Effects of simple long-term respiratory care strategies in older men with COPD

Abstract

Objective:To evaluate a 24-month supervised, community-based maintenance exercise program after 3 months of pulmonary rehabilitation (PR) in comparison with a 27-month physical activity counseling program, in terms of the effects on maximal muscle strength, muscle power output, and exercise capacity, in individuals with COPD. Methods:Sixty-three men with moderate-to-severe COPD were recruited from two previous studies. Of those 63 participants, 31 were offered 3 months of PR followed by a 24-month supervised maintenance exercise program (24MME group) and 32 were offered a 27-month physical activity counseling program (27MPAC group). Measurements at 3 months and at the end of the study period included maximal strength of the upper and lower limbs, power output of the lower limbs, six-minute walk distance (6MWD), and quality of life. Results:At 27 months, the improvements in maximal strength of the upper and lower limbs were greater in the 24MME group than in the 27MPAC group (37.6 ± 28.3% and 28.4 ± 13.3%, respectively, vs. 8.8 ± 16% and 13.6 ± 16.4%, respectively; p < 0.05), as was the improvement in power output of the lower limbs (24.6 ± 18.4% vs. −2.3 ± 28.5%; p < 0.01). The increase in the 6MWD after 3 months was also greater in the 24MME group than in the 27MPAC group (33.2 ± 36.6 m vs. 2.9 ± 34.7 m; p < 0.05), although there were no differences between the two groups in terms of the Δ6MWD at 27 months (vs. baseline). Conclusions:A supervised, community-based maintenance program is a successful long-term strategy to preserve the benefits of PR on peripheral muscle function and exercise capacity in individuals with COPD. However, physical activity counseling can maintain maximal muscle strength and exercise capacity in such individuals.

Rehabilitación Pulmonar en Pacientes con Enfermedad Pulmonar Obstructiva Crónica

“…Como aspectos poco convencionales para la evaluación en programas de rehabilitación pulmonar se encuentran los test y las medidas de equilibrio clínico que incluye la escala de equilibrio de Berg (BBS), la prueba de equilibrio de evaluación (BESTest) y la escala de confianza de equilibrio especifica de las actividades; este tipo de pruebas permite valorar la fuerza muscular de las extremidades inferiores, además, respaldan la viabilidad y efectividad del entrenamiento como parte de la rehabilitación pulmonar, para evidenciar mejoría en el rendimiento del equilibrio, fuerza muscular y función física en pacientes con enfermedad pulmonar obstructiva crónica de estadio moderado a grave (22). Dentro de la educación continua se desarrollan técnicas del manejo de la patología como la apropiación del tratamiento, ejercicios de manejo de la respiración, y control de factores intrínsecos y extrínsecos que exacerban la sintomatología (23). Se sugiere que se realice un acompañamiento permanente por parte del equipo multidisciplinar compuesto por médico deportólogo, fisiatra, terapeuta respiratorio especialista en rehabilitación cardiopulmonar, enfermero, nutricionista, psicólogo, terapeuta ocupacional y fisioterapeuta; todos estos profesionales deben participar durante el manejo integral de la rehabilitación del paciente con EPOC.…”