Short-stay comprehensive inpatient pulmonary rehabilitation for advanced chronic obstructive pulmonary disease

Votto, John; Bowen, Janet; Scalise, Paul; Wollschlager, Christine M.; ZuWallack, Richard

doi:10.1016/s0003-9993(96)90132-x

Cited by 19 publications

(9 citation statements)

References 14 publications

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“…For example, striking gains in treadmill endurance without increases in VO 2 max were noted in the randomized-controlled trial of outpatient PR conducted by Ries et al [87], as well as in another study evaluating the effects of low-intensity isolated peripheral muscle exercise in 48 patients with severe COPD [149]. Lowintensity multimodality exercise training also led to increased exercise tolerance for patients undergoing inpatient PR [52]. Gains in endurance and/or strength may be seen following such low-intensity exercise training.…”

Section: Outcomes Of Low-intensity Trainingmentioning

confidence: 97%

“…One study found that persons with severe COPD and severe dyspnea assessed by the Medical Research Council dyspnea score at baseline did not achieve significant improvements in walking distance following training [50], but several other studies have shown that even persons with severe dyspnea and disease can achieve gains in exercise tolerance with exercise training [44,51,52]. Therefore, one should not exclude patients with severe dyspnea from participating in exercise training on this basis alone.…”

Section: Patient Candidacy For Exercise Trainingmentioning

confidence: 99%

“…Cambach et al analyzed clinical trials assessing the long-term effects of PR in patients with COPD or asthma and also demonstrated significant improvements in exercise endurance (measured by 6 MWD) and maximal exercise capacity up to 9 months postrehabilitation [89]. Short-term inpatient PR also leads to improvements in exercise tolerance for persons with COPD [52,96,97].…”

Section: Improvements In Exercise Tolerancementioning

confidence: 99%

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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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Section: Outcomes Of Low-intensity Trainingmentioning

confidence: 97%

Section: Patient Candidacy For Exercise Trainingmentioning

confidence: 99%

Section: Improvements In Exercise Tolerancementioning

confidence: 99%

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Exercise training in chronic obstructive pulmonary disease

Rochester¹

2003

JRRD

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“…It is generally composed by physical activity and education, and the improvement of patients may be assessed in a number of outcomes, including quality of life, symptoms, physical performance, and number and duration of hospitalisation caused by COPD [12,13]. Regarding physical performance, the 6 minute walking test was demonstrated as an adequate index to measure the exercise capacity after an initial course of pulmonary rehabilitation [14], and the cut-off indicating a significant improvement was established in an increase of 54 metres in respect of the baseline value [9]. By contrast, thus far there is no data indicating that pulmonary rehabilitation is able to improve lung function.…”

Section: Discussionmentioning

confidence: 99%

Different outcomes of pulmonary rehabilitation in patients with COPD with or without exacerbations

Riario-Sforza¹,

Incorvaia²,

Paterniti³

et al. 2005

Monaldi Arch Chest Dis

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Background. Pulmonary rehabilitation is recognised as an effective treatment in reducing disability and improving the quality of life in patients with COPD. We evaluated the effects of a course of pulmonary rehabilitation in improving the physical performance and lung function in patients with or without COPD exacerbations. Methods. 74 patients with COPD were enrolled, 37 (24 males and 13 females, mean age 74.6 years) without exacerbations (group A), and 37 (23 males, 14 females, mean age 73.9 years) with exacerbations (group B). The latter must have had the latest exacerbation at least one month before the inclusion. All patients underwent to a rehabilitation programme of 8 visits in 4 weeks in a day-hospital setting, with exercise training, respiratory muscle training and education on COPD. The changes in physical performance and lung function in respect to baseline were measured by a 6-minute walking test, using phethysmography, and by an analogic manometer measuring maximal inspiratory and expiratory pressures (MIP, MEP). Results. Patients of group A showed a mean increase in timed walk distance of 58.38 ± 57.46 m, compared to a mean increase of 31.38 ± 44.78 m in group B patients (p = 0.028). As to lung function, a mean increase of 178.92 ± 132.28 ml in FEV1 in group A versus 67.84 ± 102.04 ml in group B (p < 0.0001) and a mean increase of 22.36 ± 25.06 cm H2O in MEP in group A versus 7.70 ± 12.28 cm H2O in group B (p = 0.002) was found. Conclusions. These findings indicate that patients with COPD with exacerbations achieve a less favourable outcome of pulmonary rehabilitation, with a significantly lower improvement of physical performance, respiratory muscle strength and lung function in respect to subjects without exacerbations.

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“…This is in part due to concerns regarding the impact of delays in surgery imposed by the implementation of a preoperative pulmonary rehabilitation program on survival. A minimum of 6 weeks of pulmonary rehabilitation is generally recommended to achieve sustainable effects, although physiologic improvements may be seen in as early as 2-4 weeks of therapy [30,31]. In a retrospective analysis [32] of 189 patients with NSCLC, treatment delays of 48 days or less did not impact survival in patients with any stage of disease.…”

Section: Effect Of Pulmonary Rehabilitation On Candidacy For Thoracicmentioning

confidence: 99%