Clinical relevance of constant power exercise duration changes in COPD (original) (raw)
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A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients
Respiratory Medicine, 2012
Purpose: Pulmonary rehabilitation (PR) has positive effects on exercise capacity in Chronic Obstructive Pulmonary Disease (COPD). However, not all COPD patients benefit from PR to the same extent. We investigated whether there is a patient profile, which is associated with the improvement in endurance exercise capacity. Methods: In this observational study, we included 102 COPD patients who followed PR (age 60 AE 10 (mean AE SD) years, FEV 1 %predicted 44 AE 16%, 54 men). Lung function, maximal incremental cycle testing (Wpeak, VO 2 peak, Dlactate), quadriceps force and incremental and endurance shuttle walk test (ISWT/ESWT) were performed at the start of PR. The ESWT was repeated after 7 weeks of PR. Results: Mean change in ESWT (DESWT) was 100 AE 154%. Four variables showed a statistically significant negative correlation with DESWT: FEV 1 %pred. (r Z À0.20), Wpeak (r Z À0.24), Dlactate (r Z À0.33) and incremental shuttle walk test (ISWT) (r Z À0.31). A cluster analysis identified two patient profiles: A profile with high DESWT, TLC and RV and low FEV 1 , VO 2 peak, Respiratory Medicine (2012) 106, 694e700 quadriceps force, Dlactate, HR peak %pred. and ISWT distance and a profile with low DESWT, TLC and RV and high FEV 1 , VO 2 peak, quadriceps force, Dlactate, HR peak %pred. and ISWT distance. Conclusions: Single variables from lung function or exercise testing at baseline have limited predictive value for response to exercise training.
2001
Introduction: patients with advanced lung disease (DPA) exhibit reduced tolerance to an effort, dyspnea, and fatigue. Pulmonary rehabilitation (RP) aims to improve exercising tolerance, controlling symptoms, minimize complications in the pulmonary disease, and improve the quality of life. Objective: to evaluate the effect of RP on exercise capacity, according to the distance traveled in the six-minute walk test (TC6M), in patients with DPA on the waiting list for lung transplantation. Methodology: patients on the waiting list for lung transplantation, referred to RP in the General Hospital of the Federal University of Minas Gerais were submitted to the TC6M, at the beginning and end of RP, and the degree of dyspnea was assessed using the Borg scale. The data were presented as mean and standard deviation of absolute values and compared using the Student's t-test. The p-values < 0.05 were considered statistically significant. Results: between January of 2011 and December of 2012, 17 patients completed the RP. The average age was 42 ± 12 years, 65% were females, the peripheral oxygen saturation on admission was 83 ± 17%, and 35% used oxygen 24 hours/day. Seven patients (41%) presented DPOC, six (35%) had pulmonary fibrosis, and four (24%) other DPA. There was a significant improvement in the distance walked in the TC6M at the end of RP (314 ± 131 m versus 427 ± 111 m; p = 0.0016), with an average increase of 118 m. Conclusion: the RP had a positive impact on the exercise capacity of patients on the waiting list for lung transplantation.
Objective: To investigate the effectiveness of pulmonary rehabilitation (PR) in exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD) with and without global fat-free mass (FFM) depletion. Design: Retrospective case-control. Setting: Outpatient clinic, university center. Participants: COPD patients (NZ102) that completed PR were initially evaluated. Intervention: PR including whole-body and weight training for 12 weeks, 3 times per week. Main Outcome Measures: St. George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), and FFM evaluation applied before and after PR. Results: Patients were stratified according to their FFM status measured by bioelectric impedance. They were considered depleted if the FFM index was 15kg/m 2 in women and 16kg/m 2 in men. From the initial sample, all depleted patients (nZ31) composed the FFM depleted group. It was composed predominantly by women (68%) with a mean age AE SD of 64.4AE7.3 years and a forced expiratory volume in 1 second of 33.6%ZÀ13.2% predicted. Paired for sex and age, 31 nondepleted patients were selected from the initial sample to compose the nondepleted group. Improvement in the 6MWD was similar in these 2 groups after PR. Both groups improved SGRQ scores, although the observed power was small and did not allow adequate comparison between depleted and nondepleted patients. There was no difference between groups in weight change, whereas FFM tended to be greater in depleted patients. This increase had no correlation with the 6MWD or the SGRQ. Conclusions: Benefits of PR to exercise capacity were similar comparing FFM depleted and nondepleted COPD patients. Although FFM change tended to be greater in depleted patients, this increase had no definite relation with clinical outcomes.
International journal of chronic obstructive pulmonary disease, 2009
Pulmonary rehabilitation (PR) is recognized as an evidence-based treatment in improving dyspnea and quality of life in patients with COPD. We evaluated the number needed to treat (NNT) to achieve an increase in physical capacity, as defined by a significant improvement in the six-minute walk test (6MWT) in patients with COPD undergoing PR. The study enrolled 284 patients aged 41 to 86 years (mean age 69.4 years) divided into two groups: a study group (222 patients) undergoing a PR program, and a control group (62 patients) treated only with drugs. The study group included patients with COPD divided in four subgroups according to GOLD stages. In the study group, 142 out of 222 patients (64%) had an increase of at least 54 m in the 6MWT following PR versus 8 out of 62 patients (13%) in the control group after the same time interval. The NNT in the overall study group was 2; the same NNT was obtained in GOLD stages 2, 3, and 4, but was 8 in stage 1. PR is highly effective in improving ...
Fisioterapia em Movimento, 2015
Objective To analyze if there is influence of body weight, body mass index (BMI), body composition, dyspnoea, grip strength and tolerance to exertion in the occurrence of exacerbation during a 12-month follow up of patients with COPD who underwent a physical training program. Material and methods Sixty three patients were distributed in two groups, (Exacerbation Group — EG, n = 29; Non-Exacerbated Group — NEG, n = 34). The Mann Whitney test was used for the comparison between groups, the Friedman test (posthoc Dunn) to compare the assessments and the logistic regression analysis, with a significance level of p < 0.05. Results There is a significant difference between the groups in age and walked distance (WD) in the sixminute walk test (6MWT). The WD was reduced in 6th, 9th and 12th month revaluation compared to baseline and 3 months for the EG. Logistic regression analysis showed a significant interaction between the lean body mass and the WD, BMI with the lean body mass and the...
Respiratory Medicine, 2007
Aim: To evaluate the long-term course of outcome indexes in patients with chronic obstructive pulmonary disease (COPD) undergoing repeated pulmonary rehabilitation programs (PRP). Design: Prospective, observational study. Setting: Pulmonary Rehabilitation Center. Patients: Forty-eight COPD patients (M 33, age 59.678.9 years, forced expiratory volume in 1 s (FEV 1 ) 58716% predicted, DLCO 71717% predicted.) undergoing 5 Day-Hospital based PRPs in a period of 7.270.8 years. Measurements: Lung function, exercise capacity (incremental cycloergometry, test-6minute walking test (6MWD)), dyspnoea (Baseline-BDI and Transitional-TDI Dyspnoea Index and Medical Research Council score-MRC), health-related quality of life (HRQL) (St. George Respiratory Questionnaire (SGRQ), and the derived BODE index were assessed pre and post each PRP. Results: During follow-up, patients showed a 18722 (mean7SEM) ml/year FEV 1 decline (95%CI: À24.4 to 11.6; po0.001). Exercise tolerance and BDI remained stable over time whereas SGRQ improved (DSGRQ total score: À9.6714%, po0.001). BODE index significantly worsened (from 1.2771.14 to 1.9871.64; po0.001), being this change mainly attributable to worsening in FEV 1 . Each PRP elicited significant improvement in ARTICLE IN PRESS exercise capacity, dyspnoea, SGRQ and BODE score. Post-PRP improvements in 6MWD, MRC and TDI were higher after the first three than after the last two PRPs (po0.001), whereas the greatest gain in SGRQ was observed after PRP1 and then it was lower (po0.03) but stable in the following periods of observation. Conclusion: Despite progressive lost in effectiveness of repeated PRP, COPD patients undergoing those programs do not show any significant worsening in exercise tolerance, dyspnoea and HRQL along a period of 7 years.
Effects of Pulmonary Rehabilitation on Exercise Tolerance in Patients with COPD
Journal of Bangladesh Society of Physiologist, 2015
Background: Pulmonary rehabilitation (PR) is known to be therapeutically useful for COPD patients. Objective: To evaluate the effects of combination of breathing exercises (pursed lip breathing and diaphragmatic breathing) and lower extremity endurance training (LEET) as part of PR program on six minute walk distance (6MWD), on oxygen saturation (SpO2%), on the level of dyspnea and fatigue in patients with moderate stable COPD. Methods: This prospective study was conducted in the Department of Physiology, BSMMU, Dhaka from July 2010 to June 2011 on 116 male stable moderate COPD patients aged 50 to 65 years. They were enrolled from the out patient department (OPD) of the Department of Medicine of BSMMU and NIDCH Dhaka. 56 patients without PR constituted control group and experimental group included 60 patients intervened with PR. The experimental patients were advised to perform the PR program for 30 minutes duration per session at home twice daily, for consecutive 60 days along with...
Respiratory Medicine, 2003
Pulmonary rehabilitation (PR) programmes produce initial improvements in exercise tolerance and health status in patients with chronic obstructive pulmonary disease (COPD). However, there is limited data on the longer term effects of PR. This study has examined whether the initial benefits gained in exercise tolerance and health status may be maintained after a 1-year follow-up programme. Sixty-six patients with COPD were assessed with the MRC Dyspnoea Scale and found to be moderately disabled due to dyspnoea (MRC Grades 3 and 4).These patients were then randomised to an 8 week outpatient programme of either exercise training and education (Exercise group) or to education alone (Controlgroup).Exercise performance was assessed withthe shuttle walking test and health status assessed with two disease-specific measures, the St George's Respiratory Questionnaire and the Chronic Respiratory Disease Questionnaire. After PR, all patients were invited to attend monthly follow-up sessions for 1 year. Fifty-six patients were available for follow-up immediately after the programme and were assessed at 6 months and1year.
Respiratory Care, 2015
BACKGROUND: Exercise training is an important component of pulmonary rehabilitation, but it remains questionable how training intensity affects patient-centered outcomes. The aim of this study was to compare the effects of 2 aerobic training intensities on health-related quality of life (HRQOL), symptom control, and exercise tolerance in subjects with COPD. METHODS: Thirtyfour subjects with mild to very severe COPD participated in an equivalence/non-inferiority randomized controlled trial with a parallel group blinded to 60 or 80% maximum work rate (W max) aerobic training intensity. The intervention was an outpatient pulmonary rehabilitation program conducted 3 times/week for 8 weeks. Outcomes were assessed with the St George Respiratory Questionnaire (primary outcome), Mahler's dyspnea index, London Chest Activity of Daily Living scale, 6-min walk test, and constant-load and incremental exercise tests. RESULTS: Subjects were randomly allocated to aerobic training intensity of 60% W max (group 1, n ؍ 17) or 80% W max (group 2, n ؍ 17). Although there were significant improvements in all outcomes for both groups, there were no between-group differences in mean change in the St George Respiratory Questionnaire (P ؍ .31, 95% CI ؊12.0 to 3.9), Mahler's dyspnea index (P ؍ .38), London Chest Activity of Daily Living scale (P ؍ .92), 6-min walk test (P ؍ .50, 95% CI 6.2-71.1), constant-load exercise test (P ؍ .50), and incremental exercise test (P ؍ .12). There was only one exercise-related adverse event of cardiac symptoms. CONCLUSIONS: Aerobic training intensity of at least 60% W max has a positive impact on COPD patient-centered outcomes, with no additional benefit of increasing intensity to 80% W max in HRQOL, symptom control, and exercise tolerance, challenging the present clinical attitude of rehabilitation professionals. (ClinicalTrials.gov registration NCT01944072.
Benefits of pulmonary rehabilitation in patients with COPD and normal exercise capacity
2013
BACKGROUND: Pulmonary rehabilitation (PR) is beneficial for patients with COPD, with improvement in exercise capacity and health-related quality of life. Despite these overall benefits, the responses to PR vary significantly among different individuals. It is not clear if PR is beneficial for patients with COPD and normal exercise capacity. We aimed to investigate the effects of PR in patients with normal exercise capacity on health-related quality of life and exercise capacity. METHODS: Twenty-six subjects with COPD and normal exercise capacity were studied. All subjects participated in 12-week, 2 sessions per week, hospital-based, outpatient PR. Baseline and post-PR status were evaluated by spirometry, the St George's Respiratory Questionnaire, cardiopulmonary exercise test, respiratory muscle strength, and dyspnea scores. RESULTS: The mean FEV 1 in the subjects was 1.29 ؎ 0.47 L/min, 64.8 ؎ 23.0% of predicted. After PR there was significant improvement in maximal oxygen uptake and work rate. Improvements in St George's Respiratory Questionnaire scores of total, symptoms, activity, and impact were accompanied by improvements of exercise capacity, respiratory muscle strength, maximum oxygen pulse, and exertional dyspnea scores (all P < .05). There were no significant changes in pulmonary function test results (FEV 1 , FVC, and FEV 1 /FVC), minute ventilation, breathing frequency, or tidal volume at rest or exercise after PR. CONCLUSIONS: Exercise training can result in significant improvement in health-related quality of life, exercise capacity, respiratory muscle strength, and exertional dyspnea in subjects with COPD and normal exercise capacity. Exercise training is still indicated for patients with normal exercise capacity.