The short and long term effects of exercise training in non-cystic fibrosis bronchiectasis – a randomised controlled trial

Abstract

BackgroundExercise training is recommended for non-cystic fibrosis (CF) bronchiectasis, but the long-term effects are unclear. This randomised controlled trial aimed to determine the effects of exercise training and review of airway clearance therapy (ACT) on exercise capacity, health related quality of life (HRQOL) and the incidence of acute exacerbations in people with non-CF bronchiectasis.MethodsParticipants were randomly allocated to 8 weeks of supervised exercise training and review of ACT, or control. Primary outcomes of exercise capacity and HRQOL (Chronic respiratory disease questionnaire) and secondary outcomes of cough-related QOL (Leicester cough questionnaire) and psychological symptoms (Hospital anxiety and depression scale) were measured at baseline, following completion of the intervention period and at 6 and 12 months follow up. Secondary outcomes of the exacerbation rate and time to first exacerbation were analysed over 12 months.ResultsEighty-five participants (mean FEV1 74% predicted; median Modified Medical Research Council Dyspnoea grade of 1 (IQR [1–3]) were included. Exercise training increased the incremental shuttle walk distance (mean difference to control 62 m, 95% CI 24 to 101 m) and the 6-minute walking distance (mean difference to control 41 m, 95% CI 19 to 63 m), but these improvements were not sustained at 6 or 12 months. Exercise training reduced dyspnoea (p = 0.009) and fatigue (p = 0.01) but did not impact on cough-related QOL or mood. Exercise training reduced the frequency of acute exacerbations (median 1[IQR 1–3]) compared to the control group (2[1–3]) over 12 months follow up (p = 0.012), with a longer time to first exacerbation with exercise training of 8 months (95% CI 7 to 9 months) compared to the control group (6 months [95% CI 5 to 7 months], p = 0.047).ConclusionsExercise training in bronchiectasis is associated with short term improvement in exercise capacity, dyspnoea and fatigue and fewer exacerbations over 12 months.Trial registryClinicalTrials.gov (NCT00885521).

Management of bronchiectasis in adults

“…At the end of treatment, patients in the exercise group had an increase in 62 m in their incremental shuttle walk distance, improved dyspnoea and a reduced time to the next exacerbation and total number of exacerbations over 12 months (median (IQR) 1 (1-3) versus 2 (1-3); p=0.01). This study clearly demonstrates a benefit of exercise to patients with bronchiectasis, but most of the benefits were not sustained to 6 or 12 months suggesting this kind of intervention needs to be continuous to achieve long-term benefits [50].…”

“…A subsequent pilot randomised controlled trial showed improvements in LCQ and SGRQ sustained to 20 weeks after treatment [49]. In a recent randomised controlled trial by LEE et al [50], an 8-week supervised exercise training schedule that include airway-clearance techniques was compared with standard care . 43 patients were randomised to exercise training and 43 to standard care.…”

Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration

“…Although few studies have explored the impact of physiotherapy in bronchiectasis, airway clearance techniques seem to be safe and allow a better sputum expectoration with an increase in patients' quality of life [20]. Evidence on pulmonary rehabilitation is scarce; however, most of the studies demonstrated an increase in patients' performance and quality of life, and an increase of the time to the next exacerbation [21][22][23]. Both physicians and patients agreed that additional controlled trials of these interventions would be beneficial but that the priority may be in identifying methods that are accessible and that encourage adherence.…”

Effects of Pulmonary Rehabilitation in Patients with Non-Cystic Fibrosis Bronchiectasis: A Retrospective Analysis of Clinical and Functional Predictors of Efficacy

“…A dissociation of lung function, dyspnea ratings, and pulmonary extension in bronchiectasis was observed by Martínez-García et al [10] , whereas Lee et al [11] , in an objective assessment of the bronchial tract involved and in a subjective assessment of HRQoL, identified the major determinants of the 6-min walk test (6MWT) in bronchiectasis. These prospective studies on the effect of PR in patients with non-CF bronchiectasis showed short-term improvements in exercise tolerance and HRQoL following a combination of lower limb endurance and strength training (but regardless of inspiratory muscle training) [12] or regular airway clearance therapy [9,13] . Longterm improvements were observed only for the frequency of acute exacerbations and the time to first exacerbation [9] .…”

“…The rationale for recommending PR to patients with non-CF bronchiectasis relies primarily on physiological reasoning and on the similarities between this disease and COPD [3,5] . Moreover, since the pathophysiology of non-CF bronchiectasis involves more factors than only airflow obstruction, PR might represent a useful tool also for patients without airflow obstruction [9] . A dissociation of lung function, dyspnea ratings, and pulmonary extension in bronchiectasis was observed by Martínez-García et al [10] , whereas Lee et al [11] , in an objective assessment of the bronchial tract involved and in a subjective assessment of HRQoL, identified the major determinants of the 6-min walk test (6MWT) in bronchiectasis.…”