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The purpose of this study is to explore the role of a stream of cool air to the face, through fan-to-face therapy, as a novel adjunct non-pharmacological therapy to enable symptomatic adults with cardiopulmonary disease to exercise at higher intensities for longer durations and maximize the psycho-physiological benefits of a supervised exercise training program. The investigators hypothesize that, compared to no fan, fan-to-face therapy will result in relatively greater improvements in exercise endurance time and intensity ratings of perceived breathlessness during constant-load cardiopulmonary exercise testing on a treadmill at 75% of peak power output following a 5-week exercise training period.
Prospective participants will complete four assessment visits (V1-V4) and 15 supervised exercise-training (T1-T15) sessions (3 sessions per week for 5 weeks). The purpose of visit 1 (V1) is twofold: 1) to screen potential participants for study eligibility; and 2) for participants identified as eligible, complete pulmonary function testing and an incremental exercise treadmill test to determine the relative intensity for visit 2 (V2). At V2, participants will undergo a dual-energy x-ray absorptiometry (DEXA) scan to assess body composition prior to the 5-week supervised exercise training. Participants will also perform an exercise endurance treadmill test at V2 performed at 75% of peak power achieved on the incremental exercise test from V1. Following V2, participants will be randomized to 5-weeks of 3x/week (total of 15 sessions) supervised exercise training to one of the two experimental conditions: (i) fan-to-face; or (ii) no fan (control). Exercise sessions will be individualized based on participants' ITT and progressed to ensure the participant is exercising at an intensity corresponding to a breathlessness intensity rating of between 3-5 Borg CR10 units and can complete at least 10 to 20-min of continuous walking. Exercise duration will be increased in 1 to 5-min intervals up to a maximum of 40-min. Thereafter, exercise intensity will be increased by 5-15% of baseline speed. Visit 3 (V3) will be done after the completion of the 5-week exercise training and will comprise of a second DEXA scan to assess for changes in body composition and the same exercise endurance test at V2 to assess for changes in exercise endurance time. Visit 4 (V4) will comprise of the same incremental exercise test as V1 to assess for changes in cardiovascular fitness.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Exercise training with Fan-to-face | Experimental | Participants randomized to the fan-to-face group will perform supervised exercise training with a basic, portable fan (Honeywell HT-900 Turbo Force Air Circulator). The fan will be placed to the front of the treadmill with airflow directed toward the area of the face innervated by the second and third branches of the trigeminal nerve. The airflow speed will be chosen by each participant so that it is most comfortable to them. An anemometer will measure the airflow from the fan. |
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| Exercise training with no fan | No Intervention | Participants randomized to the no fan group will perform supervised exercise training with no fan. The exercise duration and intensity titration will follow the same format as the experimental group. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Honeywell HT-900 Turbo Force Air Circulator | Device | This is a basic, portable, household fan with a single cost of CDN$21.99. |
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| Measure | Description | Time Frame |
|---|---|---|
| Cardiopulmonary exercise testing endurance time | Cardiopulmonary exercise testing (constant-load at 75% peak power output) will be used to assess changes in endurance time pre to post intervention. Endurance time will be defined as the total duration of loaded walking (minutes). | Pre- and post-5 week of exercise training period. |
| Borg modified 0-10 category ratio scale for breathlessness intensity | Borg modified 0-10 category ratio scale will be used to assess breathlessness intensity during constant-load (75% peak power output) cardiopulmonary exercise test at iso-time, defined as the highest equivalent 2-min interval of exercise completed by a given participant during each of the constant-load cardiopulmonary exercise test. A higher score is indicative of greater breathlessness, while a lower score is indicative of lesser breathlessness. | Pre- and post-5 week of exercise training period. |
| Measure | Description | Time Frame |
|---|---|---|
| Dual-Energy X-Ray Absorptiometry-derived body composition | Dual-Energy X-Ray Absorptiometry will be used to assess changes in fat free mass pre to post supervised exercise training program. Fat free mass will be expressed as fat free max index, which is fat free mass per kg of total body weight per metre squared of standard height. | Pre- and post-5 week of exercise training period. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rachelle I Aucoin, PhD Student | Contact | 514-398-4184 | 09081 | rachelle.aucoin@mail.mcgill.ca |
| Dennis Jensen, PhD | Contact | 514-398-4148 | 0541 | dennis.jensen@mcgill.ca |
| Name | Affiliation | Role |
|---|---|---|
| Dennis Jensen, PhD | McGill University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre of Innovative Medicine of the McGill University Health Centre | Recruiting | Montreal | Quebec | H4A 3J1 | Canada |
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| Label | URL |
|---|---|
| Link to Dr. Dennis Jensen's Clinical Exercise and Respiratory Physiology Laboratory page | View source |
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| ID | Term |
|---|---|
| D029424 | Pulmonary Disease, Chronic Obstructive |
| D017563 | Lung Diseases, Interstitial |
| D006333 | Heart Failure |
| D004417 | Dyspnea |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002908 | Chronic Disease |
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Parallel assignment
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It is impossible to blind the participants or the investigators for the intervention, as they will be able to see whether they have been allocated to the fan-to-face group or the no fan group. However, participants will complete the supervised exercise-training sessions alone (with the study coordinator) with no other participants in the room, therefore they will be unaware of who has been allocated to the fan-to-face group or the no fan group. They will also be kept relatively unaware of the study hypothesis.
| Cardiopulmonary exercise test physiological response (gas exchange) | Breath-by-breath cardiopulmonary exercise test (incremental) parameters will be averaged in 30-second intervals at rest and during exercise. The change in peak volume of oxygen consumption pre to post supervised exercise training will be reported. A greater volume of oxygen consumption is indicative of a greater cardiovascular fitness | Pre- and post-5 week of exercise training period. |
| Cardiopulmonary exercise test physiological response (power output) | Breath-by-breath cardiopulmonary exercise test (incremental) parameters will be averaged in 30-sec intervals at rest and during exercise. The change in peak power output pre to post supervised exercise training will be reported. A greater peak power output is indicative of greater leg strength and indirectly, cardiovascular fitness. | Pre- and post-5 week of exercise training period. |
| Minimal clinically important difference breathlessness intensity | The proportion of participants meeting or exceeding the minimal clinically important difference of ≥1 unit on the Borg 0-10 scale in breathlessness intensity at iso-time of exercise during the cardiopulmonary exercise test (incremental) after the supervised exercise training. A greater score is indicative of worse breathlessness, while a lower score is indicative of lower breathlessness. | Pre- and post-5 week of exercise training period. |
| Minimal clinically important difference exercise endurance | The proportion of participants meeting or exceeding the minimal clinically important difference of ≥101-seconds for exercise endurance time at iso-time during the constant-load cardiopulmonary exercise test. The longer the exercise endurance time (greater seconds or minutes) is indicative of a greater improvement in cardiovascular fitness. | Pre- and post-5 week of exercise training period. |
| Modified Medical Research Council Dyspnea Scale (mMRC) | The mMRC dyspnea scale will be used to assess change in daily breathlessness pre to post supervised exercise training program. The mMRC dyspnea scale is scored from 0 to 4, where a higher score is indicative of worse daily breathlessness and a lower score is indicative of less daily breathlessness. | Pre- and post-5 week of exercise training period. |
| COPD Assessment Test | The COPD Assessment (CAT) Test is a validated test in chronic obstructive pulmonary disease and interstitial lung disease to assess pulmonary and extra-pulmonary symptom burden. The CAT Test will assess changes in pulmonary and extra-pulmonary symptom burden. | Pre- and post-5 week of exercise training period. |
| Baseline Dyspnea Index and Transition Dyspnea Index | The Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) assesses breathlessness burden before and after an intervention or a certain period of time. | Pre- and post-5 week of exercise training period. |
| D020969 |
| Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D012120 | Respiration Disorders |
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
| D001519 | Behavior |