Impact of pulmonary rehabilitation on activities of daily living in patients with chronic obstructive pulmonary disease

Abstract

A high proportion of patients with chronic obstructive pulmonary disease (COPD) experience problems during the performance of activities of daily living (ADLs). We aimed to determine the effects of a comprehensive 8-wk pulmonary rehabilitation program on the physiologic response to and performance of ADLs in patients with COPD. Before and after pulmonary rehabilitation, 31 patients with COPD [71% men; mean age: 64.2 (SD 8.4) years; mean forced expiratory volume in the first second: 54.6 (SD 19.9) % predicted] performed physical function tests, the Canadian Occupational Performance Measure (COPM), and an ADL test consisting of the following: putting on socks, shoes, and vest; stair climbing; washing up four dishes, cups, and saucers; doing groceries and putting away groceries in a cupboard; folding eight towels; and vacuum cleaning for 4 min. Metabolic load, ventilation, and dynamic hyperinflation were assessed using an Oxycon mobile device. In addition, symptoms of dyspnea and fatigue and time to complete ADLs were recorded. After rehabilitation, patients with COPD used a significantly lower proportion of their peak aerobic capacity and ventilation to perform ADLs, accompanied by lower Borg scores for dyspnea and fatigue. Furthermore, patients needed significantly less time to complete ADLs. Dynamic hyperinflation occurred during the performance of ADLs, which did not change following pulmonary rehabilitation. Changes in physical function, including six-min walk distance, constant work rate test, quadriceps muscle strength, and COPM were significantly correlated with change in average total oxygen uptake during the performance of the ADL test. A comprehensive pulmonary rehabilitation program can improve the physiologic response to and actual performance of ADLs in patients with COPD. NEW & NOTEWORTHY A high proportion of patients with chronic obstructive pulmonary disease (COPD) experience problems during the performance of activities of daily living (ADLs). This study clearly demonstrated that a comprehensive pulmonary rehabilitation program can improve the performance of ADLs in patients with COPD, indicated by a significantly shorter time to perform ADLs and a lower metabolic load and dyspnea sensation.

Effectiveness of Energy Conservation Techniques in Patients with COPD

“…Limitations of the study are the relatively high rate of dropout from the study, which is probably related to the complexity of the study population. However, similar dropout rates have previously been reported [14].…”

“…In addition, Silva et al [13] demonstrated that simple ECTs can prevent the occurrence of dynamic hyperinflation during the performance of ADL. Vaes et al [14] recently showed that a comprehensive pulmonary rehabilitation program including ECTs can improve the performance of ADL by patients with COPD, indicated by a significantly shorter time to perform ADL and a lower oxygen uptake and dyspnea sensation.…”

“…No self-perceived evaluation of the use of ECTs has been described in this study, nor wellbeing afterwards in relation to COPD symptoms or health-related quality-oflife measures. Perceptions of patients' sensation when performing an activity have previously been evaluated with the Canadian Occupational Performance Measure (COPM), with positive results [14].…”

An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease

“…In turn, interval training should most probably be combined with resistance training. Obviously, the rehabilitation goals of the patient should be taken into the equation, as interval training matches to a greater extent the metabolic load of activities of daily living than endurance training [53,54]. If there are clear signs of exercise-induced oxygendesaturation during the cardiopulmonary exercise test [55,56], the rehabilitation team may want to consider the use of oxygen supplementation during the whole-body exercise training, although its use has been questioned recently.…”

Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases

“…Indeed, dyspnoea, fatigue, dynamic hyperinflation, a reduced physical capacity, an impaired disease‐specific health status and social deprivation already occur in patients with a mild degree of airflow limitation . Moreover, the degree of lung function impairment at entry to the pulmonary rehabilitation cannot forecast the efficacy of the programme …”