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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
Do supervised weekly exercise programs maintain functional exercise capacity and quality of life, twelve months after pulmonary rehabilitation in COPD?
Lissa M Spencer, Jennifer A Alison, Zoe J McKeough
BMC Pulmonary Medicine , 2007, DOI: 10.1186/1471-2466-7-7
Abstract: Following completion of an eight-week pulmonary rehabilitation program, COPD subjects will be recruited and randomised (using concealed allocation in numbered envelopes) into either the maintenance exercise group (supervised, weekly, hospital-based exercise) or the control group (unsupervised home exercise) and followed for twelve months. Measurements will be taken at baseline (post an eight-week pulmonary rehabilitation program), three, six and twelve months. The exercise measurements will include two six-minute walk tests, two incremental shuttle walk tests, and two endurance shuttle walk tests. Oxygen saturation, heart rate and dyspnoea will be monitored during all these tests. Quality of life will be measured using the St George's Respiratory Questionnaire and the Hospital Anxiety and Depression Scale. Participants will be excluded if they require supplemental oxygen or have neurological or musculoskeletal co-morbidities that will prevent them from exercising independently.Pulmonary rehabilitation plays an important part in the management of COPD and the results from this study will help determine if supervised, weekly, hospital-based exercise can successfully maintain functional exercise capacity and quality of life following an eight-week pulmonary rehabilitation program in COPD subjects in Australia.Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in Australian males, the sixth leading cause of death in females [1] and resulted in 5000 deaths in 2003 [2]. COPD is a progressive, disabling disease, which has a significant impact on the health care system [1,3]. Early diagnosis and management of COPD is a priority of health care services throughout Australia. Management of COPD involves optimising medical therapy, commencing smoking cessation and participating in pulmonary rehabilitation.Pulmonary Rehabilitation is a multi-disciplinary approach to the management of patients with respiratory disease. The program is individually ta
Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial
Júlio C Mendes de Oliveira, Fernando S Studart Leit?o Filho, Luciana M Malosa Sampaio, Ana C Negrinho de Oliveira, Raquel Hirata, Dirceu Costa, Claudio F Donner, Luís VF de Oliveira
Multidisciplinary Respiratory Medicine , 2010, DOI: 10.1186/2049-6958-5-6-401
Abstract: Patients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks.There was a significant difference in the distance covered on the six-minute walk test (p < 0.05) and BODE index (p < 0.001) in the outpatient and at-home groups after participating in the rehabilitation program compared to baseline.A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.Chronic obstructive pulmonary disease (COPD) is a common cause of illness and death that affects a large and increasing number of individuals in both developed and developing countries. Estimates suggest that COPD will become the 3rd most common cause of death in the world and 5th most common cause of illness in the next 20 years [1,2].Pulmonary rehabilitation (PR) is a multidisciplinary intervention that integrates physical exercise, nutritional therapy, patient education and psychological support [3-7]. Evidence indicates that PR offers numerous clinical benefits, such as improved health-related quality of life, a reduction in anxiety and depression, increased tolerance to physical exercise and a reduction in the number of hospitalizations and days of hospital stay per year [3,4]. However, despite the strong scientific recommendations for its routine use in the treatment of COPD, PR is generally underutilized [5-7]. A survey carried out in 2005 in Canada demonstrated that only 1-2% of the Canadian population with COPD has access to rehabilitation programs [8]. Similar statistics are reported for other countries [7,9].A search of the scientific literature revealed few controlled studies that demonstrate the b
Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?
Nichola S Gale, James M Duckers, Stephanie Enright, John R Cockcroft, Dennis J Shale, Charlotte E Bolton
BMC Pulmonary Medicine , 2011, DOI: 10.1186/1471-2466-11-20
Abstract: Thirty-two stable patients with COPD commenced rehabilitation, and were compared with 20 age and gender matched controls at baseline assessment. In all subjects, aortic pulse wave velocity (PWV) an independent non-invasive predictor of cardiovascular risk, blood pressure (BP), interleukin-6 (IL-6) and fasting glucose and lipids were determined. These measures, and the incremental shuttle walk test (ISWT) were repeated in the patients who completed pulmonary rehabilitation.On commencement of rehabilitation aortic PWV was increased in patients compared with controls (p < 0.05), despite mean BP, age and gender being similar. The IL-6 was also increased (p < 0.05). Twenty-two patients completed study assessments. In these subjects, rehabilitation reduced mean (SD) aortic PWV (9.8 (3.0) to 9.3 (2.7) m/s (p < 0.05)), and systolic and diastolic BP by 10 mmHg and 5 mmHg respectively (p < 0.01). Total cholesterol and ISWT also improved (p < 0.05). On linear regression analysis, the reduction in aortic PWV was attributed to reducing the BP.Cardiovascular risk factors including blood pressure and thereby aortic stiffness were improved following a course of standard multidisciplinary pulmonary rehabilitation in patients with COPD.Chronic obstructive pulmonary disease (COPD) is an increasing cause of global morbidity and mortality [1] of which cardiovascular (CV) disease accounts for approximately 30% of the excess mortality in patients [2]. Such patients have multiple risk factors for CV disease including exposure to significant cigarette smoke, physical inactivity and metabolic disorders [3]. In addition, arterial stiffness measured by aortic pulse wave velocity (PWV) is an independent predictor of CV risk [4,5], which is increased in patients with COPD [6].In the general population, addressing physical activity and nutritional optimisation, both components of multidisciplinary pulmonary rehabilitation, are associated with reducing the CV risks such as blood pressure (BP) and
The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD
Francesco Sava, Louis Laviolette, Sarah Bernard, Marie-Josée Breton, Jean Bourbeau, Fran?ois Maltais
BMC Pulmonary Medicine , 2010, DOI: 10.1186/1471-2466-10-55
Abstract: 261 patients with COPD were divided into three groups: normal body mass index (BMI), overweight and obese. Baseline and post rehabilitation pulmonary function, 6-min walking test (6MWT), endurance time during a constant workrate exercise test (CET) and St. George's Respiratory Questionnaire (SGRQ) scores were compared between all three classes of BMI.At baseline, obese and overweight patients had less severe airflow obstruction compared to normal BMI patients. There was no baseline difference in CET performance or SGRQ scores across BMI classes and 6MWT was reduced in the presence of obesity (p < 0.01). Compared to baseline, post-rehabilitation 6MWT, CET performance and SGRQ scores improved significantly in each group (p < 0.01), but 6MWT was still significantly lower in the presence of obesity.Walking, but not cycling performance was worse in obese patients. This difference was maintained post rehabilitation despite significant improvements. Weight excess may counterbalance the effect of a better preserved respiratory function in the performance of daily activities such as walking. However, obesity and overweight did not influence the magnitude of improvement after pulmonary rehabilitation.Chronic obstructive pulmonary disease (COPD) is associated with dyspnea and exercise intolerance, two major impediments to quality of life. Although low body weight[1] and muscle wasting[2] have traditionally been the focus of nutritional management in COPD, recent data indicate that obesity is becoming frequent in this disease[3]. On one hand, a high body mass index (BMI) appears to convey a survival advantage to patients with COPD[1,4]. On the other hand, obesity by itself may compromise lung function[5], decrease exercise tolerance particularly during weight bearing activities[6,7], and quality of life[8], leading to greater disability[9,10].The effects of obesity in combination with COPD on exercise tolerance and dyspnea have received little attention. In one study, obese pat
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.
Effects of short-term pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease.
Miyahara N,Eda R,Takeyama H,Kunichika N
Acta Medica Okayama , 2000,
Abstract: Although the rehabilitation of patients with chronic obstructive pulmonary disease (COPD) improves both exercise capacity and quality of life, a standard protocol for COPD patients has not been established. To clarify whether physiologic and quality-of-life improvements can be achieved by an inpatient pulmonary rehabilitation program 5 days per week for 3 weeks, 18 patients with COPD were enrolled in a rehabilitation program. The physical exercise training regimen consisted of respiratory muscle stretch gymnastics and cycle ergometer exercise training. Pulmonary function tests, an incremental ergometer exercise test, a 6-min walking test, and a quality of life assessment by the Chronic Respiratory Questionnaire were administered before and after the program. The peak VO2, an indicator of maximal exercise capacity, did not increase, although the 6-min walking distance, an indicator of functional exercise capacity, increased significantly after rehabilitation. There was a significant improvement in the quality of life in terms of dyspnea, fatigue, and emotional state. These findings suggest that even a 3-week program may be beneficial for COPD patients. Increases in functional exercise capacity, even without an increase in maximal exercise capacity, are helpful for reducing dyspnea and improving quality of life parameters in patients with COPD.
Entrenamiento físico y educación como parte de la rehabilitación pulmonar en pacientes con EPOC Exercise training and education as part of pulmonary rehabilitation for COPD patients  [cached]
KATHERINE MARíN D,REBECA LAUDE P,CECILIA MORALES D
Revista Chilena de Enfermedades Respiratorias , 2008,
Abstract: La rehabilitación pulmonar es un recurso terapéutico no farmacológico dirigido a pacientes con EPOC, sus principales objetivos son: reducir los síntomas, mejorar la calidad de vida y aumentar la participación física y emocional de los pacientes en las actividades cotidianas. Los pacientes con EPOC en todos los estadios de la enfermedad se benefician con los programas de entrenamiento, que mejoran tanto la tolerancia al ejercicio como la sensación de disnea y fatiga. La educación al paciente se incluye con el objetivo de optimizar sus habilidades, su capacidad de sobrellevar la enfermedad y para mejorar su estado de salud, además de la cesación del hábito tabáquico. A continuación se presenta una revisión bibliográfica acerca del entrenamiento físico y la educación como parte de un programa de rehabilitación pulmonar. Pulmonary rehabilitation is a non-pharmacological therapeutic resort for COPD patients. Its main goals are to reduce symptoms, improve quality of life, and increase physical and emotional involvement in everyday activities. COPD patients at all stages ofthe disease benefit from exercise training programs, as ihey improve both exercise tolerance and symptoms of dyspnea and fatigue. Patient 's education is included so that it helps improving skills, ability to cope with illness, and health status, as well as smoking cessation. We present a bibliographical review about exercise training and education as part of a pulmonary rehabilitation program.
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.
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