Pulmonary rehabilitation, physical activity and aortic stiffness in COPD

Abstract

Background Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and cardiovascular disease is a major cause of death in COPD. The current literature indicates that changes in cardiovascular risk during pulmonary rehabilitation (assessed using aortic stiffness) are heterogeneous suggesting that there may be sub-groups of patients who do and do not benefit. Objectives To investigate the characteristics of COPD patients who do and do not experience aortic stiffness reduction during pulmonary rehabilitation, examine how changes relate to physical activity and exercise capacity, and assess whether changes in aortic stiffness are maintained at 6 weeks following rehabilitation. Methods We prospectively measured arterial stiffness (aortic pulse-wave velocity), exercise capacity (Incremental Shuttle Walk Test) and physical activity (daily step count) in 92 COPD patients who started a six week pulmonary rehabilitation programme, 54 of whom completed rehabilitation, and 29 of whom were re-assessed six weeks later. Results Whilst on average there was no influence of pulmonary rehabilitation on aortic stiffness (pre- vs. post pulse-wave velocity 11.3 vs. 11.1 m/s p = 0.34), 56% patients responded with a significant reduction in aortic stiffness. Change in aortic stiffness (absolute and/or percentage) during rehabilitation was associated with both increased physical activity (rho = − 0.30, p = 0.042) and change in exercise capacity (rho = − 0.32, p = 0.02), but in multivariable analysis most closely with physical activity. 92% of the responders who attended maintained this response six weeks later. Conclusion Elevated aortic stiffness in COPD is potentially modifiable in a subgroup of patients during pulmonary rehabilitation and is associated with increased physical activity. Trial registration ClinicalTrials.gov Identifier: NCT03003208. Registered 26/12/ 2016.

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“…The sample size was calculated to have 90% power to detect such a difference between treatment arms at the 5% significance level (Type I error), assuming a standard deviation of 53 m (obtained from the same study [14]). We assumed a 29% dropout rate from rehabilitation (using data from a previous study in the same PR class [15]). Therefore, our final desired sample size was 138 COPD patients, with 98 required to complete the study.…”

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“…Moreover, the amount of annual increase in AIx was correlated to the severity of emphysema [12]. On the other hand, pulmonary rehabilitation was found to have a possible role in modification of elevated aortic stiffness in a subgroup of COPD patients [24].…”

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