Predictors of Improvement in the 12-Minute Walking Distance following a Six-Week Outpatient Pulmonary Rehabilitation Program

ZuWallack, Richard; Patel, Kaushik P.; Reardon, Jane; Clark, Bernard A.; Normandin, Edgar

doi:10.1378/chest.99.4.805

Cited by 89 publications

(47 citation statements)

References 9 publications

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“…Few randomized controlled trials of rehabilitation have included patients with equivalent levels of disability because such patients have considerable difficulty attending regular outpatient programmes. Two noncontrolled rehabilitation studies have suggested that patients with more impaired baseline exercise performance were likely to achieve greater percentage improvements in exercise performance after rehabilitation [20,21]. However, the two studies described in the meta-analysis by LACASSE et al [8], which showed the smallest change in exercise performance compared to controls after rehabilitation, recruited patients of equal severity to the present patient group, when assessed in terms of absolute FEV1 levels [22,23].…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale

Wedzicha¹,

Bestall²,

Garrod³

et al. 1998

Eur Respir J

314

217

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aaChronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality. It is characterized by progressive airflow obstruction [1] that leads to permanent disability and impaired mood state, especially with increasing severity of COPD [2]. Pulmonary rehabilitation programmes incorporating physical training have been advocated for these patients, with the aim of improving exercise capacity and quality of life [3][4][5][6][7].A recent meta-analysis of rehabilitation showed that exercise training improves the patient's sense of control over their disease and reduces dyspnoea [8]. However, the benefit in terms of improvement in exercise capacity was not so clear after training, because the confidence interval of the effect size was wider than the minimum clinically important difference. The lack of a consistent improvement in exercise capacity between studies may have been due to heterogeneity in the level of disability between study populations or to the intensity of training programmes used.Previous randomized controlled trials have included mainly patients with moderate COPD. No trials have specifically investigated patients with severe COPD who are housebound. These patients have considerable dyspnoea and frequent hospital admissions and may benefit from appropriately designed rehabilitation programmes. There is no information concerning the size of the treatment effect achieved in such patients or any comparisons with patients with less severe disability who are mobile outside the home.This randomized controlled study has been designed specifically to investigate whether there is heterogeneity in the response to exercise training in severe COPD patients with different degrees of disability. A unique feature of this prospective study is that patients have been stratified according to the level of dyspnoea into moderately dyspnoeic and severely dyspnoeic groups, with comparable controlled interventions and identical outcome measures. Methods Patient selectionOne hundred and thirty-eight patients with stable severe COPD (70 males, 68 females; median age 70 yrs (range 44-81)) were recruited sequentially from the respiratory Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale. J. A. Wedzicha, J.C. Bestall, R. Garrod, R. Garnham, E.A. Paul, P.W. Jones. ©ERS Journals Ltd 1998. ABSTRACT: This study tested the hypothesis that severity of respiratory disability may affect the outcome of pulmonary rehabilitation.In this randomized, controlled study, 126 patients with chronic obstructive pulmonary disease (COPD) were stratified for dyspnoea using the Medical Research Council (MRC) dyspnoea score into MRC3/4 (Moderate) (n=66) and MRC 5 (Severe) dyspnoeic (n=60) groups. The patients were randomly assigned to an eight week programme of either exercise plus education (Exercise group) or education (Control group). Education and exercise programmes for the moderately dyspnoeic patients were carried out i...

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Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale

Wedzicha¹,

Bestall²,

Garrod³

et al. 1998

Eur Respir J

314

217

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“…Therefore, one should not exclude patients with severe dyspnea from participating in exercise training on this basis alone. Patients with a greater degree of ventilatory reserve (minute ventilation measuring [VE]/maximum voluntary ventilation) achieve greater improvements in exercise capacity following training compared to patients with lesser reserve [53,54], particularly if they also have impaired peripheral muscle strength prior to training [54]. Inspiratory muscle strength (the maximal inspiratory muscle pressure a patient can generate during an inspiratory effort, or PImax) is another predictor of gains made with exercise training [54].…”

Section: Patient Candidacy For Exercise Trainingmentioning

confidence: 99%

Exercise training in chronic obstructive pulmonary disease

Rochester¹

2003

JRRD

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Abstract-Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high-and lowintensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower-and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed.

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“…In fact, previous studies considered the inclusion of smokers 11,12,30,31 . The negative and nihilistic psychological profile of many of these patients 29 and its possible influence on adherence to the program and relapse of ex-smokers have been cited as possible deterrents to their inclusion in PR.…”

Section: Discussionmentioning

confidence: 99%

Influência do tabagismo atual na aderência e nas respostas à reabilitação pulmonar em pacientes com DPOC

Santana¹,

Squassoni²,

Neder³

et al. 2010

Rev. bras. fisioter.

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Objective: To investigate the modulating effects of current smoking on adherence and responses to pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). Methods: In a prospective study, 18 ex-smokers and 23 current smokers (GOLD stages II-III) were enrolled in a 12-week multidisciplinary, supervised PR program. The patients were assessed clinically and as to subjective variables (dyspnea and health-related quality of life) and objective variables (body composition, pulmonary function and 6-min walking distance). The degree of nicotine dependence in current smokers was assessed by the Fagerström test. Program completion defined PR "adherence".Results: There was a significant association between current smoking and non-adherence to PR with 30.4% vs. 11.1% and odds ratio=2.9(1.6-4.1; p<0.01). However, the current smokers who completed the program (n=16) had a similar absentee rate to the ex-smokers, as well as similar gains in the subjective (quality of life) and objective (walked distance) items. Additionally, there was a significant reduction in daily cigarette consumption and in the degree of nicotine dependence in current smokers (p<0.05). Conclusions: Although current smoking is negatively related to PR adherence, COPD smokers who complete the PR can have similar gains in functionality and quality of life compared to ex-smokers. Moreover, PR may be related to decreased nicotine dependence, even without a formal smoking withdrawal program.Key words: COPD; rehabilitation; exercise; smoking; physical therapy. ResumoObjetivo: Investigar o possível efeito modulador do tabagismo atual na aderência e nos efeitos da reabilitação pulmonar (RP) em pacientes com doença pulmonar obstrutiva crônica (DPOC). Métodos: Em um estudo prospectivo, 18 pacientes ex-tabagistas e 23 tabagistas atuais (GOLD estádios II-IV) foram incluídos num programa multidisciplinar de RP com duração de 12 semanas. Os pacientes foram submetidos à avaliação clínica e à de variáveis subjetivas (dispneia e qualidade de vida) e objetivas (composição corporal, função pulmonar e teste da caminhada de 6 minutos). Nos pacientes tabagistas, obteve-se o nível de dependência da nicotina pela escala de Fagerström. A interrupção da RP antes do término previsto foi considerada indicativa de não aderência ao programa. Resultados: A proporção de pacientes não-aderentes à RP foi maior nos tabagistas do que nos ex-tabagistas (30,4% vs 11,1%, respectivamente; razão de chance=2,9 (1,6-4,1); p<0,01). Entretanto, os tabagistas atuais que completaram o programa (n=16) apresentaram taxa de absenteísmo à RP similar ao observado nos ex-tabagistas, assim como ganhos equivalentes nas respostas subjetivas (qualidade de vida) e objetivas (distância caminhada).Adicionalmente, houve redução significante no número de cigarros consumidos diariamente e no grau de dependência da nicotina nos tabagistas atuais (p<0,05). Conclusões: Embora o tabagismo atual reduza a aderência à RP, pacientes tabagistas com DPOC que completam tais programas a...

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Predictors of Improvement in the 12-Minute Walking Distance following a Six-Week Outpatient Pulmonary Rehabilitation Program

Cited by 89 publications

References 9 publications

Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale

Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale

Exercise training in chronic obstructive pulmonary disease

Influência do tabagismo atual na aderência e nas respostas à reabilitação pulmonar em pacientes com DPOC

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