Camilla Koch Ryrsø

Background: Physical inactivity contributes to functional decline and is associated with increased risk of adverse outcomes in patients hospitalized with community-acquired pneumonia (CAP). Exercise programs applied during acute hospitalization may mitigate these effects, particularly in older adults. This study aimed to evaluate the effect of standard care versus supervised in-bed cycling or booklet-exercise, including resistance and endurance exercises, on functional ability, body composition, and physical activity level in patients hospitalized with CAP. Methods: In this randomized controlled trial, 178 patients hospitalized with CAP were allocated to standard care ( n = 59), in-bed cycling ( n = 58), or booklet-exercise ( n = 61). Functional ability was assessed using grip strength, the 30-second sit-to-stand, and the Barthel index. Body composition was measured with bioelectrical impedance analysis, and physical activity was monitored using accelerometers. Outcomes were evaluated from admission to 3-month post-discharge using linear mixed-effect models. Results: Baseline measures were comparable across groups. At 3 months post-discharge, participants performing in-bed cycling showed a significant improvement in the Barthel index compared to standard care (mean difference: 4.15 points, 95% ΔCI: 0.26–8.04, P = 0.037), while no difference was observed for participants in the booklet-exercise group. There was no effect of the exercise interventions on changes in grip strength, 30-sec sit-to-stand performance, fat mass index, fat-free mass index, or daily step count. Conclusion: Supervised exercise training during hospitalization improved functional ability in patients with CAP 3 months post-discharge. However, the short duration of hospitalization may limit the overall impact of in-hospital exercise interventions, highlighting the need for continued post-discharge exercise strategies to support functional recovery and independence in patients with CAP.

Cardiovascular control during exercise is impaired in chronic obstructive pulmonary disease (COPD). The central cardiopulmonary pathologies in COPD might drive the local muscle vascular abnormalities. We hypothesised that contracting muscle perfusion and O ₂ utilisation improve after lung transplantation (LTx) in COPD. Ten patients with end‐stage COPD were tested on the LTx waiting list (pre‐LTx) and again 6 months after LTx (post‐LTx). We measured leg blood flow (, main outcome) during submaximal one‐leg knee‐extensor exercise (KEE), and femoral arterial–venous blood samples were obtained for the determination of O ₂ kinetics across the leg and vasoactive compounds. Cardiac output and stroke volume in response to KEE peak workload (WL _peak ), walking distance and physical activity (triaxial accelerometry) were also assessed. Lung function (one single and nine double LTx), walking distance and physical activity increased post‐LTx, whereas leg lean mass and WL _peak remained unchanged. Arterial oxygen partial pressure decreased in response to KEE pre‐LTx but was maintained at resting levels post‐LTx. Working muscle capillary O ₂ tension and saturation were also higher post‐LTx, with no difference in muscle O ₂ conductance or extraction. We found no changes in during submaximal KEE (pre‐LTx: 1026 ± 278 vs. post‐LTx: 941 ± 186 mL min ⁻¹ , P = 0.49); mean arterial pressure and circulating pro‐brain natriuretic peptide levels were lower post‐LTx and cardiac output higher. Cardiac output (pre‐LTx: 6.1 ± 0.4 vs. post‐LTx: 8.3 ± 0.5 L min ⁻¹ , P = 0.0001) and stroke volume responses to WL _peak were also higher post‐LTx. LTx did not affect muscle blood flow regulation during moderate‐intensity KEE in end‐stage COPD and seemed to be disconnected from the augmented cardiac output responses to exercise.

Community-acquired pneumonia (CAP) is a leading cause of hospitalization and often results in impaired health-related quality of life (HRQoL). The prognostic value of HRQoL at admission and its recovery trajectory after CAP remain unclear. We investigated associations between HRQoL at admission and adverse outcomes, including ICU admission, rehospitalization, and mortality, and described changes in HRQoL 180 days post-discharge. In this prospective cohort study, 552 patients hospitalized with CAP completed the EQ-5D-5L questionnaire at admission; 262 patients were reassessed 180 days post-discharge. Patients were categorized into tertiles based on the EQ-5D utility index and dimension-specific scores. Associations between HRQoL and outcomes were analyzed using logistic and Cox regression models. The mean EQ-5D utility index at admission was 0.609 ± 0.266. Severe impairments were most common in usual activities (42%) and mobility (30%) dimensions. Lower HRQoL at admission (lowest vs. highest tertile) was associated with an increased risk of rehospitalization at 30 days (aHR 1.92, 95% CI: 1.18–3.13), 90 days (aHR 2.01, 95% CI: 1.33–3.03), and 180 days (aHR 1.82, 95% CI: 1.27–2.59) and an increased risk of mortality at 90 days (aHR 1.91, 95% CI 1.01–3.63) and 180 days (aHR 1.84, 95% CI 1.05–3.20). Severe impairment in the mobility dimension was associated with increased risks of ICU admission, rehospitalization within 30, 90, and 180 days, and mortality within 90 and 180 days, while severe impairment in the self-care dimension was associated with increased risks of rehospitalization within 30, 90, and 180 days and mortality within 180 days. Among survivors who completed the follow-up, HRQoL improved modestly over 180 days (+ 0.109 ± 0.247). Low HRQoL at admission, particularly impairments in the mobility and self-care dimensions, was associated with adverse outcomes in patients with CAP. HRQoL is an independent prognostic marker that may support clinical risk stratification in patients with CAP. The observed improvement in HRQoL over time should be interpreted cautiously as it reflects survivors who completed follow-up. Trial registration: ClinicalTrials.gov (NCT03795662).

Background: A deficient vitamin D status is linked to increased risk of community-acquired pneumonia (CAP) and both short- and long-term mortality. Given small sizes of previous studies and lack of adjustment for key confounders, we aimed to investigate the association between vitamin D status (sufficient, insufficiency, or deficiency) and mortality risk in adults hospitalized with CAP. Methods: This study, nested within the Surviving Pneumonia Study at Copenhagen University Hospital—North Zealand, Denmark, included adults hospitalized with CAP between 2019 and 2022. Vitamin D status was assessed using serum 25(OH)D concentrations, categorizing participants as sufficient (≥50 nmol/L), insufficient (25–<50 nmol/L), or deficient (<25 nmol/L). Logistic regression was used to assess mortality risk. Covariates included age, sex, Charlson comorbidity index, CURB-65, smoking history, and BMI. Results: Among 514 participants, 29 (5.6%) and 130 (25.3%) had deficient and insufficient vitamin D status, respectively. Participants with deficient vitamin D status were younger, and more than 50% were current smokers. Vitamin D deficiency was associated with higher 90-day (OR: 3.50, 95% CI 1.01; 12.21) and 180-day (OR: 3.27, 95% CI 1.04; 10.25) mortality risk compared with participants with sufficient vitamin D status, while no difference was observed between the sufficient and insufficient group. No differences were observed for in-hospital or 30-day mortality. Conclusions: Participants with deficient vitamin D status were younger and faced higher mortality risk despite milder disease at admission. Given that vitamin D deficiency may relate to poorer health habits and low levels of other micronutrients, trials on tailored micronutrient supplementation during acute conditions like CAP could be considered.

Background: Physical inactivity is crucial to functional decline and associated with increased risk of adverse outcomes in patients with community-acquired pneumonia (CAP). We aimed to assess effects of supervised in-bed cycling or booklet exercise versus standard care on functional ability, body composition, and physical activity in patients with CAP. Methods: Secondary analysis of a randomised controlled trial, which included 178 patients with CAP randomised to standard care, in-bed cycling, or booklet exercise. Functional ability was assessed with grip strength, 30-sec sit-to-stand, and Barthel index. Fat (FMI) and fat-free mass index (FFMI) were assessed with bioelectrical impedance analysis and physical activity with accelerometers. Results: At 3-month, in-bed cycling showed an increased Barthel index (4.2 points, 95% CI 0.3–8.0) compared to standard care. No group-by-time interaction effects were seen on grip strength or 30-sec sit-to-stand. At 3-month, in-bed cycling (0.9 kg·m⁻², 95% CI 0.3–1.4) and booklet exercise (0.6 kg·m⁻², 95% CI 0.0–1.1) showed an increased FMI compared to standard care. In-bed cycling had a decreased FFMI at 3-month (−0.7 kg·m⁻2, 95% CI -1.4 to -0.1) compared to standard care. No differences were seen in daily step count between standard care and in-bed cycling or booklet exercise. Conclusions: Supervised exercise training during admission improved functional ability in patients with CAP. Due to short admissions in patients with CAP, the effect of exercise training during admission might be sparse. Therefore, the effect of exercise training after discharge should be explored.

Background: Skeletal muscle blood flow is markedly diminished in patients with COPD, contributing to reduced exercise capacity. The aim was to assess adaptations in skeletal muscle blood flow regulation and exercise capacity after lung transplantation (LTx) in end-stage COPD. Methods: Hemodynamic responses during submaximal single-leg knee-extensor exercise (KEE) were measured before and 6 months after LTx in 10 patients with end-stage COPD. Stroke volume and cardiac output were assessed using finger photoplethysmography. Leg blood flow was assessed using Doppler ultrasound, with arterio-venous variables sampled across the exercising leg. Symptom burden, exercise capacity (6-minute walking distance, single-legged peak workload [WL_peak]), body composition, and physical activity were also assessed. Results: After LTx, responses in cardiac output (6.2±0.4 vs 7.5±0.4 L·min⁻¹) and stroke volume (71±4 vs 81±4 mL) to KEE at 10% WL_peak increased significantly, while MAP response decreased (131±5 vs 117±5 mm Hg). Leg blood flow (1026±98 vs 941±66 mL·min⁻¹) and oxygen uptake (117±12 vs 103±16 mL O₂·min⁻¹) responses to KEE were similarly after LTx. Symptom burden (CAT score 26±1 vs 9±2 points), walking distance (258±32 vs 458±48 meters), and physical activity (3199±515 vs 5152±776 steps·min⁻¹⁾ increased after LTx, whereas WL_peak and leg lean mass remained unaltered. Conclusion: Despite near-normalisation of lung function after LTx, perfusion of the exercising skeletal muscle remained unaltered, showing persistent peripheral exercise limitation despite central adaptations in COPD. However, some degree of deconditioning may exist 6 months after LTx, which might be targeted and reversed with exercise training.

Objective: To investigate the effect of standard care (SoC) combined with supervised in-bed cycling (Bed-Cycle) or booklet exercises (Book-Exe) versus SoC in community-acquired pneumonia (CAP). Methods: In this randomized controlled trial, 186 patients with CAP were assigned to SoC (n = 62), Bed-Cycle (n = 61), or Book-Exe (n = 63). Primary outcome length of stay (LOS) was analyzed with analysis of covariance. Secondary outcomes, 90-day readmission, and 180-day mortality were analyzed with Cox proportional hazard regression and readmission days with negative-binominal regression. Results: LOS was −2% (95% CI: −24 to 25) and −1% (95% CI: −22 to 27) for Bed-Cycle and Book-Exe, compared with SoC. Ninety-day readmission was 35.6% for SoC, 27.6% for Bed-Cycle, and 21.3% for Book-Exe. Adjusted hazard ratio (aHR) for 90-day readmission was 0.63 (95% CI: .33–1.21) and 0.54 (95% CI: .27–1.08) for Bed-Cycle and Book-Exe compared with SoC. aHR for 90-day readmission for combined exercise was 0.59 (95% CI: .33–1.03) compared with SoC. aHR for 180-day mortality was 0.84 (95% CI: .27–2.60) and 0.82 (95% CI: .26–2.55) for Bed-Cycle and Book-Exe compared with SoC. Number of readmission days was 226 for SoC, 161 for Bed-Cycle, and 179 for Book-Exe. Incidence rate ratio for readmission days was 0.73 (95% CI: .48–1.10) and 0.77 (95% CI: .51–1.15) for Bed-Cycle and Book-Exe compared with SoC. Conclusions: Although supervised exercise training during admission with CAP did not reduce LOS or mortality, this trial suggests its potential to reduce readmission risk and number of readmission days. Clinical Trials Registration: NCT04094636.

C-reactive protein (CRP) is commonly used to guide community-acquired pneumonia (CAP) treatment. A positive association between admission glucose and CRP levels has been observed in patients with CAP. The associations between prediabetes, unknown diabetes, acute-on-chronic hyperglycaemia, and CRP levels, and between admission CRP levels and insulin resistance (IR) in CAP, remain unexplored. This study investigated the associations firstly between chronic, acute, and acute-on-chronic hyperglycaemia and CRP levels, and secondly between admission CRP levels and IR in CAP. In a prospective cohort study of adults with CAP, the associations between chronic, acute, and acute-on-chronic hyperglycaemia (admission glucose minus HbA1c-derived average glucose) and CRP levels until admission day 3 were modelled with repeated-measures linear mixed models. IR was estimated with the homeostasis model assessment of IR (HOMA-IR). The association between admission CRP levels and HOMA-IR was modelled with linear regression. In 540 patients, no association between chronic, acute, or acute-on-chronic hyperglycaemia and CRP levels was found. In 266 patients, every 50 mg/L increase in admission CRP was associated with a 7% (95% CI 1–14%) higher HOMA-IR. In conclusion, our findings imply that hyperglycaemia does not influence CRP levels in patients with CAP, although admission CRP levels were positively associated with IR.

Background: Physical inactivity is common during admission with community-acquired pneumonia (CAP) and is associated with an increased risk of adverse outcomes. Methods: In a randomised controlled trial involving 186 patients admitted with CAP, we evaluated the effect of supervised exercise training during admission on prognosis. The primary outcome was length of stay. Secondary outcomes were 90-day readmission and 180-day mortality. Patients were randomly assigned in a 1:1:1 ratio to either standard of care, standard of care combined with supervised in-bed cycling, or standard of care combined with supervised exercise training according to a booklet. Analysis of covariance was used to quantify differences in length of stay. Cox proportional hazards regression was used to assess the risk of readmission and mortality. Results: Length of stay was similar groups. The adjusted hazard ratio for 90-day readmission was 0.63 (95% CI 0.33–1.21, P=.17) for the in-bed cycling and 0.54 (95% CI 0.27–1.08, P=.08) for the booklet exercise groups, compared to standard of care. Post-hoc subgroup analysis showed a significant reduction in 90-day readmission with booklet exercise for ≥10 min per day during admission (hazard ratio 0.41, 95% CI 0.18–0.93, P=.03). The risk of 180-day mortality was similar between the groups. Conclusions: Supervised exercise training during admission with CAP had no effect on the length of stay and mortality. Subgroup analyses demonstrated a reduced risk of readmission with booklet exercises. Exercise training during admission could be a safe strategy to mitigate the vicious cycle of readmissions in patients with CAP.