Is It Really Useful To Repeat Outpatient Pulmonary Rehabilitation Programs in Patients With Chronic Airway Obstruction?

Foglio, K.; Bianchi, Luca; Ambrosino, Nicolino

doi:10.1378/chest.119.6.1696

Cited by 122 publications

(112 citation statements)

References 26 publications

(37 reference statements)

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“…Participation in pulmonary rehabilitation decreases health-care utilization for at least 1 y after participation, 3,[37][38][39][40] and our findings show that fewer subjects visited the emergency department or required hospitalization after pulmonary rehabilitation over an extended period of time. This effect was especially evident in subjects who continued to exercise regularly after pulmonary rehabilitation.…”

Section: Discussionsupporting

confidence: 48%

“…3,[37][38][39][40] We sought to extend those findings by analyzing the effect of ongoing exercise after pulmonary rehabilitation. Contrary to the findings of Heppner et al, 41 who found that subjects who continued to walk regularly after a pulmonary rehabilitation program utilized health care as often as those who did not, our findings show that fewer subjects visited the emergency department or required hospitalization after pulmonary rehabilitation.…”

Section: Long-term Exercise Adherence and Health-care Utilizationmentioning

confidence: 99%

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Additional Evidence for the Long-Term Benefits of Pulmonary Rehabilitation

et al. 2015

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BACKGROUND: Pulmonary rehabilitation programs document outcomes to prepare for program certification, to demonstrate the value of the program to upper management, and to provide feedback to pulmonary rehabilitation staff regarding the efficacy of the program. The overall goal of this study was to evaluate the feasibility of using non-research-generated clinical data to report long-term outcomes following a pulmonary rehabilitation program. METHODS: Using a longitudinal descriptive design, all subjects who completed pulmonary rehabilitation at one communitybased pulmonary rehabilitation program in the San Francisco Bay Area were asked to complete a 6-month and subsequent yearly questionnaires. Adherence to pulmonary rehabilitation techniques was described for 7 y following pulmonary rehabilitation participation, health-care utilization from 1 y before pulmonary rehabilitation was compared with subsequent years, and health-care utilization was compared between those who participated in ongoing regular exercise after pulmonary rehabilitation and those who did not exercise. RESULTS: More than 70% of subjects who completed the questionnaire reported adherence to pulmonary rehabilitation techniques, including exercise for at least 7 y following pulmonary rehabilitation. Health-care utilization declined after pulmonary rehabilitation. Subjects who did not exercise regularly required significantly more health care than those who exercised regularly (P < .05). CONCLUSIONS: This study demonstrated the ability of one pulmonary rehabilitation program to accurately monitor extended longterm follow-up after pulmonary rehabilitation. Implementing this long-term monitoring methodology consistently in pulmonary rehabilitation programs could contribute to evaluation of the comparative effectiveness of various treatment options.

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Section: Discussionsupporting

confidence: 48%

Section: Long-term Exercise Adherence and Health-care Utilizationmentioning

confidence: 99%

Additional Evidence for the Long-Term Benefits of Pulmonary Rehabilitation

et al. 2015

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“…Sixth, a few patients (n=9) underwent pulmonary rehabilitation, which usually increases the 6MWD and may alter the results. However, the number of patients who were included in the study after pulmonary rehabilitation were similar in each group, they were studied o1 yr postrehabilitation to minimise the potential benefit of it [29,30], and there was no difference in the statistical analysis whether they were included or not.…”

Section: Discussionmentioning

confidence: 99%

The 6-min walk distance: change over time and value as a predictor of survival in severe COPD

Pinto-Plata

Côté²,

Cabral³

et al. 2004

European Respiratory Journal

514

336

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The 6-min walk distance: change over time and value as a predictor of survival in severe COPD. V.M. Pinto-Plata, C. Cote, H. Cabral, J. Taylor, B.R. Celli. #ERS Journals Ltd 2004. ABSTRACT: The 6-min walk distance (6MWD) is used to evaluate the functional capacity of patients with chronic obstructive pulmonary disease (COPD). The change in 6MWD over time and its correlation with changes in spirometry and survival are unclear.Patients (n=198) with severe COPD and 41 age-matched controls were followed for 2 yrs, and anthropometrics, spirometry, 6MWD and comorbidities were measured.The 6MWD decreased in the COPD group from 238¡107 m to 218¡112 m (-26¡37 m?yr -1 ), and increased in the control group from 532¡82 m to 549¡86 m (12¡25 m?yr -1 ). In both groups, there was a poor correlation with changes in forced expiratory volume in one second (FEV1). Nonsurvivors in the COPD group (42%) had a more pronounced change in the 6MWD (-40 versus -22 m?yr -1 ) but a similar change in FEV1 (118 versus 102 mL?yr -1 ). The 6MWD independently predicted survival, after accounting for age, body mass index, FEV1 and comorbidities.In severe chronic obstructive pulmonary disease, the 6-min walk distance predicts mortality better than other traditional markers of disease severity. Its measurement is useful in the comprehensive evaluation of patients with severe disease.

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“…An analysis of pooled data from a number of trials demonstrated that pulmonary rehabilitation improves endurance time during a constant work-rate task by an average of 87%, peak work-rate by an average of 18% and peak oxygen uptake by 11% compared with pre-rehabilitation levels [22]. In addition to improving exercise tolerance by relieving dyspnoea and fatigue in COPD patients, evidence has been presented that pulmonary rehabilitative exercise training also improves HRQoL [26], reduces the number of days spent in hospital and/or the number of hospitalisations [27] and is a cost-effective intervention [28].…”

Section: Pulmonary Rehabilitationmentioning

confidence: 99%

Impacting patient-centred outcomes in COPD: deconditioning

Casaburi¹

2006

European Respiratory Review

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Patients with chronic obstructive pulmonary disease (COPD) frequently suffer from exercise intolerance, leading to a reduced ability to participate in activities of daily life and, therefore, to a reduced health-related quality of life (HRQoL). An important determinant of exercise intolerance is the loss of muscle mass.Although the mechanism for loss of muscle function is multi-factorial, deconditioning appears to play a primary role in many patients. COPD patients often have decreased fat-free mass compared with healthy counterparts and reduced muscle cross-sectional area. It seems, then, that a cycle of decline often characterises COPD, in which inactivity results in muscle weakness, which in turn acts as a further deterrent to exercise. Such deconditioning can be reversed by pulmonary rehabilitation, leading to significant improvements in exercise tolerance and HRQoL.Recent research suggests that the effectiveness of pulmonary rehabilitation can be amplified with concomitant administration of tiotropium (a long-acting bronchodilator) or supplemental oxygen. This suggests that facilitating higher training work-rates can enhance the anabolic effects of training.Patients should be encouraged to maintain activity levels in the follow-up period after training, in order to retain the benefits of rehabilitation.

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Is It Really Useful To Repeat Outpatient Pulmonary Rehabilitation Programs in Patients With Chronic Airway Obstruction?

Cited by 122 publications

References 26 publications

Additional Evidence for the Long-Term Benefits of Pulmonary Rehabilitation

Additional Evidence for the Long-Term Benefits of Pulmonary Rehabilitation

The 6-min walk distance: change over time and value as a predictor of survival in severe COPD

Impacting patient-centred outcomes in COPD: deconditioning

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