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Changes in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects
Imen Ben Cheikh Rejbi, Yassine Trabelsi, Afef Chouchene, et al
International Journal of Chronic Obstructive Pulmonary Disease , 2010, DOI: http://dx.doi.org/10.2147/COPD.S7955
Abstract: nges in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects Original Research (4780) Total Article Views Authors: Imen Ben Cheikh Rejbi, Yassine Trabelsi, Afef Chouchene, et al Published Date July 2010 Volume 2010:5 Pages 209 - 215 DOI: http://dx.doi.org/10.2147/COPD.S7955 Imen Ben Cheikh Rejbi1, Yassine Trabelsi1, Afef Chouchene1, Wafa Ben Turkia1, Helmi Ben Saad1, Abdelkarim Zbidi1, Abdelhamid Kerken2, Zouhair Tabka1 1Department of Physiology and Lung Testing, Faculty of Medicine of Sousse, Tunisia; 2Department of Biophysics, Faculty of Medicine of Monastir, Tunisia Background: The six-minute walking distance (6MWD) test has demonstrated validity and reliability to assess changes in functional capacity following pulmonary rehabilitation in patients with chronic obstructive lung disease. However, no attempt has been made to establish an iterative measurement of 6MWD during the overall period of pulmonary rehabilitation. Therefore, the aim of this study was to evaluate the impact of a twelve-week rehabilitation program on the iterative weekly measurement of 6MWD in chronic obstructive pulmonary disease (COPD) patients and healthy subjects. Methods: Twenty-six patients with COPD and nine age-matched healthy subjects were studied. Measurements were taken at baseline and after twelve weeks except for the 6MWD. The exercise measurements included a six-minute walking test (6MWT) and an incremental exercise test. Oxygen saturation, heart rate, and dyspnea will be monitored during all these tests. Results: At baseline there were significant differences between groups, except in age, body mass index, and oxygen saturation. After 12 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. The 6MWD, peak oxygen uptake VO2peak and anaerobic threshold increased significantly after training in both groups (P < 0.01). The averaged trace of the 6MWD of patients with COPD and healthy subjects was followed-up respectively by a logarithmic and linear fitting. 6MWD showed a plateau after eight weeks in patients with COPD, however, it increased continually overall in healthy subjects. Conclusion: Both patients with COPD and healthy subjects demonstrated functional responses to training but with somewhat different patterns in quality of the improvement of the 6MWD.
Changes in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects  [cached]
Imen Ben Cheikh Rejbi,Yassine Trabelsi,Afef Chouchene,et al
International Journal of COPD , 2010,
Abstract: Imen Ben Cheikh Rejbi1, Yassine Trabelsi1, Afef Chouchene1, Wafa Ben Turkia1, Helmi Ben Saad1, Abdelkarim Zbidi1, Abdelhamid Kerken2, Zouhair Tabka11Department of Physiology and Lung Testing, Faculty of Medicine of Sousse, Tunisia; 2Department of Biophysics, Faculty of Medicine of Monastir, TunisiaBackground: The six-minute walking distance (6MWD) test has demonstrated validity and reliability to assess changes in functional capacity following pulmonary rehabilitation in patients with chronic obstructive lung disease. However, no attempt has been made to establish an iterative measurement of 6MWD during the overall period of pulmonary rehabilitation. Therefore, the aim of this study was to evaluate the impact of a twelve-week rehabilitation program on the iterative weekly measurement of 6MWD in chronic obstructive pulmonary disease (COPD) patients and healthy subjects.Methods: Twenty-six patients with COPD and nine age-matched healthy subjects were studied. Measurements were taken at baseline and after twelve weeks except for the 6MWD. The exercise measurements included a six-minute walking test (6MWT) and an incremental exercise test. Oxygen saturation, heart rate, and dyspnea will be monitored during all these tests. Results: At baseline there were significant differences between groups, except in age, body mass index, and oxygen saturation. After 12 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. The 6MWD, peak oxygen uptake VO2peak and anaerobic threshold increased significantly after training in both groups (P < 0.01). The averaged trace of the 6MWD of patients with COPD and healthy subjects was followed-up respectively by a logarithmic and linear fitting. 6MWD showed a plateau after eight weeks in patients with COPD, however, it increased continually overall in healthy subjects.Conclusion: Both patients with COPD and healthy subjects demonstrated functional responses to training but with somewhat different patterns in quality of the improvement of the 6MWD. Keywords: six-minute walking distance (6MWD), chronic obstructive pulmonary disease (COPD), healthy subjects, pulmonary rehabilitation
Outcome of pulmonary rehabilitation in COPD patients with severely impaired health status  [cached]
van Ranst D,Otten H,Meijer JW,van 't Hul AJ
International Journal of COPD , 2011,
Abstract: Dirk van Ranst1, Henk Otten1,2, Jan Willem Meijer1, Alex J van 't Hul1,31Revant, Pulmonary Rehabilitation Center 'Schoondonck', Breda, 2Erasmus Medical Center, Department of Pulmonary Diseases, Erasmus University, Rotterdam, 3VU Medical Center, Department of Pulmonary Diseases, VU University, Amsterdam, The NetherlandsIntroduction: Effects of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients with severely impaired health status are poorly documented since these patients are usually excluded from clinical trials. This retrospective, observational study aims to study the impact of disease on health status and the effects of PR on COPD patients referred to a tertiary center for PR in The Netherlands.Methods: Between June 2006 and June 2010, 437 patients with COPD were allocated to our intensive, comprehensive PR program. Patients participated in this interdisciplinary program for 12 weeks for a weekly average of 20–25 hours. Before and directly after, several measures of physical performance and health-related quality of life were determined.Results: At baseline, most patients (75%) had a Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage of III-IV. Peak exercise performance on a cycle ergometer was on average reduced to 43 ± 29 Watt, and health-related quality of life was significantly impaired, with a total score on the St George's Respiratory Questionnaire (SGRQ) of 66. Health-care utilization in the year preceding PR was very high. After rehabilitation, all outcome measures improved statistically significantly (P < 0.001). Exercise performance measured with the 6 minute walking distance test improved clinically significantly in 68% of the patients, whereas 75% of the patients showed a clinically meaningful improvement in quality of life as measured with the SGRQ. Multiple regression analysis revealed that 19% of the variation in responses on the 6 minute walking distance test and the SGRQ could be explained on the basis of baseline characteristics.Conclusion: The present study provides data to indicate that COPD patients may substantially benefit from rehabilitation in a tertiary pulmonary rehabilitation center, despite a severely impaired health status and high level of health-care utilization, in which prior treatment in primary and secondary care have failed to improve health status. Individual rehabilitation responses can only partially be predicted on the basis of baseline characteristics. Consequently, no firm conclusions can be drawn from this study with respect to the selection of candidates
Outcome of pulmonary rehabilitation in COPD patients with severely impaired health status
van Ranst D, Otten H, Meijer JW, van 't Hul AJ
International Journal of Chronic Obstructive Pulmonary Disease , 2011, DOI: http://dx.doi.org/10.2147/COPD.S24579
Abstract: tcome of pulmonary rehabilitation in COPD patients with severely impaired health status Original Research (5460) Total Article Views Authors: van Ranst D, Otten H, Meijer JW, van 't Hul AJ Published Date December 2011 Volume 2011:6 Pages 647 - 657 DOI: http://dx.doi.org/10.2147/COPD.S24579 Dirk van Ranst1, Henk Otten1,2, Jan Willem Meijer1, Alex J van 't Hul1,3 1Revant, Pulmonary Rehabilitation Center 'Schoondonck', Breda, 2Erasmus Medical Center, Department of Pulmonary Diseases, Erasmus University, Rotterdam, 3VU Medical Center, Department of Pulmonary Diseases, VU University, Amsterdam, The Netherlands Introduction: Effects of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients with severely impaired health status are poorly documented since these patients are usually excluded from clinical trials. This retrospective, observational study aims to study the impact of disease on health status and the effects of PR on COPD patients referred to a tertiary center for PR in The Netherlands. Methods: Between June 2006 and June 2010, 437 patients with COPD were allocated to our intensive, comprehensive PR program. Patients participated in this interdisciplinary program for 12 weeks for a weekly average of 20–25 hours. Before and directly after, several measures of physical performance and health-related quality of life were determined. Results: At baseline, most patients (75%) had a Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage of III-IV. Peak exercise performance on a cycle ergometer was on average reduced to 43 ± 29 Watt, and health-related quality of life was significantly impaired, with a total score on the St George's Respiratory Questionnaire (SGRQ) of 66. Health-care utilization in the year preceding PR was very high. After rehabilitation, all outcome measures improved statistically significantly (P < 0.001). Exercise performance measured with the 6 minute walking distance test improved clinically significantly in 68% of the patients, whereas 75% of the patients showed a clinically meaningful improvement in quality of life as measured with the SGRQ. Multiple regression analysis revealed that 19% of the variation in responses on the 6 minute walking distance test and the SGRQ could be explained on the basis of baseline characteristics. Conclusion: The present study provides data to indicate that COPD patients may substantially benefit from rehabilitation in a tertiary pulmonary rehabilitation center, despite a severely impaired health status and high level of health-care utilization, in which prior treatment in primary and secondary care have failed to improve health status. Individual rehabilitation responses can only partially be predicted on the basis of baseline characteristics. Consequently, no firm conclusions can be drawn from this study with respect to the selection of candidates that could be deemed eligible for this rehabilitation program when entering the program.
Effect of obesity on constant workrate exercise in hyperinflated men with COPD
Louis Laviolette, Francesco Sava, Denis E O'Donnell, Katherine A Webb, Alan L Hamilton, Steven Kesten, Fran?ois Maltais
BMC Pulmonary Medicine , 2010, DOI: 10.1186/1471-2466-10-33
Abstract: Men with COPD and hyperinflation were divided according to World Health Organization BMI classification: 84 normal BMI (NBMI), 130 overweight (OW) and 64 obese (OB). Patients underwent spirometric and lung volumes assessment and an incremental cycling exercise test. This was followed by a constant workrate exercise test (CET) at 75% of peak capacity. Inspiratory capacity and Borg dyspnea scores were measured at baseline, during and at the end of CET.FEV1 % predicted was not different across BMI classes. Total lung capacity and functional residual capacity were significantly lower in OB and OW compared to NBMI patients. Peak VO2 in L·min-1 was significantly higher in OB and OW patients than in NBMI patients. CET time was not different across BMI classes (p = 0.11). Changes in lung volumes and dyspnea during CET were not different between BMI categories.OB and OW patients with COPD had a higher peak VO2 than their lean counterparts. Endurance time, dyspnea and changes in lung volumes during CET were similar between BMI categories.COPD is characterized by reduced exercise tolerance [1], which is determined by a multitude of factors whose individual contribution may vary between patients[2]. Obesity is now an important issue in COPD: it is reported in 18% [3] to 54% [4] of patients with COPD and is associated with a better prognosis[5,6]. Both conditions, when taken individually, are characterized by physiological alterations in breathing mechanics along with functional limitations. The precise combined effects of COPD and obesity on such a multidimensional issue as exercise tolerance remain ambiguous. Clinical experience dictates that their combination would lead to a worsening of functional limitations and symptoms[7,8]. However, there are complex interactions between the two conditions that could mitigate a negative synergic effect on exercise performance.On one hand, obesity is associated with an increased work of breathing [9], increased breathing resistive load [1
Characteristics of COPD Patients Enrolled into Rehabilitation Programme in Copenhagen  [PDF]
Ramune Jacobsen,Ea Rusch,Anne Fr?lich,Per Kragh Andersen,Nina Godftredsen
ISRN Pulmonology , 2013, DOI: 10.1155/2013/394042
Abstract: Pulmonary rehabilitation (PR) is a recommended standard of care for patients with chronic obstructive pulmonary disease (COPD), as it improves exercise capacity and health-related quality of life (HRQOL), attenuates perceived dyspnoea, and decreases the need for hospitalisation. The objective of this study was to compare medical and sociodemographic characteristics of COPD patients who were enrolled and completed the PR with those of COPD patients who were resident in the same municipality but were not enrolled into this PR. The data used for comparison came from the Danish National Registers. The COPD patients who were enrolled and completed the rehabilitation differed from COPD patients who were not enrolled into the rehabilitation in the following: (1) there were more women than men among those who were enrolled; (2) those who were enrolled had higher socioeconomic status compared to those who were not enrolled; and (3) those who were enrolled into the rehabilitation used more COPD-specific medication compared to those who were not enrolled. In conclusion, to enrol more COPD patients into PR, special attention needs to be paid to COPD patients from lower socioeconomic status groups as well as male patients. 1. Introduction Chronic obstructive pulmonary disease (COPD) is a disease that clinically manifests itself by gradual physical impairment, increasing breathlessness, and episodes of acute exacerbations which deteriorate overall health and require hospitalisation. Morbidity and mortality related to COPD is increasing [1]. COPD is especially frequent in Denmark. According to the calculations done by the Copenhagen City Heart Study in 2010, an overall prevalence of COPD in Denmark was 17.4% among individuals of 35 years of age or older, while estimated COPD prevalence from studies in other developed countries ranged from 5% to 19% with the majority being in the vicinity of 10% [2]. In the Capital Region of Denmark, the prevalence of COPD among individuals older than 40 years old of age is 15% corresponding to 120,000 citizens. Among those, more than 19,000 meet the criteria for a rehabilitation programme, that is, forced expiratory volume during one second (FEV1) being less than 80% of predicted value, and dyspnea scoring 3 or higher on the Medical Research Council (MRC) scale [3]. Pulmonary rehabilitation (PR) is a recommended standard of care for patients with COPD. According to the definitions set by the American Thoracic Society and the European Respiratory Society, comprehensive PR programmes should include patient assessment, exercise training,
Outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease  [cached]
Shahin Barakat,Germain Michele,Pastene George,Viallet Nicole
International Journal of COPD , 2008,
Abstract: Shahin Barakat1, Germain Michele2, Pastene George3, Viallet Nicole4, Annat Guy51Master of (experimental physiopathology) and doctoral student of physiopathology; 2Chef of the service of EFR, Hospital of the Croix-Rousse at Lyon, France; 3Hospital of Croix-Rousse at Lyon, France; 5Service of EFR, Hospital of the Croix Rousse at Lyon, France; 5UFR Médecine Lyon Grange-Blanche Université Claude Bernard Lyon I, INSERM ESPRI ERI 22, Lyon, FranceObjective: To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD, using St.George’s Respiratory questionnaire (SGRQ), the 6-minutes walking test (6-MWT) and BODE index as the primary outcome measures.Methods: A prospective, parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD (67 men and 13 women; mean age 64.8 ± 10.6 years; FEV1, 42.8% ± 7.6% of the predicted value. The active group (n = 40) took part in a 14-week rehabilitation program [3 h/wk, 1.5 h of education and exercise and 1.5 h of cycling]. The control group (n = 40) was reviewed routinely as medical outpatients. The following evaluations were carried out at study entry and after 14weeks: (1) pulmonary function studies; (2) 6-minutes walking test 6MWT; (3) quality of life; and (4) BODE index.Results: The following patients completed the study: 35 patients (87.5%) from the active group (mean age, 63.7 ± 11.9 years; mean forced expiratory volume in one second (FEV1), 41.9 ± 2.6% of the predicted value); and 36 patients (88%) from the control group (mean age, 65.9 ± 10.3 years; mean FEV1, 43.33 ± 3.6% of the predicted value). We found no changes in pulmonary function parameters in the active group and the control one at 14weeks. On the other hand, there were significant changes within the components of the SGRQ (12.3 for the score total) for the patients of the active group but not for the patients of the control one (only 1.5 for the score total), we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one, and finally a decrease of two points (from 6 to 4) was noted in the score of the active group’s BODE index without any change in the control group’s one.Conclusion: An outpatient-based of 14-week rehabilitation program significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD, and there was also a large decrease in the risk of death in rehabilitated patients as m
Pulmonary Rehabilitation in COPD: A Reappraisal (2008–2012)  [PDF]
Pierachille Santus,Linda Bassi,Dejan Radovanovic,Andrea Airoldi,Rita Raccanelli,Francesco Triscari,Francesca Giovannelli,Antonio Spanevello
Pulmonary Medicine , 2013, DOI: 10.1155/2013/374283
Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a complex pathological condition associated with an important reduction in physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life. Pulmonary rehabilitation is aimed to eliminate or at least attenuate these difficulties, mainly by promoting muscular reconditioning. The scope of this paper has been the analysis of the literature on pulmonary rehabilitation in COPD patients has appeared in the last five years, focusing on the principal outcomes obtained. The results demonstrate that pulmonary rehabilitation has a beneficial effect on dyspnoea relief, improving muscle strength and endurance. Moreover, pulmonary rehabilitation appears to be a highly effective and safe treatment for reducing hospital admissions mortality and improving health-related quality of life in COPD patients. It represents, therefore, a very important therapeutic option that, along with standard pharmachological therapy, can be used to obtain the best patient management. The favourable results obtained with pulmonary rehabilitation programs should stimulate researchers to improve our understanding of the mechanisms that form the basis of the beneficial effects of this therapeutic intervention. This would in turn increase the effectiveness of pulmonary rehabilitation in COPD patients. 1. Introduction Pulmonary rehabilitation is defined by the American Thoracic Society and the European Respiratory Society as an “evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities.” As such it is an integral part of the clinical management and health maintenance of those patients with chronic respiratory disease who remain symptomatic or continue to have decreased lung function despite standard medical treatment. Integrated into the individualised treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimise functional status, increase participation, and reduce health care costs by stabilising or reversing systemic manifestations of the disease [1]. All together these considerations underline the general implications and the importance of this respiratory treatment, which should be considered fundamental during the management of chronic obstructive pulmonary disease (COPD). In the last few years, medical literature has provided evidence that pulmonary rehabilitation favourably affects outcomes in COPD [2]. In spite of these
Self-Paced Walking within a Diverse Topographical Environment Elicits an Appropriate Training Stimulus for Cardiac Rehabilitation Patients  [PDF]
James Faulkner,Johannes Gerhard,Lee Stoner,Danielle Lambrick
Rehabilitation Research and Practice , 2012, DOI: 10.1155/2012/140871
Abstract: Purpose. To assess the effect of a self-paced walking intervention within a topographically varied outdoor environment on physiological and perceptual markers in cardiac rehabilitation (CR) patients. Methods. Sixteen phase II CR patients completed twelve self-paced one-mile walking sessions over a four-week period within a community-based CR programme. Walking velocity, heart rate (HR), and ratings of perceived exertion (RPE) were reported at eight stages throughout the self-paced walks. Results. The study showed a significant increase in walking velocity from week 1 (~4.5?km/h) to week 4 (~5.1?km/h) of the self-paced walking programme ( ). A significantly higher HR was also observed in week 4 ( ?b·min?1; ~69% of maximal HR) compared to week 1 ( ?b·min?1; ~65% of maximal HR, ). There were no changes in the average RPE across the course of the 4-week self-paced walking programme ( ). Conclusion. A self-paced walking programme may elicit an appropriate training stimulus for CR patients when exercising within a diverse topographical environment. Participants completed a one-mile walk within a shorter period of time and at a higher physiological intensity than that elicited at the onset of the programme, despite no observed changes in participants' subjective perception of exertion. 1. Introduction Cardiac rehabilitation (CR) programmes promote active lifestyles through the adherence to physical training and compliance to healthy behaviours [1]. Both cycling and walking are employed during CR to reduce cardiac risk factors and elicit improvements in peak exercise capacity and health-related quality of life [2, 3]. Of these two exercise modes, walking may be considered a more accessible, familiar, and habitual form of exercise for the average individual [4]. Prescriptive exercise is widely assumed to be the cornerstone of an effective CR programme [5]. There is however evidence that some individuals struggle to reproduce or accurately recall their exercise intensity within a prescribed training environment [6–8]. High-intensity exercise may also be dangerous and induce complications for CR patients [5]. If the enjoyment associated with an exercise programme is reduced, or the perception of pain is elevated following prescribed exercise of a vigorous nature, an individual’s long-term exercise adherence may be affected [5]. Heart rate (HR) and the ratings of perceived exertion (RPE) are often used to monitor and regulate exercise intensity [9]. Despite this, approximately 85% of individuals use an inherent sense of effort to adjust and control exercise
Peak exercise capacity estimated from incremental shuttle walking test in patients with COPD: a methodological study
Ragnheieur Arnardóttir, Margareta Emtner, Hans Hedenstr?m, Kjell Larsson, Gunnar Boman
Respiratory Research , 2006, DOI: 10.1186/1465-9921-7-127
Abstract: Ninety-three patients with moderate or severe COPD performed an ISWT, an incremental cycle test (ICT) to measure W peak and a semi-steady-state cycle test with breath-by-breath gas exchange analysis (CPET) to measure VO2 peak. Routine equations for conversion between cycle tests were used to estimate W peak from measured VO2 peak (CPET). Conversion equation for estimation of W peak from ISWT was found by univariate regression.There was a significant correlation between W peak and distance walked on ISWT × body weight (r = 0.88, p < 0.0001). The agreement between W peak measured by ICT and estimated from ISWT was similar to the agreement between measured W peak (ICT) and W peak estimated from measured VO2 peak by CPET.Peak exercise capacity measured by an incremental cycle test could be estimated from an ISWT with similar accuracy as when estimated from peak oxygen uptake in patients with COPD.Measurements of exercise capacity are important and widely used in rehabilitation of patients with chronic obstructive pulmonary disease (COPD). Exercise testing in COPD varies from maximal laboratory tests, requiring advanced technical equipment, to simple field tests. Maximal laboratory tests are mostly constructed to measure peak exercise capacity (W peak), and/or peak oxygen uptake (VO2 peak) whereas field tests have been considered to reflect functional capacity [1-3]. The incremental shuttle walking test (ISWT) is a field test which is similar to the laboratory tests as it is externally paced and progressive [4]. During ISWT there is a linear relationship between VO2 and walking speed, similar to the relationship between VO2 and work rate in incremental laboratory testing [5,6]. Singh et al found, when comparing incremental laboratory treadmill test and ISWT, that VO2 peak could be estimated from distance walked on ISWT [5].Singh et al compared two different walking tests (treadmill and ISWT) and it is unclear whether such a strong relationship would also be found between
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