• Subject Name : Nursing

Aims and Hypothesis of The Study

The main aim of this study is to check whether obesity in COPD patients can be and should be treated using diet plans and resistance exercise planning. Whether it helps in curing and decreasing it without affecting the patient's overall health and immune system. The study was made to devise how COPD patients will be obliged to treat obesity effectively. The 500 words summary of the article describes what obesity is and whom it was gained in COPD patients that led to the adoption of particular methods to overcome this factor (Lim et al., 2017 p2351). The article discusses the already real-life implemented methodologies such as diet plans and exercises for such patients and their research, findings and outcomes. And whether the obtained results matched the required ones along with what factors it influenced.

As a sample, a total of 33 participants took part in this research, the Management who implemented this set of operations focused on their plot data with a very much similar involvement of obese people that carried another disease of asthma. The results came to be a 10% decrease in weight loss, followed by a 50% decrease in high sensitivity C-reactive protein of the human body that stands equivalent to 0.5 SD. So in total, 33 participants were recruited to perform this research, and they came out with results after a well-focused and spent 12 weeks.

Sample and Recruitment

The overall process included various steps like intervention, diet plans, follow-ups, exercises and assessment meetups. The results and findings showed that out of the 33 recruited participants, 28 individuals completed the study. That makes a total of 77.8% of successful participants' involvement. The main findings included body composition, dietary analysis, and health status related to the COPD patient chronic disease, systematic inflammation, exercises, body mass index, dyspnea and obstruction followed by functional capacity and lung functionalities (Casanova & Celli et al., 2017 p27). All these hypotheses showed the first weight loss in obese COPD patients. The modest weight loss gained was 6.2% and was came out as a result of the assumption mentioned above.

Along with that, we also see that skeletal muscle mass was maintained as calorie restriction, protein intake and exercises were induced. The overall paper states that the research gained success in treating obesity in COPD patients using the above hypotheses and thus bore with fruitful outcomes leading to a more successful expected set of results in future if this practice is implemented. In the exceptional chronic COPD hospitals, patients are treated with a group of daily special exercises that the doctor himself makes them do in his supervision and a controlled diet plan that helps boost their immune system but control their obesity ( Leung et al., 2020 p54).

Main Findings and Consideration

The article states the measurements done for 12 weeks. In these 12 weeks, all the participants underwent assessment sessions that involved the valuation and validation of clinical and functional results. These measurements include all the above hypothesis stated, for the COPD clinical assessment, the Management used the SGRQ questionnaire along with this, mMRC scale evaluated disability from COPD related dyspnea (Beaumont et al., 2018 p2181). This validation also included a 6-minute walk test conducted on a 25m walking track guided by the American thoracic society.

Summary of Measurements

In calculating body mass index, DEXA was used to estimate the whole body and regional body composition. Assessment of both the left and right arms and legs of the patient focusing mainly on the lean soft tissues, their calculation led to the measurement of ASMM and was further processed to calculate the ASMM index. For the measurements of skeletal muscle mass and body fat mass, BIA was used.

For the measurement of lung functionality checking whether they processed well enough and are inclined towards a healthy working, airflow limitation was assessed using spirometry that calculates pre and post states of bronchodilator, FVC and respiratory ratio keeping in view the European respiratory society standards. The Management calculated FEVI and FVC using the national health and nutrition examination survey. It further measured static lung volume using a computerized body platysma graph.

Strength and well functionality assessment was done using standardized protocols. Poor physical performance was measured using standardized protocols. Shoulder abduction and rest of the inspections under this category were assessed using a handheld dynamometer that was suggested according to a standardized protocol (Lipson et al., 2018 p1675). For physical assessment and checking whether the body, structure and muscles of the obese COPD patients were all measured using standardized protocols.

For the measurement of systematic inflammation, peripheral blood was collected using the c-reactive protein. The analysis was done to squeeze the reports to tell the percentage of systemic inflammation in obese COPD patients.

Along with these, a dietary assessment was done to see what and how the patients are consuming. This included a semi-quantitative food diary stretched over four days. The food plans included such a balanced and systematically distributed chart that was assembled, keeping in view the health and requirements of the patient's body along with the various factors he possessed because of the disease ( Lambert et al., 2017 p72 ).

These all measurements were then listed down in the form of statistical data that were reviewed in the form of charts and graphs to get a comparison between the previous and now acquired results to see what progress or loss is made or if the conditions remained unaffected. These measurements were a real case scenario implementation, so these cannot reach an ideal level that implements that the results must be securing 100% accuracy but keeping the results, findings and the above measurements, this study carried out success to some level, 77.8% participants came out with the results and most of them gained success in getting their obesity treated and weight loss with victory in the other factors boosting health and immunity.

Strengths/ Weaknesses of The Study

As much as I have read and understood the study, I learned many positive points and deductions from this article. The analysis was applied at a smaller sample size that provided a significant incline in the positive results for the study. It was meant to check whether obesity in COPD patients is treated and reduced using a set of distinct and okay order practices and hypothesis. And so far, the results acquired were up to mark (Spelta el al., 2018 p17). For a better group of outcomes and more reliable results, it is to be applied over the larger sample size. There are many strengths in the study that helped in the progress and prosperity of the survey, and eventually, they led to these results that matched quite much to what was expected.

The first strength that I saw was the implementation of a controlled diet plan. Individuals were arranged a low-energy/diet that varied between 3850-5000 kg./day that sometimes was extended to even 5900 kg./day, keeping in view the health and requirements of the patient. This involved two replacements per day. The plan varied according to the BMI of the person, those with less than 40kg/m2 were provided with a third meal replacement to lessen their hunger and muscle loss while the obesity was being treated. And so, the diet plan helped in making the practice successful.

The second strength that came into light was the implementation of exercise daily. That included 6 minutes' walk to an increased duration per person. Moreover, the home-based practices of limb strengthening and training program that were stretched over three days/week with a resting day in between. Varying according to the patient being dealt the exercises changed and were implemented very thoughtfully, keeping in mind what the patient requires, these exercises included bicep curls, shoulder presses, wall push-ups, squats, lunges, setups and many more. This exercise implementation helped in the strengthening of the patient's body and helps in better circulation of blood in the system (Bianco et al., 2017 p23).

The third strength found was the assessment and follow-ups that were brought into implementation and practice to keep up with the changing and varying conditions of the patients. The follow-ups helped to know the doctor what changes have occurred in the patient's body and how it affects his obesity. Whether the implemented hypothesis is supporting the betterment of the person or they are leading his health to a downfall, or they are not producing any effect at all. The doctors stay updated with each coming follow up and assess the patient's condition to check whether the practices implemented need to be varied or not (Alvarez et al., 2017 p167).

The fourth strength came out to be the types of standardized protocols, theories and ways to calculate and measure the clinical and functional outcomes. These measurements included the calculations related to the body composition of the patients, followed by his health status, available capacity, body mass index, systematic inflammation and lung functionality. The measurements come out in the form of either graphs or calculations compared to standards to mark out the variations and differences between them. These strengths encourage the study to be implemented to larger sample size.

References for Effects of Inspiratory Muscle Training in COPD Patients

Alvarez, R. F., Rabec, C., Cuadrado, G. R., Hernandez, J. A. C., Rodriguez, P., Georges, M., & Casan, P. (2017). Monitoring noninvasive ventilation in patients with obesity hypoventilation syndrome: comparison between ventilator built-in software and respiratory polygraphy. Respiration93(3), 162-169.

Bianco, A., Nigro, E., Monaco, M. L., Matera, M. G., Scudiero, O., Mazzarella, G., & Daniele, A. (2017). The burden of obesity in asthma and COPD: Role of adiponectin. Pulmonary pharmacology & therapeutics43, 20-25.

Beaumont, M., Forget, P., Couturaud, F., & Reychler, G. (2018). Effects of inspiratory muscle training in COPD patients: A systematic review and meta‐analysis. The clinical respiratory journal12(7), 2178-2188.

Casanova, C., Celli, B. R., de-Torres, J. P., Martínez-Gonzalez, C., Cosio, B. G., Pinto-Plata, V., ... & Calle-Rubio, M. (2017). Prevalence of persistent blood eosinophilia: relation to outcomes in patients with COPD. European Respiratory Journal, 50(5).

Hanson, C., Rutten, E. P., Wouters, E. F., & Rennard, S. (2014). Influence of diet and obesity on COPD development and outcomes. International journal of chronic obstructive pulmonary disease, 9, 723.

Lambert, A. A., Putcha, N., Drummond, M. B., Boriek, A. M., Hanania, N. A., Kim, V., ... & McCormack, M. C. (2017). Obesity is associated with increased morbidity in moderate to severe COPD. Chest151(1), 68-77.

Leung, J. M., Yang, C. X., Tam, A., Shaipanich, T., Hackett, T. L., Singhera, G. K., ... & Sin, D. D. (2020). ACE-2 expression in the small airway epithelia of smokers and COPD patients: implications for COVID-19. European Respiratory Journal55(5).

Lim, J. U., Lee, J. H., Kim, J. S., Hwang, Y. I., Kim, T. H., Lim, S. Y., ... & Rhee, C. K. (2017). Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients. International journal of chronic obstructive pulmonary disease, 12, 2465.

Lipson, D. A., Barnhart, F., Brealey, N., Brooks, J., Criner, G. J., Day, N. C., ... & Kilbride, S. (2018). Once-daily single-inhaler triple versus dual therapy in patients with COPD. New England Journal of Medicine378(18), 1671-1680.

Spelta, F., Pasini, A. F., Cazzoletti, L., & Ferrari, M. (2018). Body weight and mortality in COPD: focus on the obesity paradox. Eating and weight disorders-studies on anorexia, bulimia and obesity23(1), 15-22.

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