospective longitudinal study [5] published in the Physical Medicine and Rehabilitation journal evaluated the relationship between knee pain, symptomatic knee osteoarthritis, radiographic knee osteoarthritis and history of swimming. Investigators included a total of 2,637 participants who have a mean age of 64.3 years. The participants mean BMI was 28.4 kg/m2. There were 44.2% males and 55.8% females.

The studys findings revealed that the prevalence of frequent knee pain was 36.4% for those with a history of swimming compared with 39.9% for those with no history of swimming. Only 54.3% in the swimming group had radiographic knee osteoarthritis compared with 61.1% in the non-swimming group. Symptomatic knee osteoarthritis prevalence was also lower in the swimming group (21.9%) compared with the non-swimming group (27.0%).

Since the study was population-based, it was the first to indicate that swimming could potentially improve knee health, especially when swimming is done before age 35 and continues throughout life. Although more prospective studies are needed to examine the relationship between swimming and knee osteoarthritis in older age groups, the findings are reassuring since they showed that swimming could benefit knee health.

Chronic stress is recognized as one of the significant mental health issues worldwide. Unsurprisingly, exposure to chronic stress can lead to other physical and mental health conditions. Specifically, chronic stress can affect our cognition and brain functioning. Recent studies [6] suggest that chronic stress is linked to psychiatric disorders such as anxiety and major depressive disorders. To treat anxiety and depression, a variety of medications and nonpharmacologic methods have been proposed. One of the nonpharmacologic methods includes exercise.

Animal studies show that exercise releases hormones that moderate stress and anxiety. In human and non-human studies, swimming can reduce anxiety symptoms, cortisol levels, and inflammatory markers.

An animal study [7] published in the International Journal of Environmental Research and Public Health examined the effects of swimming on corticosterone and anxiety-like behaviours in unstressed and stressed rats.

Findings indicated that self-paced swimming training could lessen anxiety parameters and concentrations of corticosterone, a hormone associated with stress. Interestingly, exercise can reduce stress-related hormones in both stressed and unstressed rats. In stressed rats, apart from swimming, they needed a recovery period to minimize corticosterone levels. Overall, this animal study demonstrated the effectiveness of swimming exercises in lowering hormone levels associated with stress and reducing anxiety.

A YouGov poll [8], which Swim England commissioned, examined if swimming can reduce anxiety symptoms amongst 1.4 million adults in Britain. Findings showed that 492,000 participants with mental health conditions reported that swimming reduced the number of their mental health visits to their medical professionals. In addition, more than 490,000 of those surveyed said their healthcare practitioners had advised them to reduce or stop medications for their mental health conditions. They attributed swimming as the reason why they had better mental health and were no longer required to take medications for their mental health conditions.

The benefits of swimming were also examined during the survey. About 43% of the participants in the YouGov poll who are regular swimmers stated that swimming made them feel happier. Another 26 per cent indicated that swimming helped them feel motivated to complete their daily tasks. Another 15% believed that swimming helped them feel that life is more manageable.

UKs chair of the Swimming and Health Commission, Ian Cumming [8], stated, Physical activity in any form can have a positive impact on a persons mental health, but swimming is unique because the buoyancy of water ensures everyone can take part at a pace that suits them. It is perfect for people with restricted movement.

Research shows that simply being in water can be restorative, particularly swimming outside. People relax in many ways some set a target and aim to beat their time, while others prefer a more leisurely swim on their own or with friends. Swimming provides that choice, and if it is regularly prescribed alongside other support forms, swimming could impact wider society.

Swimming is a sport or exercise that you can continue until age. However, research shows that other forms of exercise benefit the heart and muscles of the body while also improving mood. Hence, you can take up swimming along with another exercise regimen such as dancing, walking, cycling or running.

Although swimming is an excellent exercise programme and improves your health and mood, it does not do much for your bone health. Hence, many doctors advise those who take up swimming as a hobby and sport to supplement this with strength training and activities such as climbing stairs, gardening, or strength training. Other forms of weight-bearing exercises are also highly recommended to improve bone health.

It is easy to get started in swimming. As a recreational and competitive sport, it can be done by young children to older adults. Hence, it fits all age groups, fitness and skill levels.

You can contact your local public swimming pools and aquatic centres offering swimming lessons for all age groups and fitness levels. Public pools have minimal entry fees and can help you start swimming.

When planning to swim, it is vital to ensure your safety and the safety of your children and others:

Swimming is best known for improving cardiovascular health and improve mood. It can be done by anyone of all ages and at different fitness levels.

To reap the benefits of exercise, you do not need to swim long distances or several laps. You can walk through the water since it is safe for your joints and does not have the same impact on your knees as land-based activities such as running and walking.

You can also tread in water, a fun way to bond with your families and friends while challenging your cardiovascular system. In addition, there are classes such as aqua aerobics and aqua Zumba that increase the resistance of moving in the water.

For those who are more adventurous, you can start plyometric exercises in the pool. These exercises increase the bodys power and strength without the risk of overtraining your body. Some examples of plyometric exercises include running underwater with weights.

A body of evidence from published studies well supports the benefits of swimming. However, recent studies suggest swimming lessons could significantly impact their cognitive and motor development, especially among babies and young children.

Investigators from the University of Romes Department of Movement, Human and Health Sciences [9] conducted a pilot trial on the effects of swimming on babies motor and cognitive development. Investigators recruited 27 babies and randomly assigned them to a 10-week swimming intervention and a control group.

Results showed that infants in the experimental group demonstrated significant improvements in fine, gross and total motor skills compared with the control group. Likewise, there were also significant improvements in the cognition of the experimental group. Although the study had a very small sample size and would require further validation in more extensive trials, the results are promising since they showed that early swimming training could improve babies motor and cognitive skills.

The benefits of swimming on cognition may also be seen amongst older people. An animal study published in the Physiological Reports journal [10] reported that swimming exercise improves long-term and short-term memories in animal model studies. The animals in the study were subjected to training exercises of 60 minutes per day for five days a week. The animals exercised for a month. Results indicated that both short and long-term memory significantly improved even at seven days of training but plateaued in the following days until 28 days of training.

The findings of this animal model study could form a basis for the future use of exercise in healthy individuals.

Swimming is a vital exercise that you can enjoy at any age and fitness level. Start reaping its benefits now by consulting your doctor to determine if it is safe for you to take swimming lessons or engage in swimming activities.

The many benefits of swimming are well supported in high-quality studies. These include improvements in cardiovascular health, mood, and overall mental health and well-being. Since it is a low-impact activity, it is safe for both young and old and middle-aged people. This type of exercise is highly beneficial for those with osteoarthritis since it does not put weight on the knee joints.

In young children and babies, it is also reported that swimming can improve both motor skills and cognition. In middle-aged to older adults, swimming can improve short- and long-term memory.

Finally, swimming improves mood and well-being by reducing hormones related to stress and anxiety.

[1] https://ndpa.org/directory-drowning_lit/listing/swimming-and-all-cause-mortality-risk-compared-with-running-walking-and-sedentary-habits-in-men/|[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625655/%5B3%5D https://pubmed.ncbi.nlm.nih.gov/18759314/%5B4%5D https://pubmed.ncbi.nlm.nih.gov/26773104/%5B5%5D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166141/%5B6%5D https://pubmed.ncbi.nlm.nih.gov/31039481/%5B7%5D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558513/%5B8%5D https://www.swimming.org/swimengland/new-study-says-swimming-benefits-mental-health/%5B9%5D https://journals.sagepub.com/doi/abs/10.1177/00315125221090203%5B10%5D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191402/

The information included in this article is for informational purposes only. The purpose of this webpage is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Swimming: types, benefits, importance and research - Longevity.Technology

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Name something that COVID didnt ruin. OK, so maybe its responsible for an uptick in remote work, which isnt all bad, but for the most part that useless virus has given society a real gut punch and its just now finally starting to recover.

Thats why the focus of this years TEDxCharleston event the grassroots initiative featuring local speakers speaking passionately about topics ranging from health to social issues, technology and more is a celebration of our culture coming out of a tough stretch, tougher and smarter for the experience.

According to organizers, the past two-plus years have created a world fraught with new challenges and risks but new opportunities as well.

Creativity, innovation and thoughtfulness are all needed to deal with this new reality, the events website states. An exciting lineup of speakers and performers will explore many important and inspiring ideas at the event, appropriately themed Re-Emerge.

TEDxCharleston draws nearly 1,000 in-person participants each year, not including an extensive online following. This year marks the 10thyear of the event, which will be held at Charleston Music Hall on March 29.

Three of the 20 scheduled speakers/performers are MUSCs very own: surgical oncologist Andrea Marie Abbott, M.D.; trauma surgeon Ashley Hink, M.D.; and neurosurgeon Alejandro Spiotta, M.D.

Abbott, who serves as director of MUSC Healths Melanoma Program, specializes in the treatment of breast and skin cancers. Communication is something the surgeon really values. Her talk will focus on how all people, not just in health care, can better achieve their goals through communication that is calm, concise and honest.

Hink, who is passionate about eliminating gun violence in our community, not just treating those who have been hurt, has been instrumental in establishing several new programs and initiatives in and around the Charleston area. Hink plans to speak about how health care systems can work with survivors and communities to break cycles of violence by addressing its root causes.

Spiotta, a professor of neurosurgery and neuroendovascular surgery and vice chair of the Department of Neurosurgery at MUSC, has devoted much of his professional career to studying and treating cerebrovascular disease. During his career, hes performed thousands of complex, high-stakes brain surgeries in record time through deep focus and mindfulness. During his TEDx talk, he will get into how those same techniques can help with everything from exercise to finding success in the workplace.

For more information, visit http://www.tedxcharleston.org.

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'Re-emerging' from most uncertain times | MUSC | Charleston, SC - Medical University of South Carolina

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Patients in cardiac rehab program go from wheelchair to walking track in 12 weeks

Betty Berendzen works with a patient in the cardiac rehab program, taking his blood presure. (KRCG 13)

Capital Region Medical Center's cardiac and pulmonary rehabilitation programs at the Sam B. Cook Healthplex are designedto help the patient live their life with all their heart.

And Betty Berendzen, a registered nurse and cardiac rehab supervisor with the program, said the progress she sees is incredible.

Focus on Your Health

"They come in in a wheelchair, they come in on a walker, they come in on oxygen and they graduate walking. And that is rewarding," Berendzen said.

Patients in the program have had heart attacks, undergone heart surgery or lung transplants, or experience regular chest pain.

The program requires a physician referral and is highly specialized.

"Each patient has an individualized treatment plan so their first day they do a 6-minute walk and then we base an exercise program on that," Berendzen said.

"You know we start slow and build up. We want them to graduate and be able to do 150 minutes of cardiovascular activity each week," she said.

The team of nurses and exercise specialists works side by side with the patients during the 12-week, EKG monitored program while they do exercises, stretches, and lots of walking.

"We do use the track at the Healthplex or the treadmills because we want people to walk. If you can't walk then we feel like you can't have your independence," Berendzen said.

"We have different stepping machines, just moving the legs working the leg muscles and then the arms, people think it's just the arm work but not really it opens up the cardiothoracic area and helps with breathing and helps with healing and that too," she said.

The general goal of the program is better heart health, but Berendzen said every patient has their own motivation to graduate.

"Whether it's to walk a 5K with family or to get down and do stuff with their grandkids and that sort of thing, or to get back to work. When they achieve that and see the light in their eyes it's just pretty rewarding," she said.

For more information about the program visit the Capital Region Medical Center website, crmc.org.

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Patients in cardiac rehab program go from wheelchair to walking track in 12 weeks - krcgtv.com

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Introduction

Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. It is usually caused by significant exposure to noxious particles among which tobacco smoking is the main factor in France.1 Despite being preventable and treatable, COPD prevalence is still increasing and represents a major source of morbidity, mortality and a significant economic burden.2 Progression of the disease is associated with increased respiratory disability and health-related quality of life (HRQoL) alteration.

Pulmonary rehabilitation (PR) is an effective and comprehensive treatment for COPD patients combining retraining exercises, therapeutic education, nutritional and psychological supports but remains underused.3 Therefore, new models have emerge last years to improve access to PR such as home-based PR programs, which are useful for patients living far from PR centers and were also shown interesting for limiting contact during the SARS-CoV2 epidemic.4 However, impact of comorbidities on PR outcomes, particularly with these new PR modalities, is not well known.

Cardiovascular diseases such as ischemic heart disease, arrhythmia, heart failure, peripheral arterial diseases and metabolic disorders such as arterial hypertension and diabetes mellitus are frequently associated with COPD.5 These associations may be related to common underlying molecular mechanisms, but also to common risk factors such as smoking and decreased physical activity.6,7 These comorbidities were reported to be associated with higher symptoms burden and lower HRQoL in COPD.8 Moreover, cardiovascular diseases are associated with prolonged hospital length of stay after acute exacerbation of COPD and with increased mortality.9,10 However, it is proven that cardiac rehabilitation is effective in improving exercise capacity and HRQoL in patients with cardiovascular diseases.11 Only a few studies have evaluated the impact of cardiovascular comorbidities on PR-related outcomes in COPD patients and reported contrasting results.1216 Furthermore, all of these studies were center-based and none evaluated benefits up to a year after the end of the PR program.

The aim of our study was to determine whether established cardiovascular diseases and metabolic comorbidities impacted long-term effects of a home-based PR program on exercise capacity, HRQoL and anxiety-depression in COPD patients.

Data of all consecutive COPD patients addressed for the FormAction home-based PR program between January 2010 and June 2016 were prospectively collected in the computerized medical record CARE ITOU and retrospectively analyzed. All patients were addressed by a respiratory physician who confirmed the diagnosis of COPD according to GOLD definition and checked for absence of PR contraindications, ie active lung cancer, unstable cardiovascular disease, significant cognitive disorders, uncontrolled psychiatric illness, neurological sequelae or major osteoarticular restrictions.17 The choice of home-based vs center-based PR was determined according to patients wishes and/or lack of PR center close to their home. Adverse events and reasons for withdrawals were recorded with a systematic assessment of their relationship to the program. The study protocol was conducted in accordance with the Declaration of Helsinki and approved by the Observational Research Protocol Evaluation Committee of the French Society of Respiratory Disease (CEPRO 2017007). All participants signed a written informed consent prior to the start of the program which included their approval to use the collected data for research purposes and the computerized medical record declared to the National Commission for Informatics and Liberties.

Comorbidities were self-reported by patients and then completed and corrected from medical reports provided by the patient and their respiratory physician. Comorbidities were then registered in the computerized medical record when patients entered the PR program. Patients with a diagnosis of ischemic heart disease, chronic heart failure, cardiac arrhythmias, pulmonary hypertension or peripheral arterial disease were classified as having at least one established cardiovascular disease (Cardiovascular group). Patients without previous cardiovascular comorbidities but with at least one comorbidity used to diagnose a metabolic syndrome, ie hypertension, hypercholesterolemia, diabetes mellitus, or obesity (defined by a body mass index [BMI] 30 kg/m2) were classified as having metabolic comorbidities (Metabolic group). Patients having both metabolic and cardiovascular comorbidities were classified in the Cardiovascular group. Finally, patients who were not classified in these two groups were considered with no cardiovascular and metabolic comorbidities and considered as the Reference group. Underweight was defined by a BMI 21 kg/m2.18

Our home-based PR program was described in previous studies.19 Briefly, this 8-week program included exercise training and physical activities, therapeutic education, nutritional support and behavioral and motivational approaches. Patients were supervised in-person by a member of the PR team during a weekly 90-min session and encouraged to continue exercises the rest of the week in autonomy and after the end of the PR program. Patients started with individual endurance exercises on a cycle ergometer at the target heart rate in 10-min sequences, at least 5 days per week, with the goal of reaching 3045 min per sequence in one or several sessions. After the end of the program, the PR team performed home-visits at 6 and 12 months to assess encountered difficulties, find solutions and strengthen patients and caregivers motivation.

Assessments were performed at baseline before the PR program (M0), immediately at the end of the program (M2), and at 6 and 12 months after its end (M8 and M14, respectively). Exercise capacity was assessed using the 6-min stepper test (6MST) that measures the number of steps performed in 6 min on a stepper with a minimal clinically significant difference (MCID) of 40 steps.20,21 Health-related quality of life (HRQoL) was assessed using the visual simplified respiratory questionnaire (VSRQ) ranging for 0 (worse) to 80 (better) with a MCID of 3.4 points.22 Finally, anxiety and depression were assessed using the hospital anxiety and depression scale (HAD) distinguishing overall score, and anxiety and depression sub-scores. These scores increase with anxiety and depression with a MCID of 1.5 points for each score and sub-scores.23

Quantitative variables are expressed as means standard deviation (SD) and categorical variables are expressed as frequencies (percentage). Among patients who initiated PR, differences in baseline characteristics between patients evaluated and those not evaluated at 12 months after end of PR (due to death or loss to follow-up) were assessed by calculating the absolute standardized difference (ASD); an ASD >20% was interpreted as a meaningful difference. Comparisons in baseline characteristics between the three groups were performed using one-way analysis of variance (ANOVA) for quantitative variables or chi-squared tests for categorical variables. Evolution of outcomes (HRQoL, exercise capacity, anxiety, and depression) from baseline (M0) to M2, M8 and M14 were analyzed using linear mixed models for repeated measures (an unstructured covariance pattern model to account the correlation between repeated measures) by including time as fixed effect. Comparisons in evolution of outcomes from baseline (M0) to M2, M8 and M14 between the three groups were also performed using linear mixed models including groups, time, interaction time*groups, baseline outcome values and predetermined confounding factors (age, sex, BMI, FEV1, and long-term oxygen therapy (LTOT) status) as fixed effects;24 post hoc comparisons of 2-, 8- and 14-month changes were done using linear contrasts. Comparisons in evolution of outcomes between the three groups were also done after excluding underweight patients as a sensitivity analysis. Normality of residuals of linear mixed models were checked using quantile-quantile (Q-Q) plots. All statistical tests were done at the two-tailed level of 0.05 without correction for multiple comparisons. Data were analyzed using SAS software version 9.4 (SAS Institute, Cary, NC, USA).

Four hundred and nineteen consecutive COPD patients were addressed to the home-based PR program, among which 413 started the program and 380, 333, and 303 were evaluated at M2, M8 and M14, respectively (Figure 1). None of them had any contraindication to PR and no incident related to the PR program was reported. The population included 67% men. The mean age was 64.111.2 years. Most patients had severe COPD (mean FEV1 39.217% predicted, 66.3% GOLD stages III and IV) and were ex-smokers (80.9%) with cumulative smoking estimated at 4830 pack-years (Table 1). Only 23.6% did not receive LTOT, noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP). The most prevalent reported comorbidities were hypertension (40.8%), obesity (30.7%), underweight (22.8%), hypercholesterolemia (22.4%), ischemic heart disease (22.2%) and diabetes (21.7%) (Tables 1 and 2). Other self-reported comorbidities are detailed in Supplementary Table 1. One hundred and twenty-two patients (29.1%) were classified as having metabolic comorbidities without an established cardiovascular disease (Metabolic group) and 102 patients (24.3%) as having no cardiovascular nor metabolic comorbidities (Reference group). Therefore, 195 patients (46.5%) were classified as having at least one established cardiovascular disease (Cardiovascular group). Altogether, 83% had at least three reported comorbidities. The 110 patients who initiated the program and were lost to follow-up during the 14 months were more likely to have an established cardiovascular comorbidity, to be underweight, to present a very severe airflow limitation and to require LTOT or NIV (Supplementary Table 2).

Table 1 Baseline Description of the Population

Table 2 Patients Reported Cardiovascular and Metabolic Comorbidities

Figure 1 Flowchart of the whole population.

Abbreviation: PR, pulmonary rehabilitation.

At baseline, patients performed 3099 steps during the 6MST and had an altered HRQoL reflected by a low VSRQ score (31.10.8) (Supplementary Table 3). They exhibited elevated anxiety and depression scores (9.70.2 and 8.00.2, respectively) with 52% and 34% of them showing anxiety and depression scores greater than or equal to 11, respectively. Patients from the Cardiovascular group were more often men (73.8%), were older (mean age 68.59.6 years) and more frequently treated with LTOT and NIV (Table 1). Patients from Metabolic and Cardiovascular groups had a higher BMI (30.56.7 and 28.18.1 kg/m2, respectively, vs 21.23.8 kg/m2 for the Reference group) and were more often treated with CPAP (13.1 and 8.7%, respectively, vs 1% for the Reference group). Proportion of GOLD stage IV COPD was higher in Reference group (45.6% vs 23.6% and 37.5% in Metabolic and Cardiovascular groups, respectively) while GOLD stages I and II COPD were more frequent in Metabolic group (29.2% vs 17.8% and 19.9% for Reference and Cardiovascular groups, respectively). At baseline, patients from Cardiovascular group performed significantly fewer steps on the 6MST (272141 steps vs 343161 and 339164 for Reference and Metabolic groups, respectively), while VSRQ and HAD scores were similar between the three groups (Supplementary Table 4). Taking into account only patients evaluated at M2 and after adjustment to age, sex, BMI, FEV1 and LTOT status, the three groups were similar for all baseline assessments (Table 3).

Table 3 Absolute Variations of Exercise Capacity, Quality of Life and Anxiety-depression for each Group of Patients

In the whole population, all outcomes significantly improved between baseline and the end of the program (M2), 6 months (M8) and 12 months after PR completion (M14) (Table 4). After adjustment on age, sex, BMI, FEV1, and LTOT status, changes in all outcomes remained significant for all three groups for all three assessments (M2, M8 and M14), except for the 6MST at M8 and M14 in Reference group (Table 5). The proportion of patients exceeding the MCID for at least one of the outcomes, ie HRQoL, anxiety-depression or exercise capacity, was 69.8%, 56.7%, and 50.7% at M2, M8 and M14, respectively (Figure 2). When comparing groups to each other, mean HAD global score was significantly more improved at M14 in patients from Metabolic group versus the two other groups and depression subscore at M14 between Metabolic and Cardiovascular groups (Table 3). There were no significant differences between groups for other time point and outcomes. Results were similar after exclusion of underweight patients (Supplementary Table 5).

Table 4 Absolute Variations of Exercise Capacity, Quality of Life and Anxiety-depression for the Whole Population

Table 5 Comparisons to Baseline of Exercise Capacity, Quality of Life and Anxiety-depression Assessed at the End of the Rehabilitation Program and after 6 and 12 Months for each Group of Patients

Figure 2 Proportion of patients exceeding the MCID for exercise capacity, quality of life and anxiety-depression score according to the group.

Abbreviations: 6MST, 6-min stepper test; HAD, hospital anxiety and depression scale; MCID, minimal clinically significant difference; VSRQ, visual simplified respiratory questionnaire.

Notes: Proportion of patients exceeding the MCID for exercise tolerance assessed by (A) the 6-min stepper test (6MST MCID 40 steps), (B) quality of life assessed by the visual simplified respiratory questionnaire (VSRQ MCID 3.4 points) and (C) anxiety-depression assessed by the hospital anxiety and depression scale global score (HAD MCID 1.5 points). Group 1, Reference Group; Group 2, Metabolic Group; Group 3, Cardiovascular Group.

This retrospective observational study evaluated the impact of cardiovascular and metabolic comorbidities on the outcomes of a home-based PR program in COPD patients over 1 year after the end of this program. COPD patients with metabolic comorbidities but no established cardiovascular disease exhibited a significant greater improvement in depression at 12 months after PR achievement compared to control group. No other outcome was significantly different between the three groups. To our knowledge, this is the first real-life study to evaluate impact of cardiovascular and metabolic comorbidities after 6 and 12 months of a home-based PR program.

Cardiovascular comorbidities are frequently associated with COPD and remain the most common causes of mortality in these patients.25 We confirm this strong association with only 24.3% of patients who had no cardiovascular disease nor cardiovascular risk-factors excluding smoking and by the observation that 81% of patients who died during the 14 month follow-up had at least one cardiovascular comorbidity. Moreover, at baseline, patients with established cardiovascular disease exhibited significant lower exercise capacity. Although in our study this group of patient was older than others, this is concordant with previous studies reporting decreased physical activity in COPD patients with concomitant cardiovascular disease, a diminished capacity partly mediated by deleterious cardiorespiratory interactions.26 Comprehensive care integrating all comorbidities is therefore essential to improve the prognosis of these patients.

We chose to group patients with established cardiovascular comorbidity regardless of metabolic comorbidity because only 24% of those patients did not have metabolic comorbidity and those cardiovascular comorbidity are associated with a significant exercise capacity limitation.2729 The choice to categorize hypertension as a metabolic comorbidity and not as a cardiovascular comorbidity is questionable. However, definitions of metabolic syndrome consider hypertension as one of their diagnostic criteria and hypertension is clearly identified as a risk factor for adverse cardiovascular outcomes.30 In a cohort of healthy adults who underwent a cardiac health check-up, Kim et al reported that exercise capacity was more reduced, the level of coronary calcification more increased and the cardiac structure on echocardiography more altered when patients had more components of the metabolic syndrome including hypertension.31 This suggests that the impact of comorbidities defining the metabolic syndrome have a cumulative effect. Conversely these comorbidities are also improved and may be reversed to some extent by physical activity.32 Therefore, we chose to group these comorbidities including hypertension for their intermediate impact on exercise tolerance and their recovery potential.

Benefits of pulmonary rehabilitation for COPD patients are well described and our home-based PR program, as center-based programs, exhibit benefits on exercise capacity, quality of life and anxiety-depression, not only at the end of the program, but up to one year after its achievement in the whole population.19,33 Ninety percent of patients completed our home-based PR program. Compared to the British Thoracic Society objectives of achieving a 70% completion rate, this suggests that this modality would remove some of the obstacles to finalizing the PR program for some patients.34 Other effective PR models including telerehabilitation have emerged in recent years to improve access and uptake to PR and address issues related to the distance to rehabilitation centers or to constraints of the SARS-CoV2 epidemic.35 Cardiovascular comorbidities may be perceived as an obstacle to out-of-center PR, but our study demonstrates that home-based PR is feasible and effective for referred patients, provided that the prescriber first assesses the stability of these comorbidities.

Specific influence of cardiovascular and metabolic comorbidities on PR and results was evaluated by some studies immediately at the end of the PR program with contrasting effects. The association between having cardiovascular comorbidities and exhibiting a greater improvement of dyspnea after PR was not observed in all studies and only one retrospective study report an association between having cardiovascular comorbidities and exhibiting greater 6MWD improvements.12,1416 In a retrospective study, Crisafulli et al reported a weaker improvement of SGRQ score in patients with cardiovascular comorbidities, but this negative association was not observed in their later prospective study nor in the Mesquita et al or Butler et al studies.1315 Conversely, Tunsupon et al reported greater improvement of quality of life assessed with the chronic respiratory disease questionnaire in patients with cardiovascular diseases.12 None of these studies have evaluated the impact on anxiety-depression nor the persistence of benefits after the end of the PR. Considering metabolic comorbidities, to our knowledge no study reported an association between having a metabolic disorder and reporting a greater dyspnea improvement after PR.12,1416 The impact of metabolic comorbidities on exercise capacity improvement after PR is more controversial. Thus, Walsh et al have reported a greater improvement associated with these metabolic comorbidities, as observed in our study, but there were no association in three other studies.13,15,16,36 Moreover, in two other studies, exercise capacity improvement was weaker in patients with metabolic comorbidities.12,14 Finally, as observed in our study, none reported an association between having metabolic comorbidities and exhibiting greater quality of life improvement. Altogether, these discrepancies may suggest that comorbidities did not impact PR outcomes per se except when they participate in the symptomatology and the impact of the disease. A more precise phenotyping of the mechanisms involved in patients symptoms may help to clarify condition when patients will benefit the most from a PR.

Our study is limited by its design as we included only patients addressed to our home-based PR program by their physicians who may have made the choice to address their patients to our home-based program based on criteria unknown to us. As our study included only patients managed in our home-based PR program, our results may not be extrapolated to a center-based program despite the fact that studies have reported that these two modalities could produce similar results and that characteristics of patients choosing one or the other of these modalities would not differ.4,37 As comorbidities were self-reported by patients, we cannot exclude that some comorbidities were misdiagnosed. While underdiagnosis of cardiovascular diseases was shown to be unlikely, overestimation is possible as hypertension or hypercholesterolemia underdiagnosis.38,39 Therefore, there is still a risk of misclassifying patients despite we systematically corrected self-reported comorbidities from medical reports provided by patients. Moreover, due to the retrospective design of our study, some information was not available including precise dyspnea evaluation, exacerbations rate, detailed evaluation of nutritional and muscular status, emphysema severity, distention level, and quantification of physical activity after PR discharge. A significant proportion of underweight patients were present in the reference group and their characteristics have similarities with the cachectic cluster described by Vanfleteren et al, a phenotype associated with poorer HRQoL, more frequent exacerbations and higher mortality.40 However, the sensitivity analysis performed after exclusion of these patients showed similar results to main analysis performed with adjustment for BMI demonstrating the modest impact of this heterogeneity in weight profile.

Stable cardiovascular and metabolic comorbidities are frequently associated with COPD and do not limit short- and long-term improvement of exercise capacity, quality of life and anxiety-depression after a home-based pulmonary rehabilitation. Whether specific personalization of the PR program is required to improve benefits for all patients according to their comorbidities remains to be determined.

6MST, 6-min stepper test; 6MWD, distance in the 6-min walking test; BMI, body mass index; COPD, chronic obstructive pulmonary disease; CPAP, continuous positive airway pressure; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; GOLD, global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease; HAD, hospital anxiety and depression scale; HRQoL, health-related quality of life; LTOT, long-term oxygen therapy; MCID, minimal clinically significant difference; NIV, noninvasive ventilation; PR, pulmonary rehabilitation; SGRQ, St Georges respiratory questionnaire; VSRQ, visual simplified respiratory questionnaire.

The authors would like to thank the rehabilitation team who managed the patients: G. Tywoniuk, S. Duriez, M Grosbois, V Opsomer, F. Urbain, V. Wauquier, and M. Lambinet. The authors would also like to thank Adair, Aeris Sant, Bastide, France Oxygne, Homeperf, LVL, Medopale, NorOx, Santlys, SOS Oxygne, Sysmed, VitalAire, and ARS Hauts-de-France for their support of the home-based PR program. They also thank Emeline Cailliau and Julien Labreuche who performed the new statistical analyses in response to reviewers comments.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

There is no funding to report.

JMG received financial support from Adair, Aeris Sant, Bastide, Elivie, France Oxygne, Homeperf, LVL, Medopale, NorOx, Santlys, Santo, SOS Oxygne, Sysmed, VentilHome, VitalAire, and ARS Hauts-de-France for the home-based PR program. JMG reports personal fees and nonfinancial support unrelated to the submitted work from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GlaxoSmithKlein, Novartis, Vitalaire, and Roche, unrelated to the submitted work. AD reports nonfinancial support from ALK-Abello, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein, LEO Pharma, Menarini, MSD, Novartis, Novo Nordisk, Pfizer, Resmed and Vitalaire, unrelated to the submitted work. AP reports no conflicts of interest related to the submitted work. NB reports personal fees from AstraZeneca, and nonfinancial support from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKlein, Novartis, Santelys association, SOS Oxygne and TEVA, unrelated to the submitted work. TP reports grants from AstraZeneca, personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein and Novartis, and congress support from AstraZeneca, GlaxoSmithKlein, Novartis and Chiesi, unrelated to the submitted work. BW reports personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKlein, Roche and TEVA, and nonfinancial support from ALK-Abello, Aptalis pharma, AstraZeneca, Boehringer Ingelheim, Chiesi, Chugai pharma, France Oxygne, Kyowa Kirin, GlaxoSmithKlein, Mayoli, Mundipharma, Mylan, Novartis, Pfizer, Preciphar, Roche, SEFAM, SOS Oxygne, SYSMED, Vertex and Vitalaire, unrelated to the submitted work. CC reports grants from AstraZeneca and Santelys, personal fees from ALK-Abello, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein, Novartis, Sanofi-Regeneron and TEVA, and congress support from ALK-Abello, AstraZeneca, GlaxoSmithKlein, Novartis, Pierre Fabre, Pfizer, Roche and TEVA, unrelated to the submitted work. OLR reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Novartis, and nonfinancial supports from AstraZeneca, Boehringer Ingelheim, Chiesi, Correvio, GlaxoSmithKlein, Mayoli, MSD, Mylan, Novartis, Pfizer, PulmonX, Santelys Association, Vertex, Vitalaire and Zambon, unrelated to the submitted work. OLR is the principal investigator in studies for Vertex and CSL Behring.

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4. Stafinski T, Nagase FI, Avdagovska M, Stickland MK, Menon D. Effectiveness of home-based pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease (COPD): systematic review. BMC Health Serv Res. 2022;22(1):557. doi:10.1186/s12913-022-07779-9

5. Gonalves JMF, Bello MG, Martnez MDM, et al. The COPD comorbidome in the light of the degree of dyspnea and risk of exacerbation. J Chron Obstruct Pulmon Dis. 2019;16(1):104107. doi:10.1080/15412555.2019.1592144

6. Faner R, Agust A. Network analysis: a way forward for understanding COPD multimorbidity. Eur Respir J. 2015;46(3):591592. doi:10.1183/09031936.00054815

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8. Giezeman M, Hasselgren M, Lisspers K, et al. Influence of comorbid heart disease on dyspnea and health status in patients with COPD a cohort study. Int J Chron Obstruct Pulmon Dis. 2018;13:38573865. doi:10.2147/COPD.S175641

9. Laforest L, Roche N, Devouassoux G, et al. Frequency of comorbidities in chronic obstructive pulmonary disease, and impact on all-cause mortality: a population-based cohort study. Respir Med. 2016;117:3339. doi:10.1016/j.rmed.2016.05.019

10. Wang Y, Stavem K, Dahl FA, Humerfelt S, Haugen T. Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Int J Chron Obstruct Pulmon Dis. 2014;9:99105. doi:10.2147/COPD.S51467

11. Palmer K, Bowles KA, Paton M, Jepson M, Lane R. Chronic heart failure and exercise rehabilitation: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2018;99(12):25702582. doi:10.1016/j.apmr.2018.03.015

12. Tunsupon P, Lal A, Abo Khamis M, Mador MJ. Comorbidities in patients with chronic obstructive pulmonary disease and pulmonary rehabilitation outcomes. J Cardiopulm Rehabil Prev. 2017;37(4):283289. doi:10.1097/HCR.0000000000000236

13. Mesquita R, Vanfleteren LEGW, Franssen FME, et al. Objectively identified comorbidities in COPD: impact on pulmonary rehabilitation outcomes. Eur Respir J. 2015;46(2):545548. doi:10.1183/09031936.00026215

14. Crisafulli E, Costi S, Luppi F, et al. Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax. 2008;63(6):487492. doi:10.1136/thx.2007.086371

15. Crisafulli E, Gorgone P, Vagaggini B, et al. Efficacy of standard rehabilitation in COPD outpatients with comorbidities. Eur Respir J. 2010;36(5):10421048. doi:10.1183/09031936.00203809

16. Butler SJ, Li LSK, Ellerton L, Gershon AS, Goldstein RS, Brooks D. Prevalence of comorbidities and impact on pulmonary rehabilitation outcomes. ERJ Open Res. 2019;5(4):0026402019. doi:10.1183/23120541.00264-2019

17. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017;49(3):1700214. doi:10.1183/13993003.00214-2017

18. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):10051012. doi:10.1056/NEJMoa021322

19. Grosbois JM, Gicquello A, Langlois C, et al. Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:20372044. doi:10.2147/COPD.S90534

20. Grosbois JM, Riquier C, Chehere B, et al. Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients. Int J Chron Obstruct Pulmon Dis. 2016;11:657663. doi:10.2147/COPD.S98635

21. Pichon R, Couturaud F, Mialon P, et al. Responsiveness and minimally important difference of the 6-minute stepper test in patients with chronic obstructive pulmonary disease. Respiration. 2016;91(5):367373. doi:10.1159/000446517

22. Perez T, Arnould B, Grosbois JM, et al. Validity, reliability, and responsiveness of a new short Visual Simplified Respiratory Questionnaire (VSRQ) for health-related quality of life assessment in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2009;4:918.

23. Puhan MA, Frey M, Bchi S, Schnemann HJ. The minimal important difference of the Hospital Anxiety and Depression Scale in patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes. 2008;6:46. doi:10.1186/1477-7525-6-46

24. Lederer DJ, Bell SC, Branson RD, et al. Control of confounding and reporting of results in causal inference studies. Guidance for authors from editors of respiratory, sleep, and critical care journals. Ann ATS. 2019;16(1):2228. doi:10.1513/AnnalsATS.201808-564PS

25. Agarwal S, Rokadia H, Senn T, Menon V. Burden of cardiovascular disease in chronic obstructive pulmonary disease. Am J Prev Med. 2014;47(2):105114. doi:10.1016/j.amepre.2014.03.014

26. Mantoani LC, DellEra S, MacNee W, Rabinovich RA. Physical activity in patients with COPD: the impact of comorbidities. Expert Rev Respir Med. 2017;11(9):685698. doi:10.1080/17476348.2017.1354699

27. Baloch ZQ, Abbas SA, Marone L, Ali A. Cardiopulmonary exercise testing limitation in peripheral arterial disease. Ann Vasc Surg. 2018;52:108115. doi:10.1016/j.avsg.2018.03.014

28. Zweerink A, van der Lingen ALCJ, Handoko ML, van Rossum AC, Allaart CP. Chronotropic incompetence in chronic heart failure. Circ Heart Fail. 2018;11(8):e004969. doi:10.1161/CIRCHEARTFAILURE.118.004969

29. Paolillo S, Farina S, Bussotti M, et al. Exercise testing in the clinical management of patients affected by pulmonary arterial hypertension. Eur J Prev Cardiol. 2012;19(5):960971. doi:10.1177/1741826711426635

30. Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):16401645. doi:10.1161/CIRCULATIONAHA.109.192644

31. Kim HJ, Kim JH, Joo MC. Association of exercise capacity, cardiac function, and coronary artery calcification with components for metabolic syndrome. Biomed Res Int. 2018;2018:4619867. doi:10.1155/2018/4619867

32. Thompson PD, Buchner D, Pia IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation. 2003;107(24):31093116. doi:10.1161/01.CIR.0000075572.40158.77

33. Grosbois JM, Le Rouzic O, Monge E, Bart F, Wallaert B. Comparison of home-based and outpatient, hospital-based, pulmonary rehabilitation in patients with chronic respiratory diseases. Rev Pneumol Clin. 2013;69(1):1017. doi:10.1016/j.pneumo.2012.11.003

34. RCP London. Pulmonary rehabilitation: an exercise in improvement combined clinical and organisational audit 2017; 2018. Available from: https://www.rcplondon.ac.uk/projects/outputs/pulmonary-rehabilitation-exercise-improvement-combined-clinical-and-organisational. Accessed July 7, 2022.

35. Cox NS, Dal Corso S, Hansen H, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev. 2021;2021(1):CD013040. doi:10.1002/14651858.CD013040.pub2

36. Walsh JR, McKeough ZJ, Morris NR, et al. Metabolic disease and participant age are independent predictors of response to pulmonary rehabilitation. J Cardiopulm Rehabil Prev. 2013;33(4):249256. doi:10.1097/HCR.0b013e31829501b7

37. Nolan CM, Kaliaraju D, Jones SE, et al. Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study. Thorax. 2019;74(10):996998. doi:10.1136/thoraxjnl-2018-212765

38. Barr ELM, Tonkin AM, Welborn TA, Shaw JE. Validity of self-reported cardiovascular disease events in comparison to medical record adjudication and a statewide hospital morbidity database: the AusDiab study. Intern Med J. 2009;39(1):4953. doi:10.1111/j.1445-5994.2008.01864.x

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40. Vanfleteren LEGW, Spruit MA, Groenen M, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(7):728735. doi:10.1164/rccm.201209-1665OC

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This story first appeared in the Forward. To get the Forwards free email newsletters delivered to your inbox, go to forward.com/newsletter-signup.

Growing up in a suburb of Cleveland, Ohio, I never thought of the JCC as much more than a gym. While many of my Jewish friends who lived near the JCC would spend hours there after school working out, my family and I lived a 20-minute drive away and thus chose to join a gym that was cheaper and closer to home.

The Conservative synagogue we belonged to was where we made our Jewish connections, celebrated Jewish occasions and ate Jewish food. For years, it didnt occur to me that maybe there were other Jews in the Cleveland community I could interact with outside of a denominational wall.

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So when I visited the JCC in Warsaw, Poland, in 2018, while interning at the American Jewish Committee Central Europe office, I had no idea what to expect.

I was swept away by their incredible weekly kosher all-you-can-eat Sunday Boker Tov Brunch. Polish Jews of all ages gathered at JCC Warsaw to form community. I loved the way this JCC and others were playing a large role in the revival of Jewish life in Europe. I was inspired by the communities the JCC and its members helped build. From that point on, for the rest of that summer, and wherever else I traveled, including to Barcelona, London and Helsinki, I made it a point to visit a JCC.

European JCCs were places to explore Jewish culture across boundaries, without the limitations of official affiliations. It was powerful to meet people from backgrounds different than my own whom I otherwise may never have met. These interactions allowed all of us to discover new perspectives and ideas about Jewish life without feeling pressured to adhere to any specific practice.

JCCs can provide an alternative connection to Judaism beyond the religious aspect. And yet, American JCCs often seem to fall short when it comes to this Jewish community connection.

In Europe, the JCC is the first place many individuals go when they discover that they may have potential Jewish ancestry. After speaking with a rabbi or JCC director, they often want to explore what it means to be Jewish. Many JCCs in Europe are also opening Jewish community preschools and often they are the first Jewish preschool many cities have had since before the Holocaust. European JCCs frequently serve as the headquarters for Jewish student groups and Jewish senior citizen clubs.

I was so in awe of the way JCCs in Europe served as a hub for the whole Jewish community that I wanted to be part of the JCC movement back home. A few years after my summer living in Warsaw, I began working full time as the Jewish life and culture program associate at the JCC in Cleveland. Yet I couldnt help but notice that the majority of the people who entered the building made a beeline for the workout facility. Most people who came through the doors never connected with someone new, or with something specifically Jewish. I observed this same pattern at JCCs in other American cities where I have lived like Binghamton, New York, and Pittsburgh.

Frequently, the high cost of membership at JCCs keeps the community apart when JCCs should bring people together. In fact, the JCC movement started in 1854 in Baltimore specifically to help ensure Jewish continuity and provide a place for celebration outside of the synagogue environment. To truly bring a community together, that would mean people of many different backgrounds: young and old, employed and unemployed, students and retirees, and Jews from all denominations. But not everyone can afford the high membership rates, and I struggle to understand why JCCs cant provide greater financial assistance or subsidize those marginalized individuals who would benefit the most from Jewish community.

Joining an American JCC is often not only expensive, it also is not all-encompassing. On top of a membership fee, there are typically additional charges for attending group exercise classes or certain Jewish culture programs and events. In my hometown, the 2011 Greater Cleveland Jewish Population Study found significant economic vulnerability, with 36% of Greater Cleveland Jewish households just managing. For single-parent households, that rose to a staggering 58%. Just managing does not usually leave room for a JCC membership.

The community development coordinator at JCC Krakow, Joanna Fabijaczuk, told me that their membership dues are symbolic. Even without membership, any Jewish individual who lives in Krakow can attend the JCCs weekly Shabbat dinners and other activities, including yoga, Polish classes and choir. If you want to go to an activity at JCC Krakow, theyll find a way to make it work.

As with other JCCs outside the U.S., the JCC Krakow has a small gym and sauna, but no one joins it for the gym, said Fabijaczuk. They join for the community.

JCCs in the United States can learn something from that. One idea could be for JCCs to host more Shabbat meals that are open to all. Sharing food, sitting together, relaxing and talking builds community in ways that rushing in to work out and leave does not.

Another idea from the JCC in Budapest, Hungary, is a mentorship program for young adults, who are sometimes left out of conventional outreach efforts. In exchange for volunteering for the Jewish community, young adults received free access to all aspects of the JCC (though beginning in 2023, the program started charging a small amount to participate).

JCCs in America are doing great work hosting Jewish book and film festivals, summer camps and preschools. I only wish that all Jews, regardless of financial status, were able to participate in what they have to offer.

What is the point of calling it a community center, if much of the community is left out? PJC

Madison Jackson is an MFA student in creative nonfiction writing, with a concentration in travel writing, at Chatham University. She is passionate about global Jewish life and lives in Pittsburgh.

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By News.com.au

February 22, 2023 | 9:35am

A study has revealed how drinking Coca-Cola and Pepsi can lead to larger testicles and higher testosterone levels.

The Northwest Minzu University in China was attempting to determine the impact of carbonated beverages on fertility and sex organs in men.

The study looked at three groups of mice one that only drank water, another that drank different levels of Coca Cola with another doing the same with Pepsi over 15 days.

Tests on the rodents included weighing their testicles and drawing blood. They were tested on day one, as well as day five, seven, 10 and 15.

It was quickly discovered that the mice drinking Coke and 100 percent Pepsi, compared to a mixture of Pepsi and water, had a significant change.

For instance, the mice that were given pure Coca-Cola had higher levels of the male hormone compared to the group that drank water.

The study concluded: Drinking Coca-Cola and Pepsi-Cola could promote testis development and enhance testosterone secretion [ ] our findings provide the scientific basis for fully understanding carbonated beverages effects and their mechanism on development and reproduction functions of humans, and how they benefit the prevention of prostate dysfunction and cancer.

However, this contradicts previous studies that indicated sugary drinks made men less fertile, instead of more, as the new study suggested.

A previous survey of 2500 men showed those who drank a liter of cola a day had 30 percent fewer sperm than those that drank none.

But some research has shown how caffeine can increase testosterone levels.

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A study has suggested that soda consumption may increase testosterone levels and testicle size in men.

The study, conducted by researchers at the Northwest Minzu University in China and published in the scientific journal Acta Endocrinol, set out to determine the impact carbonated beverages such as Coca-Cola and Pepsi had on fertility.

As noted by the study authors, previous studies have linked soda consumption to harm to reproductive functions, reduced sperm quantity and reduced sperm motility.

The researchers, who relied on animal testing to conduct the study, found the opposite was true when it came to testosterone, the male hormone produced mainly in the testes, and testicle size.

To test their hypothesis, the researchers studied groups of male mice. The first group drank only water, while the remaining groups drank varying levels of Coca-Cola and Pepsi, respectively.

Over the 15-day period, the scientists performed tests on the mice to analyse the effects of the carbonated beverage consumption, which included blood tests and weight and diameter measurements of the testis.

The study found that the testes of the mice that just drank Pepsi or Coca-Cola were significantly increased on day 15.

The outcome demonstrated a high dose of Pepsi or Coca-Cola could promote testis growth and development, the study authors wrote.

In addition to increased testicle size, researchers also found that the concentrations of serum testosterone in all mice were enhanced after the Pepsi-Cola and Coca-Cola treatment, which indicated that high doses of Pepsi and Coca-Cola could improve testosterone secretion of male mice.

In conclusion, drinking Coca-Cola and Pepsi-Cola could promote testis development, enhance testosterone secretion, increase serum EGF concentrations . Our findings provided the scientific basis for fully understanding [carbonated beverages] effects and their mechanism on development and reproduction functions of humans, but also benefit to prevent prostate dysfunction and cancer, the study authors wrote.

Although the study suggested that males may experience increased testicle size and testosterone production as a result of soda consumption, the researchers reiterated that the findings contradict previous studies. One such previous study includes a survey of 2,500 men that suggested sperm quantity was reduced by 30 per cent when a one-litre carbonated beverage was consumed every day.

The researchers also noted that previous studies have suggested links between soda consumption and fertility. One study found that carbonated beverages are associated with alterations in hormones that affect ovulation.

The researchers claimed that, so far, there has been little documentation regarding correlation between carbonated beverage consumption and reproduction function and fertility in humans and animals.

Although the researchers said more research needs to be conducted on the link between soda and fertility, the study acknowledges that carbonated beverage consumption may lead to obesity, cardiovascular diseases and type 2 diabetes, and that previous studies have indicated health damage effects of carbonated beverages on adolescents and children were serious.

The recent study comes after a previous study found that massive consumption of coffee or caffeine increased testosterone production.

As for whether you should consume soda, health experts recommend against consuming the beverages due to the sugar content.

According to the Cleveland Clinic, one can of soda can have as much as 39 grams of sugar, while the American Heart Association recommends no more than 25 grams of sugar per day for women and 36 grams of sugar per day for men.

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Drinking Coke and Pepsi may increase testicle size and testosterone production, study says - The Independent

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Welcome to Testosterone HQMen's Health's guide to the exciting, complicated, and revolutionary world of testosterone. For everything you need to know about T, click here.

IT'S NORMAL for levels of testosterone to change depending on things like age, time of day, sexual and physical activity, and overall health, but consistently high or low levels may cause some unwanted symptoms that could slow you down in the gym and in bed.

Testosterone levels in adult males naturally decline as you age (about 1 to 2 percent each year), but testosterone deficiency in men has become a larger focus of the health community in recent years. Testing your t levels can provide more info on your sexual function and drive, muscle mass development, mood, energy, and even the production of red blood cells. But lab tests can be costly and a pain to schedule, so at-home test kits could be a great starting point for learning more about your T-levels.

Important: not all at-home test kits are created equal. For starters, they're not as reliable as health providers' lab workyour at-home kit's results could vary based on the quality of sample collection, and how you well collected it (yes, you need to read instructions!). Here's the 101 on what to know about at-home kits that are available.

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The 4 Best At-Home Testosterone Test Kits of 2023, According to Health Experts - Men's Health

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Testosterone is a hormone produced by testicles in people assigned male at birth. Testosterone can affect many aspects of life, including appearance, sexual development and sex drive (libido). It also helps build bone and muscle mass. A small amount of testosterone is also produced in people assigned female at birth, however this article focuses on low testosterone in males.

Although low testosterone can affect anyone with testicles at any age, low testosterone is more common as people age. Its important to know that it is natural for testosterone production typically to decrease with age. The Endocrine Society considers low blood testosterone to be a morning level of less than 300 nanograms per deciliter in adults. Testosterone levels vary throughout the day, so testing these levels at 8 a.m. is very important.

The symptoms of low testosterone, also known as low T or male hypogonadism, vary based on age and other factors, said Lisal J. Folsom, M.D., adult and pediatric endocrinologist with Norton Community Medical Associates Endocrinology and Norton Childrens Endocrinology, affiliated with University of Louisville School of Medicine. Sometimes when people have symptoms that may signal low testosterone, testing shows normal testosterone levels. That suggests the symptoms are related to something else entirely.

Norton Community Medical Associates Endocrinology offers care for low testosterone at five locations within Greater Louisville. Our fellowship-trained and board-certified endocrinologists provide a comprehensive and inclusive approach.

Testosterone replacement therapy is considered when testosterone is truly low, Dr. Folsom said. Before beginning treatment its very important to have a thorough evaluation, as many symptoms of low testosterone can overlap with other causes, and treatment with any medication can have risks as well as benefits.

If your health care provider recommends testosterone replacement therapy, there are several treatment options, including:

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What are the symptoms of low testosterone? - Norton Healthcare

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