Benefits of Pulmonary Rehabilitation in Patients With COPD and Normal Exercise Capacity

Abstract

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, out-patient 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.

Pulmonary Rehabilitation Improves Subjective Sleep Quality in COPD

“…[20][21][22] Despite numerous studies confirming that PR improves HRQOL and exercise capacity, its benefit in sleep quality remains unclear. Nonetheless, PR is beneficial in improving skeletal and respiratory muscle strength, 21,23 reduced dynamic hyperinflation, 24 and adaptations in breathing patterns. 25 Thus, PR may be considered beneficial to the sleep quality of patients with COPD.…”

Managing COPD using pulmonary rehabilitation: a literature review

“…Pulmonary rehabilitation is a 'comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise, training, education, and behaviour change, designed to improve the physical and £800 million (NHS 2012). The case for pulmonary rehabilitation as an effective management strategy for COPD has been demonstrated in studies resulting in reduced hospital admissions, decreased mortality, improvements in health-related quality of life, improvements in breathlessness and improvements in exercise tolerance (Puhan et al 2011, Lan et al 2013. However, some patients with COPD have a negative perception of the effectiveness of pulmonary rehabilitation.…”

“…Improvement in breathlessness in pulmonary rehabilitation was attributed to patient education, breathing retraining and proper use of inhalers (Lan et al 2013). Lacasse et al (2006) cited breathing retraining and patient education as important factors in improving breathlessness.…”

“…Improvement in exercise tolerance was demonstrated in patients with normal exercise capacity (Lan et al 2013), older patients with comorbidities (Gale et al 2011, van Ranst et al 2011 and patients who had experienced exacerbations (Cecins et al 2008). However, significant factors regarding the effectiveness of pulmonary rehabilitation in improving exercise are still to be identified.…”

“…There is conflicting evidence regarding at which stage of COPD patients would benefit from pulmonary rehabilitation (Lan et al 2013) and how soon patients can participate in pulmonary rehabilitation after experiencing exacerbations (Puhan et al 2011). This review considers pulmonary rehabilitation as a collaboration between healthcare professionals and patients, in that patients set their own goals and healthcare professionals support patients to achieve those goals (Halding and Heggdal 2012).…”